Fevers_ Agues_ and Cures

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					    FEVERS , 


Medical Life in O ld Virginia
            Todd L. Savitt

           AN EXHIBITION
      E. Lee Shepard, Pmjecf Director
       4 OCTOBER 1990 - 1 APRIL 1991
ACKNOWLEDGMENTS                                                                        PREFk

FEVER, AGUES,AND CURES: MEDICAL LIFE          Hampton    University   Museum                Today
IN OLD VIRGINIA was made possible in                                                   granted si
                                              Mount Vernon Ladies’ Association
part by a generous grant from the                                                      especially
National Endowment for the                    Eleanor S. Brockenbrough Library,        dollars thr
Humanities, a federal agency.                 Museum of the Confederacy                body, min
                                              National   Park Service, Colonial        most of us
The Virginia Historical      Society also     National   Historical Park               granted in
wishes to acknowledge        the generous                                              minor ach
                                              Mrs. Barbara S. Rennie
financial support of:                                                                  medicine 1
                                              The Richmond Academy of Medicine
                                              (Dr. Joseph Lyon Miller Collection)      pharmacy
                                                                                       that usual
                                              University of North Carolina at Chapel   bothering
                                              Hill, Health Sciences Library            the doctor
                                              Historical Collections, The Claude       she finds t
                                              Moore Health Sciences Library,           treats it, al
                                              University of Virginia Health Sciences   on our ow
                                              Center (UVa)                             ailments, I
                                              Special Collections and Archives         incredibly
                                              Department, Tompkins-McCaw

*                                             Library, Virginia Commonwealth
                                              University (VCU)
                                                                                       in the last-

                                                                                       almost do
                                                                                       thought. E
                                                                                       proper her
                                                                                       dentistry h
                                              The UCLA Art Council granted
                                              permission to reproduce the image on     having SOT
                                              page 19.                                 and most c
                                              Mr. and Mrs. J. Earle Dunford, Jr.,
The Society is also grateful to the                                                    and moder
                                              permitted access to the papers of
following institutions and individuals        Doctor Thomas Chrystie at the Virginia   health pro1
who loaned objects for this exhibition:       Historical Society.                      disease kill
James H. Bowles, M.D.                                                                  have been
                                              The State Historical Societv of
                                                                                       abuse of th
The Colonial    Williamsburg     Foundation   Wisconsin granted permission to quote
                                              from the letter of John Brown to         for million
Eastern State Hospital,   Williamsburg,       William Preston, 17 March 1772,          the most p;
Virginia                                      Draper Manuscripts Collection, on        to take adv
Goochland County Historical Society           page 28.                                 modern rnt
(Helene Agee Collection and Dr. W. S.                                                  difficulty a
Lloyd Collection)                                                                      enough mc
J. Randolph    Grymes, Jr.                                                             serve the n
     Today Americans do not take for             Despite these problems, our genera-
granted sickness and health care,           tion enjoys far healthier and longer
especially considering the billions of      lives than those of our forebears, one of
dollars they spend annually to heal         the major points that quickly becomes
body, mind, and spirit. Nevertheless,       evident in the exhibition “Fevers,
most of us do take certain things for       Agues, and Cures: Medical Life in Old
granted in regard to our health. For        Virginia.” An examination of any pre-
minor aches and pains, we go to our         twentieth-century     diary or set of
medicine cabinet or drive to a nearby       correspondence in the collections of the
pharmacy for an over-the-counter drug       Virginia Historical Society reveals a
that usually takes care of what is          regular chronicle of ailments, excruci-
bothering us. If we get sick, we go to      ating medical treatment, and all too
the doctor. More often than not he or       often death and dying. Illness was the
she finds the cause of our ailment,         constant companion of all Virginians
treats it, and sends us home to recover     regardless of age, whether they were
on our own. For the most serious of         white, black, or red, rich and famous or
ailments, modern hospitals and              poor and humble. As the exhibit
incredibly complex technology have          demonstrates, persons no less impor-
performed so many medical miracles          tant than George Washington and
in the last several years that now we       Chief Justice John Marshall frequently
almost do not give them a second            succumbed to sickness and the primi-
thought. Fluoridated public water,          tive medical treatment of their time.
proper home care, and advanced                   It is our hope that visitors to this
dentistry have resulted in Americans        exhibition will come away with a fuller
having some of the whitest, straightest,    understanding of the long and arduous
and most durable teeth in the world.        process that led to the advent of
     Without question, modern America       modern medicine. We hope that they
and modern Virginia are not free from       will gain insight into the unique
health problems. Cancer and heart           blending of three medical cultures-
disease kill by the millions. While drugs   European, African, and Native Ameri-
have been a miracle on the one hand,        can-in early Virginia.       Most impor-
abuse of them has resulted in tragedy       tant of all, however, we hope they see
for millions of people on the other. For    this as an exhibition not so much about
the most part, poor people are unable       medicine and technology, but about
to take advantage of the marvels of         people and how they attempted to
modern medicine. Rural areas have           cope with the mysterious, invisible
difficulty attracting and retaining         forces that constantly attacked and
enough medical-care professionals to        killed them and their loved ones. It is
serve the needs of their communities.       the story of sick children, pregnant
 women, of a dying former president, of      months of research and writing for this
 medicine men and witch doctors,             catalog, have formed the interpretive
 physicians on horseback riding the          core of the exhibition. Members of our
 trails of the Blue Ridge Mountains, and     staff involved in the project enjoyed
 of untrained men and women who              every minute of working with him.
 worked valiantly, but often in vain, to     Finally, Archivist E. Lee Shepard of our
 save the lives of those around them.        staff has performed over and above the
      Any exhibition of this scope would     call of duty as project director of
 not have been possible without contri-      “Fevers, Agues, and Cures.” In
 butions from numerous sources. The          addition to adding his own notable
 remarkable collection of rare medical                                   s
                                             abilities as a scholar, Lee’ willingness
books and manuscripts assembled              to work long and hard hours (on top of
assiduously by Dr. Joseph L. Miller at       his regular archival duties) with the
 the turn of the century forms the core      consultants and his colleagues on staff,
of the exhibit and comes to us on long-      especially the museum department,
 term loan from the Richmond Acad-           was crucial to the success of the
emy of Medicine. A number of other           project. I am most grateful to him and
institutions listed elsewhere were gen-      to everyone else who helped all of us
erous in lending us important objects.       gain a better understanding of the
Without both planning and implemen-          healing arts in Virginia.
tation grants from the National En-
dowment for the Humanities, “Fevers,
Agues, and Cures” would not have
been possible. Thanks to NEH support
we were able to assemble consultants
from major medical museums and de-
partments of medical history to plan
the thematic structure and contents of
the exhibit. The Endowment enabled
us to retain the fine talents and services
of exhibit designer Liza Broudy and
Jan Miller Graphics of Newport News.
It also made it possible for us to recruit
as guest curator Todd L. Savitt of the
School of Medicine of East Carolina
University, a distinguished scholar in
the field of medical history. Professor
Savitt’ remarkable insights and
creativity, not to mention his many
     Try to remember the last time you        antibiotics, pain-killers, surgery, and
were sick. Perhaps you had a bad cold         x-rays. Think instead about bad air
that hung on and would not go away.           (malaria), body humors (black bile,
You felt achy and feverish, your chest        yellow bile, phlegm, and blood), and
was full of fluid making breathing            laxatives. If you can walk in your
difficult, and you had a deep cough.          ancestors’ shoes you will understand
You told yourself that you would do           why, in 1840, you too would have
anything to get relief from this misery.      submitted to bloodletting. And you
                                              will appreciate even better how far
     Imagine yourself living in Virginia      medicine has come in the relatively
 in, say, 1840, some 150 years ago. You       short time since then.
are suffering from these same symp-               Medical history is more than a
 toms. You have tried, unsuccessfully,        simple chronicle of great events and
every remedy known to you, your               people from the past. It is also a study
family, your friends, and-if     you are a   of the diseases and health practices of
slave-your     master or overseer. In         ordinary people and of ordinary
frustration, and resentful of the cost       physicians and other healers in a
and inconvenience, you (or your              society. When you finish reading this
master) summon the family physician.         essay, you should have a better sense
He tells you that the best cure for such     of both the history of American medi-
a serious respiratory problem is             cine and the way people in the Old
bloodletting over the affected area and      Dominion fit into that history. Virginia
asks you to bare your chest for the cups     followed the general trends of medical
and scarifier he is about to apply.          practice, medical education, and health
     How do you respond to his request?      behavior of the rest of the country, but
     Few of us in the late twentieth         in some respects, as you will see,
century would voluntarily strip to the       Virginia differed from other states.
waist so that our family physician                You may wonder why the story
could make multiple tiny gashes in our       told in this booklet ends in the early
chests to remove a few pints of blood        twentieth century. By 1910 or so all the
and then sear the skin with hot glass        elements that would soon make
cups to collect it. Our predecessors did,    medicine modern were present in
though they accepted such treatments         Virginia: acceptance of germs as a
as reluctantly as most of us accept an       cause of disease, effective and safe
injection or surgery.                        anesthesia, improved diagnostic tools
     To understand why these earlier         and instruments, new hospitals and
residents of the Old Dominion submit-        laboratories, and even telephones and
ted to medical treatments that to us         automobiles. The early twentieth
seem useless, silly, and even harmful,       century was a transition period, a
try to place yourself back in time as        corridor leading from the old medicine
you read this booklet about Virginia’ s      to our current complex medical era.
medical past. Forget what you know           This essay leaves medicine in Virginia
about modern medicine, about germs,          poised on the brink of that new age.
Medical Practices
in Three Cultures
    When you hear of such diseases as        arrows and guns at each other, talking
malaria, yellow fever, smallpox,             with and learning from each other.
typhoid fever, or dysentery, you             Through these and other modes of
probably think of a foreign country,         contact they spread diseases and health
because these maladies are rarely            practices among the whole. One
encountered in America today. You            historian has called this early interac-
might also think of an earlier time in       tion of cultures and diseases in the
American history when these diseases         New World the “Columbian Exchange”
troubled our ancestors. Each of the          in recognition of Christopher
diseases mentioned, and others,                         s
                                             Columbus’ opening of America to
flourished in the United States at some      Europe in 1492. Virginia experienced
time in our history. In fact, all of them    what we might call a “Jamestown
once existed in Virginia. Where did          Exchange” of cultural and biological
they come from? To answer this               baggage between the English and the
question we must go back to the days                 s
                                             region’ Native Americans starting in
before Virginia was settled.                 1607. Beginning in 1619 there was also
    Three racial groups representing         an “African Exchange” between blacks
three distinct cultures met in what we       forced to immigrate to the colony and
now call Virginia at the start of the sev-   English and Native Americans in
enteenth century and shaped the              Virginia.
course of the area’ health. Each group
                    s                            To understand the effect of those
had to adjust both to a new natural en-      exchanges on the health histories of
vironment and to the cultural ways of        red, white, and black cultures in
the other groups. That natural environ-      Virginia, it is necessary first to look
ment included the presence of disease-       backward at the health histories and
causing organisms native to Virginia. It     practices of these groups before they
also included disease-causing organ-         met. Native Americans and Africans,
isms brought by people from the other        unlike Europeans, transmitted their
cultures, because different diseases         learning and folkways and conducted
existed on different continents. Each        their business affairs orally more than
cultural group also brought with it          in writing. What we know of health
traditional ways of handling health          practices and diseases among Indians
problems.                                    and Africans, therefore, derives
    Members of the three cultures that       primarily from archaeological evi-
met in Virginia between 1607 and             dence, oral tradition, and early descrip-
1620-Native     Americans, Europeans,        tions by Europeans.
and Africans-interacted      in friendly
and unfriendly ways: breathing on                                         t
and touching each other, shooting
The Health Practices
  of Virginia Indians
       before Contact
                              Several tribes of Native Americans
                         populated Virginia at the time of the
                         settlement of Jamestown. In the
                         immediate vicinity of Jamestown lived
                         the Algonquians, ruled by the power-
                         ful chief Powhatan. Three tribes of the
                         Iroquois nation lived to the south and
                         west of the Algonquians, and several
                         tribal groups of the Sioux nation
                         inhabited the remaining Virginia land
                         west of the river fall lines. Population
                         estimates vary, but approximately
                         10,000 to 15,000 Algonquians and an
                         equal number of other Native Ameri-
                         cans lived in Virginia at the time of
                         white settlement. Because of the
                         frequent contact Virginia Company
                         settlers had with Powhatan and his
                         people, most English writers of the
                         time described Indian life among the
                         Algonquians of Virginia and not
                        among other tribal groups.
                             In most traditional cultures health
                        and religion were intimately bound to-
                        gether. Virginia’ Indians fit this
                        pattern. Though they treated minor
                        ailments with simple, natural remedies
                        that had proven effective in the past,
                        they cared for more serious health
                        problems with one eye cast toward the
                        supernatural world on which they
                        believed their health depended. Native
                        Americans viewed sickness as the
                        result of their own individual or their
                        people’ transgressions against the
                        gods and the natural world these gods
                        controlled. Sickness meant that the
                        internal balance of the body was upset;
                        whatever foreign substance had been
intruded into the body by the bad           they lanced skin eruptions and cauter-
spirits that had brought on the illness     ized other skin problems, they rarely, if
needed to be removed. As Virginia           ever, overtly bled patients the way
historian Robert Beverley wrote in 1705     Europeans of the time treated many
after a discussion with a Native            illnesses.
American about religion:                         Captain John Smith and other ob-
                                            servers reported extensive use of
   iftheydidnotpaczyy theZz&pirit,          sweating by Indians as a curative and
   andma& him propitious, he wou ‘    d     preventive technique. Robert Beverley
   ta/@ away, or spoil aff those 8006       later described the practices of the
   things that Godhadgiven, andruine        Powhatans:
   their tieaith, their Peace and their
   Pfenty, Gysending War, TfaJue and            ‘fiey tat&Areat def&ht insweating,
   Famine among them.                           and therefore in every ‘    Town they
                                                have aSu)eating-%&se. . . . [T]hey
    If tribal members could not deter-          commonly use t&i           to refresh
mine the cause of their health problems         themsefzles, after they have Geen
and thus the proper way to atone for           fat(qu'd'   with fiknting, TraveL or
their transgressions, they went to the          the fi&, ore&e when they are trou61’ 6
tribal priest or shaman (medicine man           with Adues, Aches, or-Pains in their
or conjurer) for assistance. These              LimGs. , . . %iey creep in s&or eigh t
leaders, especially the shaman, using           at a time, or as many as the pface
knowledge of tribal and personal                wiff hofd, and then close up the
affairs, a variety of magical techniques,       mouth of theStoue, which is usuaffy
and perhaps some secret ingredients,            made fike an Oiren, in some ‘     Bank.
performed necessary rituals and                 near the % ‘ atersidL . . . After they
advised the ill or their families how           have suleat as long as they can weff
further to remedy the problem.                  endure it, they saffy out, and(tho it
    This magical approach to health             6e in the depth of wJinter)fnrthwith
and disease also included natural              plunge themsefz)es over Sad and
medicines to restore internal balance           ‘Ears in cofd%+zter, which instantly
by purging the body of its evil con-            cfoses up the Fores, and preserves
tents. To induce defecation and                 them from taking cofd
vomiting, the Virginia Powhatans
prepared infusions primarily from                       s
                                            For Virginia’ r\;ative Americans,
roots and barks of trees and herbs.         health depended on proper relation-
The;; also used natural remedies in         ships with the natural and supernatu-
poultices and other medicines for           ral worlds in which they lived.
external wounds and lesions. T~WLI,$I
The Heulth Practices
of West Africans
before Enslavement
in Virginia
     Most Virginia blacks originally         mental upset in their lives. The
derived from tribes living along the         diviner, through sacrifices and elabo-
western rim of Africa from Senegal to        rate rituals, could discover the nature
Angola. Each tribal group-Ibo,               of the problem and help patients set
Yoruba, or Ga, for instance-had        its   right the imbalances in their lives.
own customs and language. We
cannot, in this small space, describe the
health practices of all West Africans
who became slaves in Virginia and will
only speak of them in general terms.
     Though the specific gods and god-
desses, rituals, incantations, potion
ingredients, and names of diseases
differed from those of Virginia’ Native
Americans, the basic West African
concepts of and approaches to health,
disease, and healing were in some
ways quite similar. Like Native Ameri-
cans, West Africans intertwined
medicine and religion. Supernatural
forces controlled health. Transgres-
sions, either personal or tribal, could
affect physical well-being; failure to
correct the underlying problem usually
meant failure to recover. A tribe, for
instance, might attribute an epidemic
to its people’ violation of taboos and
call for days of prayer and sacrifice or
some other acts to appease the gods
who had been offended.
     In the case of individuals, tribal
herbalists might recommend remedies
that combined the performance of
certain rituals, the collecting of special
ingredients, and the saying of special
words. Alternatively,      the sick might
turn to a tribal priest or diviner rather
than the herbalist if they felt that the
problem resulted from a more funda-
Health Practices
in England before
the Settlement
of Virginia
      In some ways seventeenth-century           200?), was retranslated from Arabic
 English settlers brought with them              into Latin, the language of learning
 medical ideas not much different from                                             s
                                                 during the Renaissance. Galen’ ideas,
 those of Africans and Native Ameri-             more than those of any other ancient
 cans. Yet there was a fundamental               physician, were widely accepted and
 difference in the approach of the               used. The development of the printing
 Europeans based on the way they                 press in the late fifteenth century
 viewed the cause, and thus the cure, of         helped disseminate all these writings
 disease.                                        to the learned of Europe.
     Though seventeenth-century       Euro-           Seventeenth-century    English med-
 peans maintained a belief in divine             ical practice included a mixture of
 intervention in their lives, including          ideas not so far removed from tradition-
 their state of health, they also saw the        al West African and Native American
 natural world as an “it,” a thing to be         medicine and of ideas based on the
 studied and objectively analyzed,               writings of Greeks and Romans who
 rather than as a “Thou,” a living thing         had lived 1,600 or more years earlier.
 to be addressed personally and wor-             All seemed to stress the idea of balance.
 shiped and appeased. Religion and                   The dominant medical theory of the
 science sat side by side. Disease               day looked back to the ancient Hippo-
 resulted from changes in the natural
 world, both without and within the
 body; but these changes were not                   HUMORS, ELEMENTS
 directly manipulated by spirits watch-               AND QUALITIES
ing every individual or community or
nation. The Renaissance had much to           1. Fire                          1. Air
do with this world view.                      2. Summer                        2. spr& 1
     England was one of the last coun-        3. PKuw Bib       HOT            3. Blood
tries to experience the rebirth of            4. Liver                         4. Seart
learning we call the Renaissance.
Developing in Italy and Spain in the
twelfth and thirteenth centuries with          DRY                              WET
the exchange of knowledge between
Arabs and southern Europeans, the
recovery of ancient Greek and Roman
learning-including      medical ideas-        1. Earth     ’                  ’ 1.   Water r
spread northward over the next few            !. Autumn        COLD             2.   Wintf !I
centuries. The thinking of ancient            i. !BLk&Bile                      3.   Thleglr
physicians, especially of Hippocrates         1.Spleen                          4.   Brain
(460-377? B.C.) and Galen (A.D. 130-
 cratic and Galenic system of humors.             removing bad or excess humors by
 Greek thinkers, after studying the               letting blood from veins or purging the
 natural world, stated that all things            bowels through defecation or vomiting
 were composed of various combina-                up stomach contents or sweating out or
 tions of four basic elements-air,    earth,      urinating away excess fluids. It also
 fire, and water-and     possessed differ-        meant eating and drinking proper
 ing proportions of two pairs of basic            foods, wearing appropriate clothes,
 qualities-warmth      or coolness and            and taking the right amount of exer-
 wetness or dryness. Fire and summer,             cise. Most seventeenth-century English
for example, are hot and dry, while               people probably treated their ailments
 water and winter are cold and wet.               without necessarily thinking of hu-
Corresponding to these four elements              mors. Previous experience with such
 in the external world were four humors           symptoms or the instructions in a
within the body: yellow bile produced             popular domestic medical guide
 in the liver, blood in the heart, phlegm         indicated that a certain remedy got rid
in the brain, and black bile in the              of them. So they tried that treatment
spleen. All were present in appropriate          again. Their approach was empirical,
proportions in the healthy body. Each            trial and error, but consciously or
predominated at a certain season of the           unconsciously based on humoral ideas.
year and was associated with a combi-                  At this same time important new
nation of qualities of that season. An           ideas were coming from the Continent.
imbalance of these humors resulted in            In Switzerland, a strange but convinc-
certain kinds of diseases. Respiratory           ing and dynamic man who called
diseases, for instance, occurred when            himself Paracelsus (1493--1541) was
phlegm predominated over its sister              upsetting the medical establishment.
humors, usually in the winter when it            Paracelsus disagreed with the tradi-
was cold and wet outside. To treat such          tional Galenic humoral approach. He
illnesses one used opposite kinds of             wrote his books in vernacular German
remedies, ones that contained the                rather than in scholarly Latin so that all
qualities of heat and dryness.                   could read his ideas.
     The system had its own logic and fit             Humors were mere speculation
the observations people had made                 with no basis in fact, I’aracelsus
about illnesses. Though not correct by           argued. He advocated observation and
the standards of modern medicine, it             medical action based on that direct
fit the needs of its adherents and             ’ observation rather than on theory. The
removed medicine from the realm of               basis of disease was chemical, not
the supernatural to allow futher study           humoral, and specific, not general as
and development.                                 the humoral theory asserted. Paracelsus
      Restoring humoral balance meant            introduced metallic remedies such as
lead, sulfur, iron, arsenic, copper                If you do 6ut consider the whole
sulfate, and potassium sulfate to                 universe a.~ one united 6ody, and
medicine.                                         man as an epitome of this 6ody, it
     Andreas Vesalius (1514-1564), a              will seem strunde to none 6ut
Brussels physician trained at Padua,              madmen and fool2 that the stars
published in 1543 De Fnbricil Hzll~nni            shouldhaue injkence upon the 6ody
Corpwis (On flzc Fabric of fhe Hziwznrz           of man, considering he, Ge[ingl an
&@I/), which disputed a number of                 epitome of the Creation, must needs
Galen’ anatomical statements and                  have a celestiaf world written
urged every medical student to under-             himsev. . . . Eve y inferior worldis
take a human dissection to learn                  govemed6yitssuperior,andreceives
anatomy firsthand. His book con-                  influence from it.
tained accurate drawings of the body,
something not previously available.                 Medical practitioners and lay-
     William Harvey (1578-1657), an            people used astrology to guide their
Englishman, made another significant           treatments of the sick. The planets and
breakthrough in overcoming Galen’          s   the demarcated regions of the heavens
stranglehold on medical thought. In            named with the signs of the zodiac
1629 he published a book entitled DC           controlled various parts of the body
Mofzr Cordis ef Srr~lg~li~is (OH the Mofiorz   and the kinds of treatments one
of tllc Hefirt ill2cI Bloocl). Using proof     received. Most astrological healers
based on his own animal vivisection            incorporated the familiar ideas about
and dissection experiments, he con-            humors into their systems. To rid the
cluded that the blood circulated               body of phlegm, a cold and moist
through the body and returned to its           humor, for example, they advocated
starting point.                                the application of the remedy when the
     Harvey and Vesalius did not imme-         hot and dry sun was in a favorable
diately affect the practice of medicine        position in the heavens. Practitioners
for the masses, however. Most people           cast horoscopes for the sick based on
when sick turned first to folk medicine        the time of occurrence of the illness
and home remedies. Astrology was an            and for newborns at the moment of
important component of that popular            birth.
(and even professional) medicine.                   In addition to astrological healers
Nicholas Culpeper, one of the best             and university-trained     physicians, a
known seventeenth-century English              number of other types of healers
proponents of astrology and domestic           practiced in England. Situated in status
medicine, explained the theory briefly         just beneath the physicians, who were
in his 1654 book, PiznurnncopnciaLorllli-      formally chartered in 1518 as the Royal
f7cfxis: or fh Lo~~dolrDispwwfo~~/:            College of Physicians of London, were
                                        I I?                                              Ii

the surgeons and the apothecaries.             structured and regulated, with little
Both had organized into guilds that            tolerance for alternative medical ideas
were most powerful in London.                  that might threaten the existing relig-
Attempts to regulate the practice of           ious and political system. English
medicine outside the capital city failed       medicine was already in a state of flux,
throughout this period. Even in                accepting new ideas from the Conti-
London proper, however, surgeons,              nent and from within its society.
members of the Mystery and Commu-              Religious healing was only one facet of
nality of Barbers and Surgeons of              medicine and was not a mainstay of
London (formed 15201, and apothecar-           either the culture or the government.
ies, originally part of the Grocers’           The English populace could pick and
Company during the sixteenth century,          choose from among several competing
acted independently, treating patients         healing systems because the govern-
not just in surgery or by dispensing           ment did not restrict and barely
medicines, but also in all aspects of          regulated the practice of medicine in
health care.                                   the country.
     Ordinary practitioners, self-pro-             What happened to the medical
claimed and usually trained through            practices of these three cultural groups
experience, constituted another popu-          when they met in Virginia in the early
lar group of healers both in London            seventeenth century?
and in the countryside. Midwives (who
assisted at childbirth) plied their trade
 and competed to some extent with
 regular physicians. For those who
 wished to treat themselves (and most
 people generally did and still do try to
 cope with illnesses at home before
 calling for outside professional help),
 English physicians published numer-
 ous domestic medical guides.
     English medicine appears much
 more complex and varied than either
 the West African or the Virginia Native
 American. This difference results in
  part from the relatively closed nature
  of the latter two cultures at the time of
  Virginia’ settlement and the close
  intertwining of health with religion.
  Both of those cultures were highly
Not only did medical practices differ
among the three groups that ultimately
came together in Virginia in the early
seventeenth century; so, too, did
diseases. Because each culture devel-
oped in a different part of the globe,
separated by large land and water
barriers, with different natural envi-
ronments, and because each culture
developed a different life-style, includ-
ing housing, diet, clothing, and work
habits, the English, the West Africans,
and the Virginia Native Americans
each suffered from a number of               sleeping sicl&ss
diseases unique to themselves.
    Not all their diseases were different.
Probably all suffered from the common
cold, from overeating, overdrinking,
overexposure to extreme heat or cold,
accidental falls, burns, wounds,
difficult pregnancies or childbirths,
menstrual cramps, cancerous growths,
congenital malformations, and the like.
Because we are interested in what
happened when the three cultures
finally met in Virginia, however, we
will mention only the differences in
diseases rather than the similarities.
     Certain infectious diseases-those
caused by viruses, bacteria, rickettsia,
protozoa, and parasitic worms-were
absent on some continents and over-
whelmingly present on others. Dis-
eases unique to those living on one or
two of the three continents before the
first English settlement of Virginia

      The Diseases of
    Three Con tinen ts
     Meet in Virginia
                               Red, white, and black people met in
                          early seventeenth-century      Virginia.
                          Within a hundred years only whites
                          and blacks remained in any numbers.
                          Immigration (willing and unwilling),
                          of course, accounts for much of the
                          increase of both blacks and whites. The
                          military technology of the English
                          settlers also helped protect the num-
                          bers of whites and blacks while reduc-
                          ing the numbers of Native Americans.
                          Superior arms and numbers tell only
                          part of the story, however. The remain-
                          der has to do with the introduction of
                          new diseases, with the Jamestown
                          Exchange. It was not an even ex-
                          change; Native Americans came out
                          the worst.
                              Of the three groups that met in
                          seventeenth-century     Virginia, Indians
                         were the most susceptible to new
                         diseases. Their ancestors had migrated
                         from Asia across the Bering land
                         bridge and spread out over the North
                         American continent centuries before.
                         Germs had a difficult time establishing
                         themselves in America because they
                         and their weakened human carriers
                         could not survive the cold of the Arctic
                         region through which they had to pass.
                         Anthropologists     have called that
                         phenomenon the “cold screen.” Those
                         people who, generations later, reached
                         the more temperate climates of Vir-
                         ginia arrived free of the serious infec-
                         tious diseases that plagued their con-
                         temporaries in Asia, Africa, and
                              As long as this isolation lasted
                                                                                 5%1~u LATION
                                                                                  G ROWTH IN


Indians lived free from many of the            The first recorded smallpox epi-            White
serious infectious diseases to which       demic in Virginia occurred in 1667 on      Population
humans are subject. When whites and        the Eastern Shore. The report of it
blacks came to Virginia from Europe        indicates that, as was true in other             Black
and Africa with their unfamiliar germs,    parts of the New World, Native             Population
Indians’ bodies were not prepared to       Americans coped poorly. A sailor
ward off the attacks of the new            infected with the disease passed
invadersThese diseases ran rampant         through the area on foot. He stopped at
through Native American bodies and         several Indian settlements and gave
made the Europeans’ conquest of            smallpox to some tribal members who
Virginia’ Indians that much easier.        then spread it widely through the
    Most of us are familiar with epi-      Indian population. Thomas Jefferson,
demics. The devastating bubonic            in his famous descriptive book Notes 011
plague of the late Middle Ages comes       the State of Virginia, implicates small-
to mind when we hear or read the           pox as one of the major reasons that
word epidemic. When an infectious          “the [Indian] tribes . . enumerated [in
disease invades a community that has       the census of 16071 were, in the space
never experienced that disease before,     of sixty-two years [by the census of
it spreads easily throughout the           16691, reduced to about one-third of
population because none of the people      their former numbers.”
have developed any immunity to it.             Other diseases unfamiliar to
    An endemic disease, on the other                s
                                           Virginia’ Native Americans also
hand, is so prevalent in the population    struck and destroyed the Indian
that almost all adults have survived a     population of the region. A pandemic
bout with it as children and become        of what may have been bubonic
immune. Only children remain as a          plague, for example, spread northward
nonimmune population. Most of the          from Florida to New England between
white settlers arriving in Virginia, for   1613 and 1617, reaching Virginia in
example, had already suffered through      1617. Governor Samuel Argall wrote
endemic childhood diseases or had          of “mortality far greater among the
encountered them as adults and             Indians” than among the white settlers
survived, thus building immunities         of the area.
against future attacks. No Powhatan            In addition to the biological effect
had suffered and recovered from            of these diseases on Native American
measles or smallpox or a number of         health, Virginia Indians were faced
respiratory diseases brought by the        with having to formulate a cultural
English. When these diseases struck in     response to a new disease. During
the New World, many Native Ameri-          times of sickness, family and friends        L

cans were affected, and many died.         normally nurtured the sick and gave        1620   1700   1790
them food, water, warmth or coolness,               s
                                          mosquito’ bite and finds its way into
companionship, and encouragement to       the bloodstream and ultimately the
get better. “Virgin soil” epidemics,      liver. There it multiplies and finally
such as occurred in seventeenth-                                  s
                                          erupts from the host’ cells back into
century Virginia, where entirely new      the bloodstream, where it colonizes red
diseases invaded a population, upset      blood cells. When the plasmodium has
that system. Kinship and friendship       reproduced many times, it ruptures the
were of no avail when everyone            red blood cells and re-enters the
became ill at much the same time.         bloodstream, thereby causing the cycle
When smallpox or measles or dysen-        of chills (“agues”) and fever so com-
tery affected a large proportion of a     mon in malaria. An appropriate
community, each individual was            mosquito carrier of the Plasmdiurn
forced to care first for himself or       aivax resided in the New World just as
herself, then for others. This neces-     it had in the Old, so malaria could and
sarily selfish behavior doubtless         did become endemic in Virginia by the
worked against the overall survival       mid-seventeenth century.
of the community.     Failure of tradi-        The surprise came when West
tional healers to control new diseases    Africans brought a new form of
further undermined Native American        malaria to Virginia, a form much more
culture.                                  deadly than uizmx. Plasmodiwn fdcipo-
    The Jamestown Exchange, of            mm tends to clog blood vessels to the
course, worked both ways for all three    brain, heart, and intestines and thus
population groups. Fortunately for the    cause death. In the late seventeenth
English settlers, there were few Indian   century epidemics and seasonal out-
diseases that they had not already        breaks of malaria occurred because this
experienced in their own country. West    new, more virulent form had taken
Africans, however, brought a few          hold. A new Jamestown Exchange had
surprises with them to Virginia’ new      occurred.
white residents and to the already            For West Africans, as well, there
disease-pressed Native Americans. The     were adjustments to be made. They
most important surprise was a differ-     came from a bad disease environment,
ent form of malaria.                      arguably the worst of the three. Fevers,
    English settlers knew malaria from    parasites, and infectious diseases were
their home country. The disease causes    rife in their homelands. Yet the germs
a typical pattern of chills and fever     that commonly cause such severe
during the mild months of the year and    respiratory diseases as influenza,
relapses for several years. The tiny      pneumonia, tuberculosis, and measles
parasitic animal P/fwnoditfm    zks       seem not to have existed in Africa.
enters the human body through a           Africans did have natural defenses
against certain diseases, particularly      new diseases for which no antibodies
malaria. If, for example, they pos-         had been developed.
sessed, through genetic inheritance,             The late entry of large numbers of
only one gene for sickle cell anemia        West Africans into Virginia (1700)
(two genes for sickle cell meant they       compared to the English (16071, and
would suffer from the disease and           the continued immigration of both
probably die at a young age), they          groups to the colony for the remainder
were usually immune to falciparftm          of the eighteenth century, ensured a
malaria; and if they, as was true of        lasting presence and exchange of
most West Africans, lacked an antigen       diseases from different continents
in their blood known today as the           among the three population groups
Duffy Factor, they were immune to           living in the region.
vivax malaria.                                   None of the three groups that met
     Up until about 1700 the majority of    in seventeenth-century Virginia
blacks arriving in Virginia came from       escaped the Jamestown Exchange of
the West Indies. Many had already           diseases, though the English may have
adjusted to the disease climate of the      suffered least and the Native Ameri-
New World. The Jamestown Exchange           cans the most. The Europeans,
of diseases did not affect them as          however, did have many health prob-
greatly as it had Native Americans and      lems. These were not related to the
new English settlers. After 1700,           exchange of diseases with other
however, almost all blacks entering         populations but rather to the way in
Virginia came directly from Africa and      which the English established their
thus had no time in the Indies to           settlements and lived their lives in the
acclimate to the disease environment.       new environment of Virginia. The life-
Africans began to experience their own      style they chose also affected the health
Jamestown Exchange well after the           of African-Americans.
English and Native Americans. Mortal-
ity rates ranged as high as 25 percent
for Africans during the first year after                                 8
their arrival in Virginia and more than
50 percent after the first ten years. The
terrible living conditions on the trans-
Atlantic slave ships meant that most
Africans arriving in the New World
were in a weakened condition from
both malnutrition and disease and
were thus unable to resist the inroads
of even familiar diseases, much less the
               I was welcomed to James towne 6y a violent ague; 6einicj
 cur-edofit, within three weekes after I Gegan to 6e ditetnper-edwith
 other-grievous sic&esses which successively andseverally assailed me,
for Gesides a relapse into the former disease, which with much more
 violence heldme more than a moneth, and6rought me togreater
 weaknesse; the flux surprised mee, and’kept me many daies, then the
 crampe assaulted my wea& 6ody with strong paines, and after, the gout;
 all those drew me to that weaknesse, Geind una6Ce to stirre, Groudht
 upon me the scurvie, which thouah in others it 6e a -.cidk.~.cp -J
  I                                u                    --.v-----

sloth@nesse, yet was it in me an effect of weaknesse, which never left
me, till I was ready to leave the world.
settlements: the two groups encoun-        allowed colonists to settle where they
tered much less serious disease during     pleased did the severe health problems
what had been the unhealthiest time of     of early white Virginians ease.
the year.                                       Virginia remained a predominantly
     Politics may have governed the        agricultural and rural colony with few
health of the Jamestown settlers until     centers of population. Epidemic
 1624. Mortality rates generally im-       diseases took root less easily when the
proved when the colonial leaders           population was scattered into the
moved people away from Jamestown           countryside away from the rivers.
and worsened when they moved them          More stable settlement also meant
back. Thus, when most colonists lived      development of orchards, vineyards,
in the freshwater areas farther up the     and grain fields, the products of which
James after the building of the new        were made into such beverages as
town of Henrico in 1613, deaths in the     cider, wine, and beer. Settlers no longer
summertime from diseases declined          relied on possibly contaminated or
dramatically. It was at Henrico that the   dangerously salty river water as their
first English public hospital was built    primary source of drink, nor did they
sometime between 1611 and 1613. The        have to rely on such risky foods as
Virginia Company of London intended        oysters and clams gathered in river
that hospital, named Mount Malado          beds so often harboring germs during
(or Mount Malady), toserve as a transi-    the warm months of the year. Whites
tion station for new arrivals where they   learned how to live with the land and
could rest and build up their strength     make adjustments in order to survive
after the long journey from England.       the new disease environment of
Then, after acclimating themselves to      Virginia, just as Native Americans had
the weather and the fevers of the new      done before them.
land, these settlers could become full         Health problems eased after 1624
participants in the activities of the      but did not disappear. The Jamestown
settlement and assist in planting the      Exchange of diseases, for example, that
colony of Virginia. When Governor          had worked so much in their favor
Samuel Argall arrived in 1616 and          when they first arrived began to
ordered settlers back to Jamestown and     reverse itself after one or two genera-
thus to the saltwater areas, the old       tions. Maladies such as smallpox,
health problems reappeared. What           measles, tuberculosis, and other
earlier colonists had learned about        respiratory diseases that had been
disease and getting along with the en-     endemic or at least common in Eng-
vironment in the new land was forgot-      land were not so common in Virginia.
ten or abandoned. Only when the            Children born and raised in the colony
Virginia Company‘ demise in 1624           did not necessarily encounter those
diseases as they grew up on tobacco
 farms or even in courthouse villages.
By late in the seventeenth century,
epidemics of smallpox affected not just
the Native American population of the
colony but also the white and black                        IOYFVLLNEWES                                     j$CCjZW
     Summer fevers such as malaria
                                               #/Out ofthe New-found
began to take their toll as the century    @ j&J      VVovMe.
progressed and conditions for their
spread improved. Seasoning became a                 Wherein are declared, the rare and
catchword as new residents discovered               finpjtlervcrtuesofdiuertHcrbs,Trecs,
that they had to pass through one or                Plantes,Oyla &Stones, with their ap-
                                                              afkvll rof hr v/;
                                                    plicrriams,                    cfP kl/;ct,      as of
more bouts with “the fever” as part of
                                                     Ckirwgqy:       nhicb&riy   Utellapp&d,&!       kg
their adjustment to a new disease envi-                                    fb aI
                                                    l^#cb pt f/illt rrmrdiir       dy’ ea/rr   , a~
ronment. William Fitzhugh wrote in                     /;tmcalte~ethrrincrcdrbk        : note&
1687 that his newly arrived sister had                      pmding      f,’ ~~&+utldowt
had “two or three small fits of a feaver                                         .
and ague, which now has left her, and
so consequently her seasoning [is]            $!    AIfo   theporttWutcofthef%d Heaths,
over.”                                          3             vcrie aptly deictibed:
    Not surprisingly, seventeenth-                  Eoglifhcd by      741~ Fr*mpcnMlrch;rnt.
century promotional literature on                   jpeluly! co2redcD bjj conbrettct lui@
Virginia did not place much emphasis                   tbt @[De copiesutav appearc,~fitm
on poor health conditions in the new                   bnto are aDDeb   tbzeeother booheft
colony. Instead, the pamphlets, books,                 tlrafing oftbe 8czaar Bone,tbt @et%
and broadsides painted Virginia as an                  Efiierconen , t4e p~aperfioeofjron
ideal place in which to make one’    s                                               ttp
                                                      anb $9Qtitein ~eoicinc , SHD her
fortune and to live a long, good life                  ntfft ef@noU~.
thereafter.                                                   LO7qJO1\C,
    Part of the attraction of this new              Printedby E.rAfldc, by the &igocof
land was one of its products-tobacco.                         Ti?hmhanI5yyten.
Even before the colony’ settlement,                               * 596,
reports reached the Old World of the
wonders of this newly discovered
plant and its medicinal powers.
Thomas Hariot, a mathematician
whom Sir Walter Ralegh employed to
make scientific observations during an
                                      The Univerfal Medicine,

                                     A DISCOVERY ,

                                          of the
                                        Wondcrfulf Verrucs
                                                      0 F’

                                              Taken in a Pipe,
                                          Its Operation Ui? borhin
                                     Fph~/lc~ and Cbyt urgery.
                                      -.--^ _-.- - . . ..-_-__   ---

expedition to the New World, wrote
enthusiastically in his 1588 book A
Briefe and True Report of the New Found
Land of Virginia that tobacco “purgeth
superfluous fleame & other grosse
humors, openeth all the pores &
passages of the body        . [and] preser-
veth the body from obstructions” so
that users “know not many greevous
diseases wherewithal1 wee in England
are oftentimes afflicted.” English and
continental Europeans soon made
tobacco a fad as they smoked it, sniffed
it, chewed it, and ingested it, partially
for pleasure and partially because of its
presumed healing qualities. Later in
the eighteenth century tobacco-smoke
enemas were employed as stimulants
and as a means of restoring life to those
people apparently dead from drown-
ing or electrocution.
     Despite the touted benefits of life in
the New World, colonists encountered
great mortality. In a telling comment a
clergyman of the late seventeenth
century observed that Virginia’    s
Indians “seldome live longer than 40 or
50 years. Neither do the Inglish who
are born in Virginia live beyond that
age ordinarily.”
Self-Help         Medicine
      White immigrants came to Vir-       replace them. Thomas Glover, an
ginia knowing that their access to        English surgeon who lived for several
skilled medical assistance, such as it    years in Virginia, reported in a 1676
was, would be limited. Though the         issue of the Philosophica Transactiotzs of
Virginia Company sent over a few          the Roya/ Society the presence of “great
physicians and though some practitio-     numbers of Herbs, whose names,
ners did migrate during the seven-        nature, virtues and operations are
teenth century, trained physicians were   altogether unknown to us in EnroF7e.“
few in number and widely scattered.       He speculated that “if the use of them
People were on their own, medically       were well known, it might prove a
speaking, but apparently often content    great and beneficial addition to the
to be so. Of planters in the colony,      Materia Medica [useful medicines].”
Robert Beverley wrote,                    People experimented with local herbs,
                                          plants, and tree barks to develop
  They have the tiappiness to have        remedies suited to the diseases of the
  ve yfew Doctors, andthose such as       new land.
  make use only of simple !Qemedies,          Captive to their medical heritage,
  of whicfi their Woods affordgreat       some white Virginians bought or
  Plenty.Andindeed, their%tempers         brought medical books from the British
  are not many, and their Curesare so     Isles and the Continent to help them
  Benerallj known, that there is not      deal with household health problems.
  %tyAtey enou& to ma/&ealrade of         Some people possessed only one or
  Thysick there, as the Learneddo in      two such works; others assembled
   other   Countries, to the peat         home medical libraries. Ralph
   oppression of !34an!+d.                Wormeley owned eighteen medical
                                          volumes, Colonel Richard Lee four-
     The freedom and openness of the      teen, the Reverend Thomas Teackle
new land, the lush natural environ-       100, and William Byrd II 141 (out of
ment full of new plants, and the          about 3,500 in his entire library) upon
limited access of Virginians to physi-    his death in 1744.
cians encouraged a spirit of independ-        Though some people owned
ence from the old, seemingly distant      learned books on various aspects of
medical practices of European physi-      health and disease including anatomy,
cians. In addition, some of the most      surgery, pharmacy, midwifery, and the
popular natural remedies with which       practice of physic (medicine), most
settlers had been familiar in England     colonial Virginians who possessed only
did not grow in the New World, a          one or a few medical books probably
want that demanded the search for and     used a domestic medical guide of some
development of new botanics to                                     s
                                          sort. Nicholas Culpcper’ 1675 transla-
     tion of the Lonno~ Phar~~acopia (Phnr~na-
     coyoeia Lo~rdincnsis) from scholarly
     Latin to English vernacular opened
     that aspect of the medical world to
     laypeople, much to the chagrin and
     anger of English apothecaries. Books
     such as Culpeper’ though condemned
     by physicians and apothecaries alike,
     were popular on both sides of the
     Atlantic, including Virginia house-
          Not all domestic medical guides
     were written abroad and imported into
     Virginia. William Buchan, a member of
     Edinburgh’ Royal College of Physi-
     cians, published American editions of
     his Dornesfic Medicine; or, Tke Family
     Physiciarr that attained great popularity
     in late eighteenth- and early nine-
     teenth-century Virginia. John Tennent,
     an English physician who practiced
     medicine in Spotsylvania County about
     1725, wrote Every Mm his own Doctor
     or, Tke Poor Plmter’ Physician, which
     quickly became popular in Virginia.
     Published in Williamsburg in 1734, the
     book was designed to appeal directly
     and undisguisedly to Virginia’ pre-s
     dominantly rural and agricultural
     white population who wished to or
     had to treat medical problems without
     engaging a member of the local medi-
     cal profession. Tennent did not win
     friends among fellow physicians with
      the book’ title, or its subtitle, Plni~r n,zrt
     Easy Means for Persons fo cure fkemsclues
     of all, or most of the Disfempeus, imided
      to tkis Climate, rend with very little
     Ckarge, tke Mcdicir?es being ckiefly of tke
Grozcltlr and Production of this Country.    one that I brot from Philadelphia. The
Tennent continued his controversial          dose is 30 drops on a lump of sugar, in
course with Virginia’ physicians when        a fit of the flatulent colick. Old Mr.
he asserted that rattlesnake root,           Allen declares from repeated experi-
Polygala serle~a, cured pleurisy and         ence that in the above mentioned kind
other ailments.                              of colick, this medicine is infallible. I
    Among the remedies colonists used        wish it may prove so in your case.”
in treating their health problems were            Sometimes friendship extended
some that had to be purchased for            beyond the mere giving of advice or
home medicine chests rather than             the lending of medicines to providing
gathered. Despite the emphasis on            actual care for others. William Byrd II
natural curatives, certain botanics and      was such a person. He prided himself
many of the nonplant ingredients for         on his ability to cure illness and openly
popular cures were not available in the                             s
                                             criticized the colony’ medical profes-
colony and were imported from other          sion. A 1736 letter of Byrd to Sir John
colonies or England. Those cures also        Randolph, treasurer of the colony and
included patent medicines that local         Speaker of the House of Burgesses,
drug merchants, who often were also          illustrates his sarcastic attitude:
physicians, obtained from England or
that travelers brought with them from           % strande that none of your
the mother country. Doctor George               Thysiciansshoudhit upon theproper
Gilmer of Williamsburg, for example,            ~emedyforyourDistemper6ut      %.
announced in a 1737 advertisement in            [‘OFE~ CUSTLS[Byrd2 Grother-in-
the Virginia Gazette that he sold “all          law]&!&.!Bm~.       you mghthave
manner of Chymical and Galenical                run the whole Gantlope ,@auntCet]
Medicines” and such English patent              of Thysick without reaching your
medicines as Bateman’ Drops, Squires            Complaint. ,qou really needed a
Elixir, and Anderson’ Pills.                    plentiful and constant Discharge,
    Colonials themselves were not shy           or eke one of the Gest He& in the
about offering advice on treatments             County wouldhave 6een in danger,
that had worked for them or that they           and pro6a6ly Like several other
had heard or read about. Letters (and           valua6fe Tersons, you might have
presumably conversations) at all levels         out-fivedyour seF I amgCzdI had
of society were full of medical advice.         a hand in doing so pu6Liikagood
Wrote Richard Henry Lee of Chantilly,
Westmoreland County, to Landon                  All too often sickness resulted in
Carter of Sabine Hall, Richmond              death. Dealing with it, even though it
County, in December 1774, “I          send   was much more common than today,
you a bottle of Harlem Oil, the only         was, of course, not easy. Letters of the
time reflect that sadness and resigna-      tines, treatments, and health care
tion. One downhearted father of three       providers that even the poorest free
deceased sons wrote in 1772:                white or white indentured servant had.

      ~$0 Dou6t you have heard of my
      son2 Beath after a sore conffict
      occationed6ygetting Teeth (which
      threw him into Fitts.) [?tj’ fled
     from this unfriendfy world, into the
                            here is 6ut a
      other the 28th ult. [I’
      narrow passage Getween Death ei-’
      Life, and it is attended with such
      important Consequences that it is
      theflreatest Wisdom topreparefora
      happy Eternity. My 3 sons have
      taken possessions of their worldly
      Inheritance a few feet of Ground
      contain their Remains.

     If Virginia’ white residents had a
difficult time with illness and death
during the colonial period, Virginia’s
blacks, mostly enslaved in the eight-
eenth century, had an even more
difficult time. At least most whites
coming to this new land spoke a
common language and shared a com-
mon heritage. It is not easy to be sick
with a disease never before encoun-
tered, unable to communicate easily
with those who wished to help or who
were angry with you for getting sick
when there was work to be done, and
being treated with strange medicines
and healing techniques that might
directly oppose the health beliefs of
your religion and tradition. Enslaved
blacks did not have the control over
their health care, or over their medi-
 doctors made public calls for appren-       Hornby, “from London,” announced in
 tices. “Wa~zted immediafely,” Messrs.       an August 1772 advertisement: “He
 Ramsay and Taylor of Norfolk an-            performs all Operations on the Teeth
 nounced in a Virginia Gazetfr advertise-    and Gums, extracts decayed Teeth and
 ment in 1766, “AN APPRENTICE, to            Stumps, scales and cleans Teeth, and
 serve at least four or five years in the    entirely eradicates the Scurvy; he
 business of Physick, Surgery, Phar-         transplants artificial Teeth, so neat as
 macy, &c. who has had a good educa-         not to be discovered, and to perform
 tion, and whose character will bear a       all their Functions.” He also gave
 strict inquiry.” The successful candi-      “ADVICE and MEDICINE, to the
 date, they continued, “will be well ac-     POOR, gratis.”
 commodated with bed, board, and
 washing.” Apprentice training re-
 mained popular in Virginia until well
 into the nineteenth century.
      In the colonial period druggists
 practiced medicine, and most physi-
cians prepared and dispensed medi-
cines as necessary. Seldom did some-
one restrict practice solely to surgery or
physic. There were two medical areas,
however, in which people did special-
ize-obstetrics     (midwifery) and den-
tistry-though      general practitioners
also cared for patients with those
     Dentistry was not yet a profession.
Physicians carried with them dental
forceps to pull out bad teeth, but they
had few dental skills beyond that.
There were people who traveled from
town to town in the colonies, caring for
the special dental needs of the popula-
tion. These dentists took out advertise-
ments in the Virginia Gazette announc-
ing the dates of their expected arrival
in various towns so that patients could
plan to come in from their farms for
care. A typical “Surgeon Dentist,” Mr.
The Valley and
     For a long time Virginia’ colonial                        s
                                             western Virginia’ Native Americans
population remained concentrated             lost in numbers and in land.
close to the Atlantic coast along the             Some of the whites moving into
rivers that emptied into the sea and in      western Virginia came from Tidewater
the rolling hills west of the rivers’ fall   plantations and villages, but most
lines. A shift in the colony’ population
                             s               arrived from the north. They also
began to occur in the 173Os, a shift that    derived from different stock, European
allows us to turn our attention from the     to be sure, but Scotch and German,
Tidewater to the land across the Blue        rather than English. They migrated
Ridge Mountains, to the Valley of Vir-       from ethnic settlements in western
ginia, and to the mountains beyond.          Pennsylvania and western Maryland or
     In these new white settlements we       directly from Europe. The Scotch-Irish,
once again encounter the meeting of          Scats who migrated to the Ulster area
cultures, a mixing edged with tension        of Ireland, and Germans of Reformed
from the start. European settlers had        or Lutheran denominations, made up
heard about the “savages” and the            the majority of these new Virginians,
atrocities they had committed in             the former settling primarily in the
previous battles with whites who were        southern Shenandoah Valley and the
trying to stake out land in the wilder-      latter in the northern end.
ness. These stories were confirmed by             Granted patents of land in the
personal experience. During one              Valley, these migrants established
campaign of the French and Indian            farms and villages and retained many
War, in July 1755, for example, Dr.          of their ethnic ties to Europe. They also
Thomas Lloyd of Botetourt County, a          brought their diseases with them, most
surgeon in Preston’ Rangers, submit-
                     s                       of which the Native Americans of the
ted a bill to the county for “Curing         region had not experienced or had only
Nathaniel Welcher of a Wound rec’      d     recently encountered. The effect of this
from the Indians at Mr. Bingiman’ ons        changing disease environment on
New River” and “For Medicines to 2           Native Americans was predictable.
Women that was Wounded in their                                   s
                                                Western Virginia’ white residents
Breasts at Starks on New River.”             retained their basic humoral medical
    Iroquois and Sioux, for their part,      belief system, similar to that de-
attempted to turn back the rising tide       scribed for the earlier English settlers,
of white settlement, especially in their     though modified for the new, warmer
Shenandoah Valley burial grounds, but        environment.     The Germans and, to a
to no avail. Between European fire-          lesser extent, the Scotch-Irish also
power and the continued spread of            brought a different language and
European diseases such as smallpox,          culture and some different medical
measles, and respiratory ailments,           folkways to Virginia.
     German settlers retained their belief
 in astrological signs and the zodiac’
 control over events. Valley almanacs
 published for the German population
 always contained horoscopes and
 phases of the moon to inform readers
 of the best and most appropriate times
 to perform certain tasks or apply
 remedies. The Reverend Joseph
 Doddridge recalled that during his
childhood in the mid-eighteenth
century “charms and incantations were
in use for the cure of many diseases. I
learned, when young, the incantation,
in German, for the cure of burns,
stopping blood, tooth ache, and the
charm against bullets in battle.”
     The German and Scotch-Irish physi-
cians of the Valley seem to have
practiced medicine like their English
colonial counterparts farther east.
Records of the medicines they used,
the books they kept in their personal
libraries, and the instruments they
owned resemble those of their English

George Washington
      The eighteenth century ended in the    the resultant deep pittings on
 newly formed United States with the                      s
                                             Washington’ face in his famous
 death on 14 December 1799 of its            portrait of the president painted in
 leading military hero and statesman,         1796.
 George Washington, Virginia’ native              During his lifetime, Washington
 son. Though basically a strong and          suffered at least ten attacks of serious
 healthy man, Washington had been            illness, some disabling him for as long
 subject to the same ills that plagued       as a year. Between 1755 and 1768, for
 most eighteenth-century    Virginians.      example, he contracted dysentery at
 The kinds of health problems Washing-       least three times, once for five weeks
 ton encountered during his sixty-seven      during the French and Indian War at
 years and the way he dealt with them        Fort Duquesne. In 1789 and 1790,
 typify both the state of medicine and       shortly after assuming the presidency,
 the kinds of care available at that time.   Washington was stricken twice with
 Washington’ death is not significant        pneumonia.
 medically, but it is a convenient                            s
                                                  Washington’ false teeth have
 occurrence to sum up the state of           always excited interest among the
medicine in the late eighteenth century      public, perhaps because they survived
and to launch a discussion of medicine       him and are thus the only tangible
in the new republic and the new state                                 s
                                             remains of our nation’ first president.
of Virginia.                                 His first tooth extraction occurred in
     Born in 1732, George Washington         1754 at age twenty-two, and his last,
survived the high-mortality     years of     which removed his last natural tooth,
early childhood when intestinal              in 1796 in Philadelphia. Washington
parasites, severe diarrheas, and respi-      consulted several dentists over the
ratory problems such as scarlet fever,       years and replaced his dentures, in part
measles, and bacterial infections took       or in full, at least nine times between
so many young Virginians‘ lives. At          1781 and 1798.
age seventeen he became a surveyor                Washington did not have the aver-
and, presumably in the course of his         sion to or fear of physicians evinced by
duties in Fairfax County, became             some other eighteenth-century      Virgini-
victim to the bite of a plasmodium-          ans. Yet, like most of his neighbors, he
infected mosquito. For the rest of his       preferred to care for himself and for his
life, Washington suffered from periodic      white and black households without
and sometimes severely debilitating          outside medical assistance. To that end,
bouts of malaria. He had but one bout        he regularly ordered large quantities of
with smallpox, in 1751, leaving him          common medicines and even some
immune to the disease but scarred for        patent medicines from London. He
life. Gilbert Stuart chose not to depict     also owned and presumably used some
                                   , 34

 medical texts and domestic medical          until he had done a few more chores in
 guides. Washington subscribed to the        the house and eaten. The next after-
 humoral theory of disease and, consis-      noon, after the snow had stopped, he
 tent with that thinking, he did not shy     went outside briefly to mark some
 away from recommending bloodletting         trees for removal. Later that evening he
 for his own or his “people ’ ” ailments    complained of a cold and sore throat
 when he thought it necessary. That         but told Tobias Lear, his personal
 same attitude toward bleeding later        secretary, “You know I never take
 played a significant role in the           anything for a cold. Let it go as it
 president’ final illness.                  came. ”
     In at least one other respect, Wash-        At three the next morning, Wash-
ington was representative of eigh-          ington awoke feeling sick. He could
teenth-century Virginians with medical      hardly talk to his wife and could
 problems. Despite a wariness of            breathe only with difficulty. He had his
quacks, he did on occasion use itiner-      overseer come and bleed him and tried
ant quacks himself and even purchased       to swallow a mixture of molasses,
a set of the popular Perkins’ Metallic      vinegar, and butter that Lear gave him
Tractors in 1796. These implements          to relieve his throat. Washington
were pairs of rods designed, when           choked on it and almost suffocated in a
dragged over the affected part, to          coughing fit.
remove pains and inflammations from              His old friend Dr. James Craik
the body.                                   arrived later that morning, took more
     Washington was already declining       blood, and applied a blister to his
in health by 1798, but he remained          throat. A vinegar gargle and steam
active at Mount Vernon until two days       inhalation did little to change the
before his death in December of the                    s
                                            president’ condition, nor did another
following year. The medical story           bleeding. Craik called in Dr. Gustavus
behind his death describes the state of     Brown from nearby Port Tobacco,
medicine and of approaches to sickness      Maryland, and Elisha Dick, a young
in the eighteenth century.                  physician from Alexandria. They
     On Thursday, 12 December, the          arrived between 3:30 and 4:00 p.m.,
former president was out riding and         removed more blood, gave the presi-
seeing to various matters on the estate     dent a laxative and an emetic, and
between 10 a.m. and 3 p.m. The              blistered him again. Doctor Dick
weather, cloudy and cold in the             wished to relieve Washington ’ s
morning, turned worse in the after-         breathing problem by opening his
noon as rain, sleet, and snow fell          windpipe surgically using a procedure
alternately. Washington returned home       known as tracheotomy, something that
at three, wet but unwilling to change       had been done occasionally in the past
 but never on so illustrious a person as
 Washington. The two older physicians
 opposed the procedure, intimidated by
 the responsibility of caring for the
 former president and well aware of
 future public scrutiny of their actions.
 Dick opposed the excessive bleeding
 the other two physicians were using
but was overruled again.
     Washington seemed resigned to his
fate and even told Lear at one point,
 “My breath cannot last long. I believed
from the first that the disorder would
prove fatal.” He died quietly at about
11 p.m. that night. The three physicians
published a full account of the events.
Brown publicly stated that he felt timid
about using tracheotomy and that Dick
was correct in thinking that they had
bled Washington too much. By one
calculation, Washington lost ninety-six
ounces (three quarts) of blood, or about
half his blood volume. The president
probably died of a severe streptococcal
infection, aggravated by blood loss and

         Medical life in
     antebellum Virginia
 -the period from about
  1800 to the Civil War-
resembles in many ways
  that of the colonial era.
The po ulation was more
   stab P as immigration
 from Europe and Africa
  slowed. Consequently,
  the importation of new
diseases declined, except
  for cholera and yellow
 fever. Some changes in
    treatments occurred,
      althou h the basic
   approac a to medicine
   remained as it was in
          earlier days.
     Let us return to the hypothetical         the ingredients in homemade cures
situation with which this essay began.         could be purchased from drug suppli-
It is 1840, and you wake up feeling                                          s
                                               ers and stored in the family’ medicine
sick. What do you do? What are your            chest, while others were natural
options? Assume for now that you are           botanics that people could gather at ap-
a white adult and that vou live, like the      propriate times of the year and prepare
majority of white Virginians, with your        as needed. Virginians grew their
spouse and four children on your small         favorite herbs as well, both for medi-
farm some fifteen or twenty miles from         cines and seasonings.
the county seat.                                    Richmond resident and United
     You are not entirely certain what         States Chief Justice John Marshall
causes disease, but you accept the idea        suggested the use of a natural remedy
that the environment in which you              to his son Edward in 1821: “I am very
live, your diet, activities, emotional         sorry to hear that you are afflicted with
state, and developmental events such           sore eyes. Your mother recommends it
as puberty all affect your body’   s           to you to get the small twigs of sassa-
natural balance and therefore your             fras which have young pith, to strip off
health. You think about and describe           the outer bark & then split the twigs &
sicknesses in terms of symptoms-               cut them into tolerably short pieces &
diarrhea, continued fever, ague-and            put them in a cup of water & stand
classify your remedies by their actions        there an hour or so when the water will
on the body-cathartics       for defecation,   become a jelly. Bathe your eyes in this
emetics for vomiting, anodynes to              jelly & [she] thinks it will be of great
relieve pain, diuretics to induce              service.”
urination. Your goal in treatment is to             In addition to medicines, white
restore the natural balance of the body        antebellum Virginians also owned
with its environment by adjusting your         certain implements they believed had
diet and activities and by taking              medical value. Most had bloodletting
medicines that promote recovery of             instruments. George Washington and
that balance.                                                                    s
                                               other Virginians used Perkins’ Metal-
     How did antebellum white Virgini-         lic Tractors. Interest in applying elec-
ans care for their ailments within that        tricity to cure health problems per-
basic medical framework? Like their            sisted well beyond the life of Perkins’  s
colonial predecessors, they turned first       Tractors. A few decades into the
to self-help. Medical recipes copied or                                        s
                                               nineteenth century the state’ newspa-
pasted into diaries and commonplace            pers contained advertisements that
books or remembered from previous              often invoked the phrase “medical gal-
illnesses served as the first line of          vanism” to promote such things as
defense. Patent medicines and some of                         s
                                               “Dr. Christie’ Galvanic Rings, Bands,
 Belts, Bracelets and Magnetic Fluid.”       the trip the greatest benefit. I have lost
More than one Virginia household             a good deal of confidence in Drs. &
owned a “Magneto-Electric       Machine.”    medicine for any protracted sickness,
     Not many households had mad-            and believe that an excursion to some
 stones, however. These medical objects      healthy and interesting region will do
 had nothing to do with electricity.         more to renovate and invigorate the
They were harder to obtain because           system and enable it to throw off any
 they derived, it was said, from small       general or even local disease than any
concretions in the intestines of cows        thing else in the world.”
and certain other herbivorous animals.           Taking advantage of people’   s
Madstones, generally no more than an         normal desire to care for their own
inch or two in any dimension, were           health problems, and continuing a
applied to cure rabies and dangerous         tradition begun in England, a number
snakebites. They adhered to a wound         of physicians on both sides of the
for several hours and supposedly drew        Atlantic and on both sides of the
out the poisons from the body. When          Mason and Dixon line wrote domestic
the stone fell off the leg, arm, or other   medical guides. Because the commonly
part of the body it was soaked thor-        held medical beliefs of the time corre-
oughly in milk or some other alkaline       lated local environment and life-style
substance to remove the poison to           with health, most of these books had
make the stone ready for the next           regional circulation near the homes of
person to use. Madstone owners              the writers. James Ewe11 of Savannah,
generally shared them (for a fee) with      Georgia, for example, published a
neighbors.                                                              s
                                            popular book, The Planter’ and
    For those who could afford it, the                s
                                            Mariner’ Companion, in 1807 that
healing waters of western Virginia’  s      discussed “the diseases common to
world-famous medicinal springs              warm climates.”
beckoned-Warm        Springs, Hot                In their attempt to appeal to a rural
Springs, White Sulphur Springs, and         audience, the authors of these domestic
Sweet Springs. Some people went to          medical guides included as much
the resorts primarily for social reasons,   information as possible. Doctor Tho-
to see and be seen; but others took the     mas Ewe11 of Virginia, who was
waters regularly to maintain health or      “formerly Surgeon of the Navy Yards
went specifically to treat a troublesome    at New York and City of Washington,”
ailment. R. E. Lee stated the prevailing    packed into his 1824 book, The American
view of the value of taking the waters      Family Physician, discussions of medical
in an 1838 letter to a cousin: “I am        care “from infancy to old age,” instruc-
delighted to hear that Mrs. L. has gone     tions for birthing women “and the
to the Va. Springs and I anticipate from    diseases peculiar to the sex,” and an
appendix with “Hints respecting the        States (what became the University of
Treatment of Domestic Animals, and         Pennsylvania) received wide distribu-
The Best Means Of Preserving Fish          tion and acceptance.
And Meat.” In the Valley of Virginia,          There were four ways to let blood,
Dr. Ralph Schenck of Botetourt County      only three of which actually resulted in
(“formerly of New Jersey”) published       the removal of blood from the body.
The Family Physician in 1842. It covered   These methods were known as vene-
not only “Diseases which assail the        section, wet cupping, dry cupping, and
human system at different periods of       leeching.
life” but also chemistry, anatomy,             Venesection-cutting     into a vein-
physiology, and materia medica.            was usually done on the same arm vein
     Virtually every antebellum domes-     where blood is taken today for blood-
tic medical guide contained instruc-       bank donations. The operator took a
tions for performing one of the most       small, sharp knife known as a lancet
common and popular procedures of           and incised the vein, taking care not to
the time, bloodletting. Doctor James       sever it and nick the pulsating artery
Ewell, author of one of the home           beneath it. Blood flowed from the
medical guides, believed that everyone     wound into a strategically placed bowl.
should know how to let blood, “since       Pressure applied to the incision
cases of emergency may happen, when        stopped the bleeding when an appro-
the necessity of its being performed is    priate amount had been removed.
evident, and where life may be lost            Wet cupping was more complex. It
before medical assistance can be           required use of a scarifier or scarifica-
obtained.” Though the procedure goes       tor, a cube-shaped instrument three or
back to ancient Greece and earlier,        four inches in every dimension. Inside
Philadelphia physician and signer of       the scarifier were six to thirty-two (and
the Declaration of Independence Dr.        sometimes more) tiny blades attached
Benjamin Rush was largely responsible      to axles that rotated when a spring was
for its continued popularity in nine-      released. The scarifier was placed on
teenth-century America. Rush, a            the chest, back, leg, or temple. When
student of William Cullen at the           the spring was released, the rotating
University of Edinburgh, maintained        blades passed rapidly through open-
that hypertension or excess blood          ings in the casing and then back inside
causing pressure in the circulatory        the instrument. For the instant they
system was the root of most ailments       were exposed to the outside, the blades
and that bleeding would effectively        made multiple incisions in the skin
ease the problem. His ideas, expressed     under the scarifier, causing blood to
in books, essays, and lectures at the      flow. At that moment a glass cup that
first medical school in the United         had been exhausted of its air by
burning some flammable material in it
was applied over the wound. The cup
sucked out blood from the incisions.
This procedure could be performed
with several cups at once or repeated
in different places on the body. Not
only did this technique remove blood,
but it also irritated the area over the
ailing part, causing blistering and
“healthful healing.”
     In dry cupping, the operator used
the same procedure as in wet cupping
but did not scarify. This approach
drew blood to the body surface near
the afflicted part and also provided
     Leeching seems the least pleasant
technique because a living animal
sucked the patient’ blood. It had the
virtue of versatility, as leeches could
attach to any part of the body. One
could gather leeches by following the
instructions in Schenck’ Family
Physician or purchase them from
suppliers who advertised regularly in
the newspapers or from a local apothe-
cary shop. To make a leech attach to
the skin, operators placed a drop of
milk or blood on the spot with the
animal. When a sufficient amount of
blood had been removed, they put
something the leech did not like, such
as salt, on the spot and the leech let go.
     Simple, but not always easy to do.
Some people preferred to have some-
one else perform the bloodletting, so
they turned to “leechers and cuppers”
who usually lived in Virginia’ larger
towns. “Mrs. Woolhouse offers her           the hooping cough in our family, and I
services to the Medical Faculty and the          t
                                            don’ know what to do with it,” wrote
Ladies of Richmond, as Leecher and          the same planter four years later. “I
Cupper, and trusts by assiduous             send to you for advice. Be particular, if
attention to merit their kind patron-       you please, as to diet, drink, exercise
age,” advertised one such person in the     &c.     . P.S. My stock of medicine is
Rickwzomf Dispatck in 1855.                 made up of Jalap, Rhubarb, Calomel, &
    When home treatments failed and         ipecacuanha, so that you will have the
the patient’ condition worsened, it         goodness to supply whatever you may
was time to call the physician. For         think wanting.”
rural Virginians this meant addressing          The term physician derives from the
a brief note to the doctor laying out the   Greek word for nature. When the
situation and all previous treatments,      doctor entered a home he tried to help
sending someone to the physician with                                s
                                            nature restore the body’ normal
the note, and either waiting for the        balance. Physicians, as experts in
doctor to write a response or escorting     natural diseases, used medicines to
him back to the farm. If the messenger      induce or assist “the healing power of
found the physician immediately, the        nature.” Alterations in discharges from
process might take a few hours. If he       body openings, in the blood removed
was out on a call, it took much longer.     during bloodletting, or in the skin
“My Daughter Lucy has been ex-              showed that the prescribed regimen
tremely sick for three weeks of a           was working.
constant fever,” wrote William Fleming          Sometimes, perhaps often, the
Gaines to Dr. Thomas Chrystie in 1805,      regimen did not work, and the patient
“at the beginning common medicines          became sicker or even died. Then, as
were used to make way for the bark          now, physicians could offer no guaran-
both of which have proved too weak          tees that their services would indeed
for the enemy, for the fever continues      result in a cure. Patients might then
accompanied with a sick stomach &           move on to other healers or treatments,
depression of spirits-.     . I depend on   though they were still expected to pay
your goodness & friendship in riding        the doctor.
up as soon as you can this morning to           Not all antebellum Virginians could
her relief.”                                afford care by a physician. The poor
    Because physicians and patients         generally received medical treatment
shared a common approach to and             as part of the care counties provided all
understanding of medicine, both felt        indigent residents. Since colonial days,
comfortable making patient-care             Virginians supported those poor in
decisions by exchanging notes when          their parish or county who were too
necessary. “For the first time we have      sick, handicapped, mentally incompe-
tent, young, or old to care for them-       to the Frederick County prison during
selves. Sometimes officials paid a          the summer of 1841, for example,
neighbor or friend to keep one or two       found eight lunatics living in a small,
such people. Many counties later built      dirty, unventilated portion of the
poorhouses where the indigent and           building:
incapacitated could live. Children were
often apprenticed to a craftsman or a          A third apartment which opened
household to learn an appropriate              into a narrow passage, was if
trade and gain an education. In all            possi6le still more revolting than
these situations the community paid            either of theformer, not Gecause it
for medical care as well. Regardless of        appeared more uncomforta6le or
their economic status, people preferred        cheerless . . . 6ut Gecauseit was the
to care for their own ailments first, but      a6ode of FWE insane females, three
the poor did not always have that              of whom were white andtwo 6lbcli;
freedom if they were wards of the              one of each color was chained in
county.                                        opposite corners ofthe room, whilst
     Other Virginians who had little           the remaining three were permitted
control over the medical care they             during the day to exercise or fa6our
received were the insane. Most families        in the &joining passge.
cared for lunatics in their homes,
though not always under the best of             Virginia supported two state insti-
circumstances. Because the “mentally        tutions for the insane, one in Wil-
deranged“ did not respond as did            liamsburg and one in Staunton. They
other Virginians and could not com-         were called asylums because they
municate well, all too often their          provided a refuge from the harshness
families and friends assumed they           of the outside world and sometimes
needed no heat, fresh air, good food, or    even an opportunity to recover one’   s
companionship. Families did call in         senses and return to everyday living at
physicians in some cases of insanity,       home. Local authorities sent men and
thinking that medicines might restore       women declared legally insane to these
balance within the body and thus            institutions in hopes of curing them.
improve the patient’ mental status.
                      s                     Both the Eastern and Western Lunatic
     If an insane person began to           Asylums emphasized “moral treat-
threaten the family or became uncon-        ment,” a new approach to patient care
trollable or a wanderer, the family         that originated in Europe in the late
could turn him or her over to local         eighteenth century. Patients were
authorities for confinement in the jail     treated with respect and dignity but
or poorhouse. Care there might be           followed regular routines established
even worse than at home. One visitor        by the physicians and their staffs and
completed tasks that fit with their con-
ditions and abilities. Eastern Asylum in
Williamsburg, founded in 1773 and the
oldest state-supported mental institu-
tion in America, housed many more
chronic patients with little hope of cure
than did the Western Asylum in
Staunton, founded in 1828. Both were
always full.
     A sick person, not insane, poor, or
shy, but definitely ready for a change
in medical approaches, could turn to
one of the alternative healing systems
available in Virginia.
    The People’
    Medical          Revolution
I        People adopted irregular medical        appeal to a rural audience.
     systems in revolt against the harsh,             The botanic medicine movement,
     expensive, and unreliable treatments of     because it grew so large both in
     regular physicians. The earliest and        Virginia and across the nation, and
     most popular of these systems in            because it directly opposed physicians
     antebellum Virginia was the Thom-           with its slogan “every man his own
     sonian.                                     doctor,” threatened and upset the
         At least ten Friendly Botanic Society   regular medical profession. Physicians
     chapters formed across the state, as did    fought back in print and in legislatures,
     many more around the nation, most in        but the Thomsonians succeeded in
     the countryside, to follow and discuss                                 s
                                                 eliminating or, in Virginia’ case,
     the teachings of Samuel Thomson.            preventing passage of medical licens-
     Shortly before the turn of the century,     ing laws, fulfilling the wishes of the
     Thomson, a New Hampshire farmer,                       s
                                                 movement’ founder.
     started a botanic self-help health               Thomas Nash, proprietor of the
     movement by protesting the crude,           Thomsonian Infirmary in Norfolk and
    sometimes life-threatening     remedies of   a Thomsonian physician (Thomson
    regular medicine. Thomson based his          himself vehemently opposed both
    system on medicines derived from             infirmaries and physicians for what he
    plants, not from the metals (such as the     founded as a self-help movement),
    mercury in calomel) and salts used by        wrote strong letters of encouragement
    physicians. According to Thomson, all        to Thomsonian followers and to those
    disease resulted from a loss of internal     who might stray, such as Major W. H.
    body heat. Replacement of that heat          Shover:
    through the use of lobelia, cayenne
    pepper, teas, brandies, wines, and              3lm sorry to find         you still
    steam baths restored the body’ natural           complaining of i+estion.      I hope
    balance and health.                             you wiLTcarry out my advice and6y
         For twenty dollars one could pur-          so a&g carry on that thorough
                                                     constitutionalchange which is now
    chase a box containing Thomsonian
    medicines and Samuel Thomson’ New  s            Join. on in you. It wiLT6e apity not
    Guide to Health and autobiography, A             to take an occasionaLSteam [Gath]
    Narrative of the Life and Medical Discov-        & %uztic (lo6eCia inflata]. I trust
                                                    my dear friend, you will remem6er
    eries of Samuel Thomson. Thomson’   s
    domestic medical guidebook was                  its happy influence. Such a course
    organized by symptoms. One simply               can 6e prescri6ed without danger,
    followed the directions using the               andwithgreat 6enefit. any mem6er
    special medicines in the home medi-             of your family can assist you in it,
    cine box. Thomson knew how to                   and I am sure they wiCllfyou will.
      OFFICE-AT       THE FLOYD              HOUSE,
             ,    J i,, I “?llZ 7 8’ ‘
                                   8, ,;.rlr.                                              52

      The Thomsonian Recorder, the                    practiced in Fredericksburg.
  movement’ journal, offered news and                     There was also talk about hydropa-
 advice and announced annual confer-                  thy, a water cure movement, and about
 ences, such as the 183.5 national con-               Grahamism, a movement founded by
 vention held in Richmond.                            Sylvester Graham of Pennsylvania that
      Another national alternative health             stressed vegetarian diet, whole grain
 movement that gained some adherents                  flour (the Graham cracker), and
 in Virginia, primarily in the cities, was            exercise. Neither of these movements
 homeopathy. This program was the                     touched many antebellum Virginians,
 creation of a German physician,                      though Stonewall Jackson purchased a
 Samuel Hahnemann, who developed a                    number of books on hydropathy for his
 system in the 1790s that stressed two                personal library before the Civil War.
 basic tenets: first, similia similibus curan-
 ttlr (“like cures like”), a drug reproduc-
 ing a symptom will remedy that very
 problem; and second, infinitesimal
 doses, very dilute concentrations of a
 drug, are more effective than larger
 ones. The movement reached Virginia
 in the late 1830s and was new and
 exciting, even to regular physicians,
 some of whom adopted the homeo-
pathic approach themselves.
      Hahnemann’ book, The New Or-
ganon, was translated into English and
published in an American edition for
all to read. So popular did the phrase
sirnilia similibrrs curantur become in
some Virginia circles that Dr. A. H.
Atwood, a Richmond homeopath,
used it in his advertisements to the
public without further explanation.
Some people purchased their own
homeopathic home medicine chests,
but the system was complex despite
its appeal of small doses. Most adher-
ents called on trained homeopathic
practitioners, both men and women,
such as Margaret Conway, who
 If You Got Sick and                         L
 You Were Black
      It is 1840, and you wake up feeling         gentler, herbal treatments that circulate
 ill. You are a black adult living, like          in the slave quarters of this and nearby
 about 70 percent of Virginia’ African-           plantations. Though white medicines
 Americans, on a white-owned farm                 and treatment regimens do sometimes
 with ten or more other blacks. Blacks            seem to cure, they are different from
 constitute between 40 and 50 percent of          the ones you have learned in the
 the total population of the state,               quarters; nor do you particularly like
 though only about 10 percent of your             the white physician who comes when
 number are free. How do you handle               ailments do not respond to the master’   s
 your sickness?                                   ministrations. Besides, whites do not
      (We will not discuss free blacks in         understand that sometimes sickness
 the Old Dominion because of their                and injury result from conjuring and
 small number and our limited space               rooting, things their medicines cannot
but will concentrate on the remaining             cure. You decide to treat yourself.
90 percent of the state’ black popula-                The symptoms persist, however,
tion. In general, free blacks had little          and your self-help approach fails.
 money to use for professional medical                       re
                                                  Now you’ getting worried both
care when home remedies did not                  because your health is worsening and
work. Some Virginia physicians                   because you cannot ask your fellow
provided them with medical care                   slaves to cover for you much longer.
grafis, and some whites paid for free            You swallow hard and turn to the
black medical care or took the cost of           master, trying to look as healthy as
providing such care from their free              possible, though it is obvious from the
black employees’ salaries. Eastern               seriousness of your symptoms that you
Lunatic Asylum admitted free blacks              have been sick for a while and have
throughout the antebellum period.)               waited to inform him.
      The major issue you confront this               Such delays in informing slavehold-
morning as a sick slave is, Who con-             ers of illnesses only confirmed white
trols your body? It is, after all, your          Virginians’ stereotypes of black self-
body that ails. By caring for your own           care. In letters about health matters
illness you are making a statement of            masters typically observed, “I know
autonomy. You know that the rule of              that negroes especially, are very
this plantation is to report all illnesses       inattentive to such [health] matters as
to the master or the overseer, or face           require attention and trouble.” Own-
the consequences. You risk at least a            ers wished to keep their slave invest-
reprimand if not physical punishment             ments healthy; they tended to see
for your action. All you want to do is           blacks as people unwilling to care for
get relief from illness in your own way.         themselves and their children and
      Then, too, you really prefer the           incapable of doing so.
     Masters, mistresses, and sometimes         attendedoccasionally with extreme
 trusted servants treated ailing slaves in      pain in the ear, jaw and teeth. I
 a hospital or cabin in the slave quar-         wish you to visit her as soon as you
 ters. The quarters actually formed a           can, or prescri6e.
 small village where blacks encountered
 a variety of public health problems.             Physicians used the same approach
 Close contact in the confined space of      for all patients, though with some
 the quarters, especially in winter,         modifications based on whites’ medical
 allowed respiratory diseases to spread      ideas about blacks. The editor of a
 easily. If people followed unsanitary       prominent Richmond medical journal
 waste disposal practices and allowed        openly declared in 1855 that “the
 waste to seep into wells or flow into       African constitution sinks before the
 streams from which drinking water           heavy blows of the ‘                ’
                                                                   heroic school” that
was drawn, parasitic worm and                advocated, like Benjamin Rush, large
intestinal diseases occurred. Children       doses of medicines and treatments
played close to the earth and put dirty      such as bleeding, purgatives, and
fingers that sometimes contained tiny        emetics that depleted the body. Blacks,
parasite eggs into their mouths. Insects     physicians argued, were more suscep-
attracted to decaying garbage and            tible than whites to certain diseases
human waste sometimes passed                 and more resistant to others. Still, the
infections to the humans on whom             power of the humoral system often
they landed. Poorly cooked food              outweighed other considerations for
contained parasites or bacteria that         both physicians and slaveholders.
could infect all who ate it.                 Wrote one master to a physician in
     Not surprisingly, under these           Hanover County:
conditions disease was a major factor
in slave life. When plantation re-
                                                Sir, Boston tooka dose of Salts [a
medies failed, slaveholders, without
                                                laxative] &was Gledonfriday. We
the advice or consent of the enslaved
                                                tooknearly apint; westoped6ecause
patients, turned to physicians:
                                                he complained of 6ein.gfain ty. %e
    iBetty a negro woman ofmine is ve y         safts operated three times that day
    sic/& and I am fearful in a very            e!~ he had not another passage tiff
    dangeroussituation. fiere had6een           [act ntght, which was 6y injection. I
    no appearance of the Menses                 think he is something Getter than
    [menstrualperiod]jor    upwardi   of        usuaf this morning, no fever. He
    three months orpro6a6ly more, tila          wants to eat milk& mush. May he?
   fortnight ago, Since which time it           XL- cough is not so violent nor so
    has continued to flow ve y fargely         frequent.
    In some instances, slaveholders             Herbal practitioners were one thing,
sought the aid of physicians outside        conjurers another. Conjuring origi-
their own communities, practitioners        nated in Africa, where traditional
such as John Peter Mettauer of Prince       medicine and religion were bound
Edward County, whose reputation at          together, and came to America with
curing stubborn ailments traveled by       slavery. In Virginia, conjurers gained
word-of-mouth    across the common-        power among slaves by playing on
wealth:                                    these African traditions and supersti-
                                           tions. They did succeed in curing some
   I haue heard that you have Geen         slaves.
   successful in curing some cases of          If slaves began acting oddly they
   Scrofula [a form of tu6ercufosis]. I    might be judged insane and admitted
   have ta/&z the CiGerty to send my       to the Eastern Lunatic Asylum. There
   man Washington to you in the hupe       Dr. John Minson Galt accepted blacks
   that he may 6e another evidence of      for treatment. Though they received
   your sl$icc. If; after e<amination,     the same sort of “moral-treatment”
   you think that you zuiCl6e a6fe to      approach to insanity as did the white
   releive him, you will please retain     patients, blacks were put to work on
   him as long as necessary. . . . My      much more strenuous tasks and placed
   o6ject is the Genefit ofthe negro.      in less desirable living quarters.

     Though masters frowned upon
them, black practitioners, both slave
and free, were active all over Virginia.
Some were herbalists, such as the man
owned by Robert Carter of Nomini
Hall in Westmoreland County. Wil-
liam Dawson, a neighbor, informed
Carter in 1788: “Some of the negroe
Children is very Sick. (Janey’ young-
est). please to let Bro’ Tom Coachman
come and See it this morning. The
Black people at this place hath more
faith in him as a doctor, than any white
Doctr. and as I wrote you in a former
letter I can not expect you to loan your
mans time &c for nothing But am very
willing to pay for the Same.”
Workers’ Health
     Good health, in the past just as now,   kicks from animals, and cuts from axes
 depended on conditions both at home         or scythe blades were the most com-
and at work. For most antebellum             mon types.
Virginians, black and white, home and             Though most antebellum Virginians
 work were located in the same place-        labored on farms, a number earned
 the farm. Many farm tasks, especially       their livelihoods in other occupations
 during planting and harvest times,          that had their own special dangers to
were tedious, stressful on specific parts    life and limb. They worked, for in-
of the body, and physically exhausting.      stance, on railroad lines, fishing boats,
Sore muscles, strains and sprains, and       and canals, in mines, forests, and
tired bodies were the result. Besides        tobacco factories, and at iron works.
experiencing these routine sorts of          Though not as industrialized     as some
health problems, agricultural workers        of the northern states, Virginia could
found climatic and other external            boast that it manufactured much of the
situations also had an effect on their              s
                                             nation’ tobacco in Richmond and
well-being.                                  Petersburg, produced a good bit of iron
     Farm laborers, most of whom were        at forges in the mountains and at the
slaves, endured the summer heat to a         Tredegar Iron Works in Richmond,
point, but they suffered sunstroke, heat     mined coal both in the mountains and
exhaustion, and dehydration when             near the capital, and obtained shingles,
conditions became excessive. Cold            timber, and turpentine from the Great
weather also took its toll on outdoor        Dismal Swamp south of Norfolk.
agricultural workers, especially on               As with agricultural hands, indus-
blacks, who were more susceptible to         trial workers were exposed to extremes
frostbite and not necessarily provided       of climate. Railroad, canal, and road
with warm clothing or appropriate            workers in particular endured heat, as
coverings for hands and feet. Working        the best seasons for construction co-
with animals put some farm workers at        incided with the hottest months of the
additional risk for diseases recognized      year. Those in tobacco factories were at
only recently: brucellosis (undulant                                       s
                                             least shielded from the sun’ rays and
fever), leptospirosis (mud fever), and       direct heat, though even there the
anthrax. Work in swampy areas                temperatures were often unbearable.
exposed laborers to disease-carrying              The environment of the tobacco
insects, especially to those mosquitoes      factory posed other kinds of health
infected with malarial parasites.            hazards as well, the greatest being lung
     Farm accidents posed another kind       diseases and constant inhalation of
of threat to farm laborers. Falls, over-     tobacco fumes. Tobacco dust irritated
turned carts, runaway wagons, drown-         eyes, causing excessive tearing; a
ings, limbs caught in farm machines,         combination of dust and tobacco juice
 from the leaves also caused rashes on        Though plantation owners, the state,
 the face and backs of hands. The dust        and the private operators of industrial
 liberated during the drying and              concerns usually owned slaves, they
stemming processes contained enough           also hired slave workers during times
 respirable-sized silica particles to cause   of heavy demand or for special tasks
a lung disease, tobacosis, only recently      that required specific skills. Companies
recognized, similar to the black lung         knew that masters were reluctant to
disease of miners.                            send valuable slaves to dangerous jobs
     Each industry exposed workers to         and tried to minimize the risks in their
different types of dangers. The hazards       advertising. Stated one industrialist in
of coal mining included methane               his 1846 newspaper pitch, “[Tlhere is
 (marsh) gas explosions, black lung           no work in which slaves are better
disease (not then recognized), suffoca-       satisfied and contented than coal-
tion from lack of oxygen, drowning in         mining. There have been fewer deaths
flooded mine shafts, and flash fires.                                  s
                                              amongst the Company’ hands from
Falling trees and rocks, steep cliffs, hot    disease or casualties, since its organiza-
furnaces and forges, unsafe equipment,        tion 12 years ago, than will be found in
and nonexistent safety practices              a like number of men any where.”
threatened the lives of laborers at                Slave hiring contracts did not
public works projects, ironworks, and                                       s
                                              always stipulate the lessee’ responsi-
railroad yards.                               bility to provide medical care in case of
     Testimony to the recognized                                             s
                                              sickness and the slaveowner’ respon-
dangers of some occupations are               sibility to reimburse the lessee for
standard slave life insurance policies        doctors’ bills and medicines. Virginia
written in the 1850s. They specifically       custom dictated this to be the practice
exclude coverage for anyone employed          unless otherwise stated, however.
“as an Engineer or Fireman in running              Slaves, no matter what their work,
a Locomotive or Steam Engine, or as an        no matter where their work-farm,
Officer or Brakeman upon a Rail Road,         city, or industrial site-endured    one
or as an Officer, Hand, or Servant on         kind of “occupational hazard” that
any Steam or other Vessel, or Raft, or        white workers missed: whippings and
as a Miner or hand in any Coal or other       beatings. The whip was an integral
Mine, or in the manufacture or trans-         part of slave life in the Old Dominion.
portation of gunpowder.”                      When strong discipline was called for,
     Slaves generally made up a major-        so, very often, was the lash.
ity of the labor force at most farms,                From a medical point of view,
tobacco factories, mining operations,         whipping inflicted cruel and often
iron forges and furnaces, and public          permanent injuries upon its victims.
works projects in antebellum Virginia.        Laying stripes across bare back or

buttocks caused indescribable pain,              tie has GeenGeaten a6out the Head,
especially when each stroke dug                  amu; &San& withSti&        or6ilets
deeper into previously opened                    of Wood, So as to render his arms
wounds. It resulted in multiple lacera-          entirely uselessfor the present. in
tions of the skin, loss of blood, injury to      addition, he has Geen whipt with a
muscles (and internal organs, if the             keen Cow Fhde, SO as to leave
lash reached that deep), and shock. A            Upwards of one tiundred cuts on
wooden paddle, sometimes used                    his Gack& BeLlI which has Grought
instead of the whip, jarred every part           on Fever e+-much InjTamation. . , .
of the body by the violence of the blow          IJive you notice that ~06 shallnot
and raised blisters from repeated                return to your Services that I shaE
strokes. In addition to the possibility of       immediatelySue you in damagesfor
causing death, there was the danger              the improper6eatingandthat IShalT
that muscle damage inflicted by any of           make you Tay for my attention in
these instruments might permanently              curing him and that if he Dies, you
incapacitate or deform a slave.                  needonly elipect such lenity as the
    Doctor Thomas Chrystie of Han-               Law willaaCCowyou.
over, for example, was surprised to see
his slave Bob arrive home in 1811 in              Such corporal punishment was part
mid-year until he took a second look at       of being a slave laborer in antebellum
him. Then he was outraged and said            Virginia.
so in a letter to the man who had hired
Women and Medicine
           Though our discussions of antebel-
        lum Virginia medical life to this uoint
        have puyposely not specified geider
        except when presenting specific

           health concerns differed from those
             of men. Such regular and expected
               events as menstruation, preg-
                 nancy, and childbirth affected
                  women’ daily routines in
                   predictable ways. Gyneco-
                    logical and obstetrical dis-
                    eases and disorders were,
                     of course, not predictable
                      and caused more serious

                  L       Because of the nature
                       of slavery, we have
                       better records about the
                      health of antebellum
                              s black women
                      than of white women.

                        for slaves, but few white
                       women wrote consistently
                     about these personal mat-
                       rs in diaries and letters
                   even to close friends and
                  relatives. Some whites did
                refer to medical guides that
              specifically addressed female
            health concerns, such as Samuel K.
                  s                 s
        Jennings‘ Mnrried lady’ Cornpnim
        (Richmond, 1804) or Lcffers fo Ldics by
        Dr. Thomas Ewe11 of Virginia. Our
        information about Virginia’ white
        women is sketchy, but we can assume
    hat they encountered the same sorts of   tions. One Virginia slaveowner com-
    lbstetrical and gynecological problems   plained to traveler Frederick Law
  as black women.                            Olmsted about such malingering
       Based on plantation records,          women:
  women in pre-Civil War Virginia
  complained more of the pain, discom-           The women on a plantation. . . will
  fort, and disorders associated with            hardly earn their salt, after they
  menstruation than from any other               come to the Greeding age; they don ‘t
  cause. Slaveowners did not usually             come to the field, andyougo to the
  identify illnesses in their farm or            quartersandaskthe oldnurse what 2
  plantation records, but the frequency          the matter, andshe says, bh, she 2
  and regularity with which women of             not we& master; she 2 not fit to
  childbearing age appeared on slave             worli, sir; ’ and what can you do?
 sick lists indicate that menstrual              you have to take herwordforit that
 conditions were the leading complaint.          something or other is the matter
 We learn from such sources as medical           with her, andyou dare not set her to
 journal articles, white correspondence          work andsoshe lays up tillshe feel;
 mentioning slaves, and letters to               f&e ta/&q the air again, andpfays
 physicians requesting medical help              the lady at your e;\lPense.
 that common problems beyond heavy
 flow and severe cramping during                 Bondswomen of childbearing age
 menstruation included amenorrhea            received particular care, as masters
 (lack of menstrual flow), abnormal          encouraged the birth of new slaves.
 bleeding between cycles (sometimes          Plantation management guides recom-
 caused by benign and malignant              mended that “pregnant women. . . be
 tumors), and abnormal discharges            exempted from any but the lightest
 (resulting from such conditions as          labor for several months before and
gonorrhea, tumors, and prolapsed             after confinement.” When women,
uterus). Women also developed                both white and black, were ready to
tumors, cysts, and infections of the         give birth they usually called in
ovaries, uterus, cervix, and other repro-    midwives. Most were inclined to call
ductive organs.                              on physicians only when difficulties
      Slave women were able to use real      arose and lives were threatened. One
and contrived female health com-             Virginia physician estimated that 90
plaints to get time off from work.           percent of black deliveries and half the
Masters found it difficult to separate       white deliveries in the state were
the sick from the women feigning             performed by midwives, most of
illness and so often indulged them           whom were black. Not only did
rather than risk unknown complica-           women usually prefer other women in
     Today physicians perform Caesar-         other thz
ean sections in many cases of difficult       sister-in-
labor. Safe Caesarean deliveries were         some for
not possible in antebellum times,             more sul
however, before the discovery of              Bennett :
anesthesia to eliminate pain, reliable        cannot CI
suturing materials and techniques to          first Caer
stitch up the uterus and other tissues,       States.
and antiseptic techniques to eliminate             Anotl
germs during surgery. Antebellum              tine relai
physicians in the Old Dominion                one true,
reported performing six Caesarean             tauer of 1
operations, almost all of them               credited
unsuccessful in saving both mother            vesico-v;
and baby.                                    between
     A Caesarean section plays a leading     that allot
role in one of the enduring legends of       into the f
Virginia medical history. In the             urethra. I
January 1929 issue of the Virginia           surgery s
Medical Monthly, Dr. Joseph Lyon             Dr. Jarnet
Miller published an article asserting        ery, Alab
that Dr. Jesse Bennett (1769-1842) of        reliable o
Virginia performed the first successful      uncomfoi
Caesarean section in the United States       received I
in 1794 on his wife during a difficult             Thouf
labor. Miller’ evidence came from an         Virginia 1
1891 book on the history of the Ka-          the regul:
nawha Valley, now part of West               did treat i
Virginia. A recent historian of the          and in tht
subject has concluded, however, that         midwives
Bennett was probably not a physician         their freec
at all (there is no evidence that he had     ranks oft
ever studied medicine) but rather a          bleeders E
shopkeeper who sold, among his               wholehea
general supplies, some medicines and         system.   7
did some medical prescribing, blood-         meopathil
letting, and treating in the fifteen years   Conway q
before the arrival of trained physicians     sonian mc
in the Kanawha Valley. No proof exists       Sinclair of
other than the statements of Bennett’  s     free black woman, Jensey Snow of
sister-in-law related to another person      Petersburg, opened a hospital and
some forty years after the fact. Until       served the public for over thirty years.
more substantial corroboration of the
Bennett story surfaces, historians
cannot credit Virginia as the site of the
first Caesarean operation in the United
     Another legend of Virginia medi-
cine relating to women’ health, this
one true, involves Dr. John Peter Met-
tauer of Prince Edward County. He is
credited with successfully repairing
vesico-vaginal fistula, a tear in the wall
between the vagina and the bladder
that allows urine to seep from the latter
into the former rather than into the
urethra. Mettauer performed his
surgery some fifteen years earlier than
Dr. James Marion Sims of Montgom-
ery, Alabama, but never perfected a
reliable operative procedure for this
uncomfortable disorder, so Sims
received the credit.
     Though few if any antebellum
Virginia women entered the ranks of
the regular medical profession, they
did treat and nurse the sick at home
and in the neighborhood and act as
midwives. White women, having
their freedom, could and did join the
ranks of the homeopaths, become
bleeders and cuppers, and adopt
wholeheartedly the Thomsonian
system. They could even go into ho-
meopathic practice such as Margaret
Conway of Fredericksburg or Thom-
sonian medical practice such as Mary E
Sinclair of Alexandria. At least one
           :CAL LIFE IN
      The Medical              Profession
           At the center of medical life in ante-
      bellum Virginia stood the physician.
      Despite competition from self-help
      medical guides, and from “irregular”
      doctors-homeopaths,      Thomsonians,
      hydropaths, and the like-those
      practitioners (known as regulars or
      allopaths) who saw themselves as
      descendants of medical thinkers from
      Hippocrates on were the dominant
      medical force in the state.
          As far as we know, virtually all
      regular practitioners in antebellum
      Virginia were white males. Though a
      small number of women and free
      blacks earned medical degrees at
      medical schools in the North during
      this period, none moved to the Old
      Dominion, nor, it appears, did any
      study at Virginia medical schools (from
      which they were barred) or become
      apprenticed to Virginia physicians.
          Young Virginia men who wished to
      study medicine had several options.
     They could apprentice themselves to
     practitioners for a set term of years and
     learn the art and mystery of medicine
     by watching, reading, and gradually
     doing the things their preceptors did.
     Mentors varied in their teaching
     interests and skills, thus leaving
     apprentices with varying levels of
     preparation for medical practice.
     Apprenticeship     was most popular in
     the early part of the century, though
     even at mid-century when more and
     more students attended medical
     schools, many institutions required
     that students spend one or two years
 studying with a preceptor.                      Some Virginia students went
     Those who could afford to attend       abroad to study medicine, usually to
medical schools had their choice of         Edinburgh in the late eighteenth and
 institutions. The University of Virginia   early nineteenth centuries or to Paris in
 offered medical instruction when it         the 1810s through the 1850s.
 opened its doors in the mid-1820s and           Most scl~ools required two years of
 the Medical Department of Hampden-          attendance at lectures, though the
Sydney College in Richmond (later the       second year was merely a repetition of
 Medical College of Virginia) admitted       the first. Students were expected to
 students continuously from 1838.           obtain experience with patients by
Winchester Medical School operated           working with a medical practitioner in
from 1847 to the start of the Civil War,     the state during the approximately
and John Peter Mettauer maintained          eight months they were not in classes.
 the Prince Edward Medical Institute        They could also observe their profes-
 from 1837 to 1847 and then affiliated it   sors’ demonstrations of medical and
with Randolph-Macon College as that         surgical practices on paying patients or
school’ medical department.                 on indigent patients who came to the
     Many Virginia medical students         medical school clinic or hospital
preferred to leave the state for their      because they could not afford to
training. They matriculated primarily       summon physicians to their homes.
at the University of Pennsylvania and       The quality of medical education
Jefferson Medical College in Philadel-      varied widely across the state and the
phia, though a small number attended        nation, in part, because there was no
schools in New York, Boston, and            central body regulating the curriculum,
Maryland. Fully 30 percent of all pre-      the faculty, and the facilities at medical
Civil War medical graduates of the          schools or among those physicians
University of Pennsylvania and 40           who taught apprentices.
percent of its southern graduates                All schools in Virginia taught
hailed from Virginia. The great draw        anatomy and required dissection of a
at Philadelphia in the early part of        human cadaver, though obtaining
the century was Benjamin Rush.              bodies was often difficult. Because few
Students flocked to sit at the feet of      antebellum Virginians donated their
the Revolutionary War hero and of           loved ones’ remains to medical schools
the other great instructors at the          for dissection, the schools had to resort
University of Pennsylvania. Even after      to covert means of filling the need.
the passing of Rush’ generation, large                                  s
                                            They picked on the state’ voiceless
numbers of Virginia students contin-        residents-the     poor and people of
ued the tradition of studying at the        color.
I’hiladelphia schools.                           Medical students, professors, and

hired graverobbers, also known as              put advertisements in local newspa-
resurrectionists, disinterred bodies           pers, printed business cards or other-
from pauper and black cemeteries in            wise spread the word of their arrival,
Richmond, Norfolk, Petersburg,                 and waited for patients. Competition
Alexandria, Charlottesville, W inches-         could be keen, especially in towns. To
ter, and Prince Edward County.                 ensure incomes some town physicians
Authorities usually ignored these              operated pharmacies, and some rural
illegal but necessary activities unless        physicians operated farms or planta-
an irate citizen filed a complaint. In the     tions and practiced only part-time.
1840s and early 1850s the University of            Physicians interested in exchanging
Virginia had to engage in fierce compe-        information about treatments, talking
tition for bodies with the Medical De-         medicine, or simply meeting and
partment of Hampden-Sydney College             socializing with peers organized city-
in Richmond. John Staige Davis,                or county-wide medical societies. Such
professor of anatomy in Charlottes-            organizations existed in the towns of
ville, called upon former students and         Richmond, Charlottesville, W inchester,
professional acquaintances in                  Petersburg, Fredericksburg, and
Richmond, Norfolk, and Alexandria as           Norfolk and in numerous counties
agents to hire resurrectionists for the        across the commonwealth. Some
university. Only with the signing of an        societies established uniform fees for
agreement in 1851 between Davis and            their members ’ services in answer to
the anatomist at Hampden-Sydney to             competition from irregular practitio-
share the available supply of bodies in        ners or from regular practitioners who
the Richmond-Petersburg area did the           charged patients at lower rates. Medi-
war between the two cease.                     cal societies also took on a political role
      After two years medical students         in attempting to regulate medical
had sat through hours of daily lectures,       practice through licensing laws. The
passed numerous exams (easier in the           Medical Society of Virginia, really a
poorer schools that wanted to attract          Richmond association, tried to secure
students), performed one or two                such regulations several times during
dissections and perhaps some labora-           the antebellum period but failed in the
tory work or written a dissertation,           legislature each time. Virginia physi-
attended surgical demonstrations at            cians were also involved in the Ameri-
public clinics, and followed outside           can Medical Association (AMA)
 preceptors around the countryside.            throughout the 185Os, and proudly
They were finally ready to enter               hosted the 1852 annual meeting in
 practice for themselves. They moved to        Richmond that selected Dr. Beverley R.
 their new homes, hung up their                Wellford of Fredericksburg to serve as
 diplomas inside and shingles outside,         president for the year 1853.

      Most antebellum Virginia physi-
  cians did not get involved with the
  AMA or even with state medical
  societies. They focused their attention
 on their own practices and lives. As
 letters from patients indicate, doctors
 were on call all the time, even when
 they themselves were ill. “As you were
 sick,“ wrote a man living near Han-
 over, “I have been persuading . . . [my
 mother] to send for some other physi-
 cian, but she appears to want no other,
 but you. Should you be well enough, I
 will be very much obliged to you, if
 you’ ride over to see her to day after
 breakfast.” They went out in bad
 weather to see patients who needed
 them, and they sacrificed family life
 and personal pleasures. “Give my love
 to sister S. & all the family,” wrote Dr.
George Watson in 1828, “particularly
 to Sister Dabney, whom, I am very
sorry I shall not see whilst she is down.
But he who is to live by the practice of
physic in these times is without doubt
the greatest slave in the whole commu-
nity. It is literally a strtlggle for life.”
     Doctor Watson may have exagger-
ated a bit, but antebellum Virginia
physicians could count on unexpected
calls in all sorts of weather to see to all
sorts of health problems. Patients
expected physicians to come whenever
summoned but to send bills and
request their settlement only annually.
Citizens of the Old Dominion accorded
their physicians a mixed status in the
                 % beSOLD&    km&Hundred,    cn Friday
                           tbt I#& fi&tht.
                 A NUNbRED      and FIFTY ONE hea&
                    choice SLAVES. -
                                                                          A Prefatory


                                                                1 IiVOCULATORS

     Most diseases that struck antebel-                                  s
                                                         lost on Virginia’ slave traders of the
lum Virginians aroused little attention                  eighteenth century. One advertisement
among the general citizenry or local                     in a 1770 issue of the Virginia Gazette
governments. The mention of small-                       announced a slave sale at Bermuda
pox, yellow fever, or cholera to an                      Hundred and explained that some of
antebellum Virginian, however, would                     the blacks recently had had smallpox
elicit quite a different reaction. An                    but were well now. “We would not for
outbreak or even the threat of an                        any consideration,” it continued, “be
outbreak of any one of these diseases                    instrumental in spreading this infec-
struck fear into the hearts of residents                 tious distemper in the colony; for two
of the Old Dominion and provoked                         of us, and our families, have not had
newspaper editors, city councils,                        the smallpox.” Smallpox was an
normally dormant boards of health,                       alarming disease because of its quick
and individual citizens into frantic                     spread and devastating effects on the
activity. These diseases were among                      population of an area.
the most vicious and fatal of the                            Even in an age when most medical
period, and they always struck in                        theories explained the spread of
epidemic form.                                           disease in terms of bad air, locally poor
     Smallpox was the earliest and most                  atmospheric conditions, and decaying
frequent of the three major epidemic                     organic matter, people recognized that
diseases to plague the Old Dominion.                     smallpox was different. It spread by
At its worst the disease, caused by a                    contact. Beginning in colonial times,
virus, produced confluent or discrete                    residents of areas threatened with an
papules, known as pocks, over the                        outbreak of smallpox acted on this
entire body, destroying skin tissue and                  assumption by establishing hospitals
causing death from blood poisoning.                      known popularly as “pest houses,”
Less virulent forms left permanent                       where victims of the disease could be
scars, such as those on George                           isolated. Tended by immune people
Washington’ face, but did not neces-                     who had recovered from smallpox or
sarily kill patients.                                    who had been inoculated or vaccinated
     A highly contagious disease, small-                 against it, smallpox hospitals were
pox infection spread rapidly and easily                  guarded strictly lest a patient escape,
from one person to another via con-                      or a nonimmune person try to visit, or
taminated air droplets from victims’                     a contaminated object from a patient be
respiratory systems or through infected                  removed. Such pest houses were often
clothing, bedding, and similar objects.                  located in out-of-the-way parts of town
A bout with the disease usually                          or in the country.
conferred immunity from future                               Virginians employed a second,
attacks, a circumstance that was not                     more controversial and potentially
  dangerous means of stopping the             passed by the General Assembly in
  spread of smallpox during the eigh-         1770 restricting inoculation in the
  teenth century: inoculation. This           colony resulted from the incident.
  technique, imported from Asian and              A new and much safer form of
 African cultures and first employed in       smallpox prevention was discovered in
  Boston in 1721, required the presence       England just before the end of the
 of a person with the disease who could       century. In 1798 Edward Jenner, a
 provide some live smallpox matter            country physician, published An
 from a pustule. A small amount of that      Inquiry into the Causes and Effects of the
 matter was then inserted under the           Variolae Vaccinae, a Disease . . . Knozun by
 skin of nonimmune people in hopes of         the Name of the Cozu-Pox, announcing
 passing on a mild case of smallpox          that cowpox, a mild eruptive disease of
 from which they would recover.              cattle, remained localized and benign
 Recovered victims were then immune          when transmitted to humans but also
 to future infections.                       conferred immunity to smallpox upon
     Inoculation was a dangerous proce-      those infected. Benjamin Waterhouse, a
 dure on two counts. First, one could        Boston physician, immediately began
 develop a severe case of smallpox and       promoting the new discovery in the
 die. Second, authorities controlling        United States, even sending informa-
 isolation could allow those inoculated      tion about it to the soon-to-be presi-
 to leave the hospital and return to their   dent, Thomas Jefferson. Jefferson tried
homes too soon, thus starting a small-       out the vaccine matter on his own
pox epidemic in the community with           white and black families during the
tragic results. For this reason many         summer of 1801, pronounced it good,
Virginians remained wary of inocula-         and spread the word throughout the
tion throughout the eighteenth century.      neighborhood and the state. He even
     In 1768 smallpox epidemics erupted      distributed live matter from vaccine
in both Williamsburg and Norfolk             scabs to Richmond, Petersburg, and
because physicians allowed recently          other parts of the state.
inoculated patients to return home too                                    s
                                                 As a result of Jefferson’ efforts,
soon. So outraged were the residents of      vaccination became an accepted
Norfolk at Drs. Archibald Campbell           procedure in Virginia. The state even
and John Dalgleish-who       had insisted    established the position of vaccine
on performing the inoculations at            agent to help disseminate cowpox
Campbell’ house despite the neigh-           matter to physicians. Had people
bors’ objections-that    a mob burned        asked the source of the matter they
the house and forced the removal of          used on their own bodies and those
recovering inoculees to the city pest        whose lives they valued, they would
house during a thunderstorm.       A law     have learned that it came from both

white and black residents.                  with many gradations of severity,
     By the time the first cholera epi-     cholera may kill a person in just a few
demic struck Virginia in 1832, residents    hours or produce only a mild diarrhea.
had dealt with enough outbreaks of          This varying pattern helps to explain
smallpox to have established proce-         the confusion antebellum Virginians
dures for handling contagious diseases.     experienced in identifying and describ-
Isolation of patients, however, either at   ing the disease. It also allowed some
home or at hospitals, as was done with      people to deny they were infected
smallpox, had little effect on the spread   though the evidence seemed to indi-
of cholera, nor did vaccination, or         cate otherwise.
street and house cleaning, or draining           Littleton Waller Tazewell, a re-
of stagnant ponds, though all were          spected Virginia statesman, was an
good public health measures. Cholera        example. He was living in Norfolk
was a new disease with no known             when cholera struck in 1832. Both his
cure. It marched across the eastern and     white and black families escaped
far western portions of the Old Domin-      illness for about two weeks and then
ion in 1832 and attacked the state at       suffered three cases in four days.
least four more times (1834,1849,1854,      Tazewell accepted the doctors’ diagno-
18661, in each instance traveling unpre-    sis of cholera in two of his servants, but
dictably, unhampered by human               he disagreed with the physicians when
efforts to restrict it.                                                s
                                            they called his son John ’ complaints
     Cholera was a disease endemic to       “the ‘  premonitory symptoms ’ of this
parts of Asia that began to spread to       disease.” He believed “that it was a
Western Europe and then to North            simple attack of bilious fever. . . which
America for the first time in the 1820s     would yield to the ordinary treatment.”
and 1830s. People watched helplessly             Why did it matter to Tazewell so
as the malady invaded their home-           much that his son not be diagnosed
lands and killed their neighbors and        with cholera? Because he believed that
their families. W e now know that a         people of high morals, clean living, and
comma-shaped bacterium enters the           religious temperament simply did not
human digestive system with contami-        get cholera. “[Cholera] has been
nated drinking water or with foods          confined very much to the negroes,
taken from or washed in such water.         altho’ a few whites in that class of
This germ releases a toxin into the         society next above the slaves in condi-
small intestine that produces severe        tion have also fallen victims,” Tazewell
diarrhea, sometimes so severe that          remarked. Of the twenty whites who
victims develop dehydration and             had perished to that point in the
chemical imbalance and die of shock         epidemic, he continued, “there has not
and cardiovascular collapse. A disease      been one known to me either by name
or reputation. You may infer from this        from hemorrhage into the stomach and
fact something as to the true character       yellow jaundice are two visible signs of
of the distemper.”                            the disease.
     In truth, cholera did strike                  Yellow fever rarely spread inland
Virginia’ dark-skinned residents at a
          s                                   from the port cities where it struck. In
higher rate than its whites. This             Virginia, Norfolk experienced regular
circumstance resulted from living con-        epidemics during the eighteenth and
ditions, nutritional state, availability of   nineteenth centuries, Alexandria less
clean water, and decreased resistance         so, and Portsmouth even less. Resi-
to disease. During the 1832 epidemic          dents reacted to yellow fever as they
the Norfolk Board of Health concluded         did to cholera, by cleaning streets and
that “the best means of preventing the        homes, restricting sale and consump-
spread and also the fatal termination of      tion of foods considered dangerous,
the disease, is, close and strict attention   and quarantining any vessels sus-
to the condition, habits and health of        pected of harboring yellow fever
the colored population.” In reality, part     patients. None of these activities had
of the motivation for providing pest          any real effect on the disease, though
houses, hospitals, and homes for the          they did raise the general standard of
poor was the hope that these measures         living for the poor whenever yellow
would help keep the disease from              fever threatened. Blacks seemed to
spreading to “respectable” persons and        have a higher tolerance of the yellow
valuable servants.                            fever virus, generally losing a much
     The third major epidemic malady of       smaller percentage of their number
antebellum Virginia was, like small-          and suffering fewer severe symptoms
pox, a disease its residents had experi-      during epidemics than did whites.
enced since colonial times, and, like              Probably the best public health
cholera, a disease whose mode of              measure that could be taken when
transmission was baffling. Yellow             yellow fever threatened was flight,
fever is a tropical disease caused by a       a course only the free portion of the
virus and transmitted by a certain type       population could take at will. Resi-
of mosquito, Aedcs aepypti, that              dents of uninfected areas did not
abounded along the coastal areas of           always welcome Virginians fleeing
Virginia and southern North America.          from yellow fever, cholera, or small-
The virus enters the human blood-             pox, fearing quite naturally that these
stream when the mosquito bites and            people carried the disease with them.
wreaks havoc with the small blood             Even the staff of Eastern Lunatic Asy-
vessels of the body, causing vascular         lum in Williamsburg issued a notice at
congestion, frequent hemorrhages, and         the height of the 1855 yellow fever epi-
destruction of the liver. Black vomit         demic in Tidewater announcing that no

 yellow fever patients would be admit-      many as two-thirds of all the whites
 ted to the hospital.                       who remained in town. Portsmouth
      The worst yellow fever epidemic to    was similarly depleted. Only about
 strike Virginia was this Tidewater        2,000 whites and 2,000 blacks faced the
 outbreak in 1855. It appears to have      epidemic out of a population normally
 been brought by a ship named the Ben       amounting to some 6,500 whites and
Franklin, whose most recent port of call   3,000 blacks. Of these, nearly half of the
 was fever-ravaged St. Thomas in the       former and only 5 percent of the latter
 Virgin Islands. The Norfolk health        died.
officer found no yellow fever among              During the epidemic much of the
the passengers and crew, so he allowed     activity that usually centered around
 them to go ashore but kept the boat in    the marketplace was abandoned in
quarantine just in case it harbored the    favor of the local hospitals, where
effluvia or bad air that was thought at    nursing replaced bartering and small
the time to cause these sorts of dis-      talk. The Howard Association, a
eases. Two weeks later, on 19 June, the    national charitable organization,
captain requested and received permis-     established an infirmary at the old City
sion to take the Ben Franklin to the       Hotel in Norfolk to supplement care
Gosport shipyards near Portsmouth for      provided at the city pest house and the
a much-needed overhaul. On 5 July a        naval hospital at Gosport. Relief goods
worker on the ship took ill and died       and funds poured in from all over the
three days later of what was quickly       country. Physicians and nurses, black
diagnosed as yellow fever. The disease     and white, came from as far away as
spread, killing more workers and then      New Orleans and New York, the
some nearby residents. By mid-July         northerners at great peril because they
yellow fever had infected many in          had not developed any immunity to
Portsmouth and crossed the river to        yellow fever. After the worst of the
attack Norfolk’ citizens as well.          epidemic was over, people helped
Tidewater Virginia’ worst epidemic         distribute food to recovering victims
gained momentum and reached full           trying to get back on their feet.
fury by the end of August. Only with
the frost on 26 October did the epi-
demic finally cease.
     Norfolk’ 1855 population of ap-
proximately 15,000 was reduced to
about 6,000 by flight. Almost 2,000
persons died, according to several
contemporary estimates (no accurate
count was ever made), including as
Sou them
                                         Though the events leading to the
                                      secession of Virginia and other south-
                                     ern states from the Union in 1861 took
                                     place primarily in the political arena, a
To discuss the medical aspects of
                                     few had a medical twist. Southern
the Civil War fully would            physicians, including Virginians,
require a booklet and                developed and argued for a southern
                                     view of medicine that played into the
then some. We must limit     our
                                     secession movement and the justifica-
discussion here to such broad        tion of slavery.
concerns   as the argument   for
                                         Physicians became involved in
                                     sectional discussions to the extent that
southern medical distinctiveness,
                                     they saw medical practice in the South
medical problems on the home         as differing from northern or western
front, and general medical issues    practice. Two key differences between
                                     the South and elsewhere, they argued,
in the military.
                                     were the presence of a large black
                                     population and a warmer, more
                                     tropical climate.
                                         That these two factors necessitated
                                     an alteration in medical practice should
                                     not seem surprising. Though the basic
                                     principles of anatomy, physiology, and
                                     chemistry applied no matter where one
                                    hung out one’ shingle, other aspects of
                                     the medical profession, particularly
                                    diagnosis, treatment, and prognosis,
                                    depended in great part on one’ loca-
                                    tion. Physicians tailored their medical
                                    treatments to the situations of their pa-
                                    tients, always with the goal of restoring
                                    the natural balance within the body.
                                    Weather, season, work, family situation,
                                    location of housing, and atmospheric
                                    influences all affected a person’ health
                                    and the treatments physicians prescribed
                                    to restore it. Race made a difference
                                    too, because blacks were considered
                                    medically different from whites.

    Such views in the 1840s and 1850s                    s
                                             ing Brown’ execution on 2 December.
led inevitably to questions about the        Spurred to action by Virginian Hunter
medical training of southern students        Holmes McGuire, a future president of
in northern medical schools. Southern        the American Medical Association,
writers argued that much of what             some 200 Jefferson and 100 Penn
students learned about the practice of       medical students, southerners all,
medicine had to be revised when they         seceded from the northern schools and
returned home and began seeing               went to Richmond, Charleston, and
southern patients, so why go North at        other southern towns with medical
all when there were ample opportuni-         schools to continue their educations.
ties to study in the South? In the mid-      The Common Council of Richmond ap-
1850s some physicians proposed               propriated $3,555.95 to the Medical
merging the medical schools at the           College of Virginia (MCV) for, as Dean
University of Virginia and the Medical       Levin S. Joynes put it in his report, “the
College of Virginia, partly in the hope      expenses of the Philadelphia stam-
of improving medical education and           pede.” MCV paid the Richmond,
partly to compete with northern              Fredericksburg & Potomac Railroad
schools. According to the editor of          Company $8.50 for each of the 244
the Virgirria Medical ]ourrd, writing        medical students who traveled to
in 1857:                                     Richmond. Of the approximately 140
                                             who stayed to study at the Richmond
    [B]uty and interest alike [have]         school gmtis, fifty-six graduated the
    com6ined to induce the southern                                     s
                                             following March. Virginia’ students
    medical&dent toseekhis education         were finally studying at home.
    andhis el(perience of disease at home,        And then the war came. Suddenly
    a6andoning the pernicious ha6it of       all the discussions about southern
   going a6road in search of superior        medical distinctiveness and the need
    advantafles which do not e&t, or of      for southern medical schools to edu-
    clinical     opportunities      whose    cate southern practitioners lost their
   flattering promises are easily shown      significance. Regardless of where
    to 6e fallacious.                                 s
                                             Virginia’ physicians received their
                                             education or of what they had learned
Times were changing. Two years later         about differences in treatment between
the emigrant students in Philadelphia        North and South, many now learned to
and New York were shocked by John            apply their knowledge on soldiers of
Brown’ bold raid on the federal              the Confederacy.
arsenal at Harpers Ferry in their home
state and were further outraged at the
march Philadelphians staged protest-
                                            i MILITARY          SURGERY,

The Front
     Because so many of the battles of      available had springs, making even a
the Civil War occurred on Virginia soil,    short ride from the front to the field
the state witnessed much of the             hospital a most painful experience for
carnage firsthand. These were still the     the severely wounded.
days before antisepsis, before sophisti-        Once back behind the lines at a field
cated surgery, before antibiotics, before   hospital the wounded soldier received
germ theory, and just after the intro-      a more thorough examination. The regi-
duction of chloroform and ether             mental surgeon, in charge of the field
anesthesia. Death from wound infec-         hospital, worked with the assistant sur-
tion was likely to occur if one did not     geon in caring for the wounded and the
die during or from the surgery. If one      sick from that and previous days. Some-
was able to avoid battlefield injuries,     times, just after major engagements,
there were plenty of diseases in the        the medical staff was overwhelmed by
camps to threaten health. Compound-         the large numbers of wounded men in
ing the difficulties for Virginia and all   desperate need of treatment.
Confederate soldiers and physicians             The surgeons also faced the difficult
were a lack of medical supplies,            task of getting their charges back to the
especially drugs, instruments, and          front as speedily as possible without
such pain killers as opium, chloroform,     jeopardizing their health. As one
or ether, and a shortage of physicians.     private in the Army of Northern
     Soldiers incurred three general        Virginia wrote in his diary, these
types of injuries on the battlefield,       physicians did not always convey a
usually the result of projectiles from      sympathetic impression to the sick and
guns: severe flesh wounds, broken or        wounded:
shattered bones, and wounds to vital
organs. The physicians who accompa-            @ported at the Hospital           this
nied units to the front, called assistant      morning and am now on the sick
surgeons despite their lack of real            list. We receive de ypoor treatment
surgical experience before entering the        at the handr of theSurgeon. He tries
military, could do little in the heat of       to drive us to the front, think&g we
battle other than to apply some first-         are avoiding the dangers of an
aid measures such as splinting, ban-           e;\[pectedft>ht. Andindeedthere are
daging, and ligaturing, do minor               a g-eat many s&lers            in the
surgery, provide comfort and reassur-          Hospital. My complaint is diarrhea,
ance, perhaps offer some whiskey to            andin conjunction with that, I am
kill pain, and transport soldiers back to      quite prostratedfrom       wor&g    at
the field hospital. Ambulances were            thegunsin thefastf&ht. Ourbattey
sorely lacking in the Confederate              ha.5again tai&enposition on the lines.
military, and few of those that were           I am left in the rear, with the sick

      If a soldier’ medical problem                Sally L. Tompkins of Richmond had
 required extra or longterm care and               opened a facility, Robertson Hospital,
 transportation was available, the                 with her own funds shortly after-the
 surgeon might send the man to one of              first battle of Manassas and wished to
 the larger general military hospitals,            continue operating it as a military
 located behind the lines in such cities           hospital despite the new law. A
 along major railroad lines as Staunton,           personal appeal to Jefferson Davis and
 Lynchburg, Charlottesville, or                    a display of the fine record the hospital
 Richmond. Field hospitals were often              had earned in returning men to mili-
 outdoor affairs unless the surgeon was            tary service convinced the Confederate
 able to commandeer a vacant house or              president to keep the hospital in
 find a cooperative homeowner. Gen-                           s
                                                   Tompkins’ hands. He therefore
 eral military hospitals, on the other             appointed her a captain in the army
 hand, were usually housed in build-               assigned to Robertson Hospital at the
 ings and run in stricter fashion than the         corner of Third and Main streets.
 more open battlefield hospitals.                  Tompkins, a group of male surgeons
 Unfortunately,     like the field hospitals       and assistant surgeons, servants (most,
 these larger hospitals often lacked               no doubt, slaves), and a large staff of
 adequate staffing and medical sup-                female assistants cared for over 1,300
plies. The latter deficiency was much in          patients between August 1861 and
evidence later in the war when Union              April 1865.
blockades and a lack of raw materials                   Doctor James B. McCaw, a well-
and manpower in factories prevented               known Richmond physician and MCV
ready renewal of medical stocks.                  faculty member, served as medical
     According to one estimate, fully 60          director and commandant of
percent of all Confederate wounded                            s
                                                  Richmond’ and the Confederacy’      s
were treated at Virginia hospitals, no            largest military hospital, Chimborazo.
doubt because so much of the war was              Built on Chimborazo Hill overlooking
fought on Virginia soil. Richmond                 the capital, the hospital was like a
quickly became a hospital city, the               small city, containing 150 one-story
largest in the Confederacy. Through-              wooden buildings, 100 feet long by 30
out the town, a variety of private                feet wide. Each building held from
buildings-factories,       warehouses,            forty to sixty beds. When needed,
stores, churches, and hotels-served          as   surgeons could assign an additional
havens for sick and wounded troops.               eight to ten patients to each of 100
     Soon after the start of the war the          tents. Chimborazo had five ice houses,
Confederate Congress decided it                   a bathhouse, a sewage disposal system,
needed to appropriate all privately               a bakery, a brewery, a farm to pasture
operated hospitals for military use.              cows and goats for dairy products, and
a boat used to trade cotton, shoes, and
yarn for provisions with people along
the James River and Kanawha Canal. A
self-supporting hospital, Chimborazo
served over 77,000 patients during its
                                                MEDICAL COLLEGE

The Changing               Scene
     While the war was raging through-       groups became resourceful in the face
out Virginia, civilian life continued        of shortages of medicines by trying out
apace around it. People still got sick,     natural remedies in hopes of finding
still needed medicines, still required       substitutes.
medical attention. With almost 800 of            The Civil War did not contribute
the state’ physicians serving the mili-
           s                                 much to medical advancement except
tary medical needs of the Confederacy,       to provide a cohort of young physi-
with a severe shortage of medical           cians-those,    that is, who managed to
stores, instruments, and drugs across        survive injury on the battlefields and
the state and the entire Confederacy,        disease in the military hospitals-with
and with a premium on private hospi-        a lot of surgical and medical experi-
tal beds in most towns, civilian medical    ence. The management of wounds and
life on the home front was not easy.        infections and common diseases
     When white men went off soldier-       during the war remained similar to
ing in 1861, they left vacancies in the     techniques used before. Medicine,
medical care system. White women            however, was changing in Europe at
filled much of that gap and played an       the very time the United States was
even larger role in domestic medical        fighting its civil war. Had American
care than before, especially on planta-     physicians, both northern and south-
tions with numbers of slaves. When the      ern, been able to pay attention to these
battlefield came to them, as it did in      advances, they might have saved more
many parts of both rural and urban          lives. Take the case of a typical Confed-
Virginia, these women also helped           erate surgeon, Hunter Holmes
nurse the injured and sick. Black men       McGuire (183551900) of Virginia, and
and women on farms and plantations          his handling of a typical Civil War
with missing masters also took on           injury in a typical but very important
more tasks involving medical care and       patient, Thomas Jonathan “Stonewall”
even gained a bit more freedom to care      Jackson (1824-1863).
for their own ailments, though the                                     s
                                                 In May 1863 Jackson’ own men
rules on plantations seem to have re-       accidentally shot him during the battle
mained much the same as before the          of Chancellorsville. Wounded in the
war. Some slaves did their part for         right hand and the left shoulder, the
Virginia’ war effort when they were         general had to be placed on a stretcher
hired out to work as nurses and             and carried through rough wooded
attendants at military hospitals. Those     terrain to an ambulance. During this
physicians who did not join the             difficult walk, one of the men fell and
military served their state at home by      dropped his corner of the litter, throw-
taking on the medical care of their         ing Jackson hard to the ground.
absent colleagues’ patients. All of these   McGuire, medical director of Jackson’   s
 unit, met the group on the path and         was fighting his losing battle with
rode in the horse-drawn ambulance            pneumonia and wound infection,
 with the general to the field hospital at   Joseph Lister in Scotland was testing
Wilderness Tavern. He kept his finger        the germ-killing abilities of a thick,
on the bleeding artery above the             tarry chemical called carbolic acid. He
general’ shoulder wound and success-                                    s
                                             had read Louis Pasteur’ recent specu-
fully stanched the bleeding. Whiskey         lations about how microscopic germs
and morphine helped to lessen the            in the air, invisible to the naked eye,
pain somewhat during the uncomfort-          caused infections and wondered if        /                     94
able ride.                                   applying carbolic acid to surgical
      The ball in Jackson’ right hand        wounds, surgical instruments, and
had broken two bones and remained            physicians’ hands would eliminate the
lodged under the skin. The two shoul-        frequent infections that accompanied
der wounds were severe and appeared          compound fractures and surgery.
to require amputation of the left arm.              s
                                             Lister’ experiments with antiseptic
Before administering chloroform              techniques, performed in 1865, proved
McGuire received Jackson’ permission         that wound infections could be
to amputate if necessary. He removed         prevented by cleansing. He published
the ball from the general’ right hand        the results in 1867, too late for Stone-
and amputated the left arm very              wall Jackson and all the others who
rapidly, as he described it, “and with       had died of wound and surgical
slight loss of blood, the ordinary           infection during the Civil War, but in
circular operation having been made.”        time to save many other Virginians if
Other than some pain in the right side,      only they believed him. The era of
Jackson seemed to be recovering well         modern medicine was beginning.
during the next few days. On the
fourth day after surgery, however, he
complained again of great pain in his
right side. McGuire’ examination
revealed “pleuro-pneumonia,”        which
was treated, as was the custom, with
cupping, mercury, antimony and
opium, and a blister. His treatments
continued for a few more days but
failed to cure his patient. Infection, in
those days before antisepsis, took
Stonewall Jackson’ and many another
Virginia soldier’ life.                                                                         I' ,'   ,   ,
     At about the same time that Jackson                                                  ,,m

     conservative physicians to absorb and
     accept them. Virginians were no
     exception. In response to a speech on
     the utility of antiseptic surgery pre-
     sented at the September 1884 Medical
     Society of Virginia meeting in Rawley
     Springs, for example, Dr. Hunter H.
     McGuire remarked that Virginia
     country doctors did not need to con-
     cern themselves about antiseptic tech-
     nique. “It is generally unnecessary,“ a
     fellow physician paraphrased McGuire
     as saying, because “the pure country
     air in Virginia [was] in itself aseptic.”
          Even when they were accepted,
     most of the innovations actually
     affected the treatment of diseases
     very little, though physicians could
     diagnose and prognosticate better than
     ever. Clinicians had given up the
     heroic doses of depletive drugs so
     characteristic of early nineteenth-
     century medicine in favor of lesser
     doses of tonics, stimulants, fortifiers,
     and relaxants. Bleeding was still used
     for certain specific problems, and
     such drugs as digitalis, opium and its
     derivatives, quinine, mercury, and
     the newly discovered salicylate
     preparations (now known as aspirin)
     had their defined uses. For the most
     part, however, treatments were still
     aimed at relieving symptoms rather
      than at curing diseases. Therapeutics
      would not catch up with diagnosis
     until the discovery of sulfa drugs and
      penicillin in the middle decades of
      the twentieth century.
          The new knowledge allowed
   Hampton          Training   School   I

              For     Nurses

physicians to specialize their practices     ion and throughout the United States.
if they lived in population centers that               s
                                             St. Luke’ Training School opened in
afforded them a sufficient patient load.                      s
                                             1886 at St. Luke’ Hospital in
Some Virginia doctors began limiting         Richmond to educate future nurses in
their practices to, for example, eye, ear,   the new medicine. Hampton Training
nose, and throat (EENT), surgery,            School for Nurses began operation at
obstetrics and gynecology, and neurol-       Dixie Hospital in Hampton in 1891 as
ogy, while others decried this trend,        the first and only facility for the
saying it spelled the end of the family      education of black nurses. Students at
physician. Doctors, they said, now                     s
                                             St. Luke’ still studied blistering,
treated cases of disease rather than         cupping, and leeching, along with
diseased people.                             anatomy, physiology, and other
     As medicine became more scientific,     modern scientific subjects.
and as new, more complex tests and                          s
                                                 The state’ medical schools had to
procedures were introduced, the locus        keep pace with advancements in
of practice began to shift from the          medicine, too. If students were not
        s                        s
patient’ home to the physician’ office       well enough trained they would not
or the hospital. It was much easier to       pass the increasingly stringent medical
perform surgery aseptically in the           licensing exams in states where they
controlled environment of an office or       wished to practice. The University of
operating room than on a patient’  s         Virginia Medical Department, the
kitchen or dining room table. Blood          Medical College of Virginia, and, after
and laboratory tests could also be done      1893, the University College of Medi-
as needed and the patient’ condition
                           s                 cine, a private school in Richmond,
better monitored during recovery. The        competed for students and status. By
number of hospitals in Virginia’ cities      1913 the two Richmond schools had
grew rapidly toward the end of the           merged, and the state was left with two
century as more physicians used them         strong, publicly owned medical
for surgery and diagnostic procedures.       schools, U.Va. and MCV.
The function of hospitals as places for                  s
                                                 Virginia’ medical profession
the medical care of the poor began to        changed with the times as well. The
change as the middle and upper classes       Medical Society of Virginia, re-estab-
were admitted for more sophisticated         lished in 1870 after its dissolution in
and complex procedures.                      1859, began meeting annually in
    The need for skilled assistants and      various cities across the Old Dominion.
for improved, knowledgeable patient          One of its major objectives was the
care in hospitals spurred the profes-        enactment of a medical licensure law
sionalization of nursing in the late         that included establishment of a board
nineteenth century in the Old Domin-         of medical examiners. It took fourteen
                                             103                                   104

years for such a bill to pass the legisla-       Local physicians did provide some
ture, but in 1884 Virginia finally had       free care to blacks or accept payment in
its first medical licensing regulation.      kind as they did for their white pa-
     Regulars still felt keenly the compe-   tients. Some labor contracts between
tition from irregulars, including            white employers and black workers
homeopaths, remnants of botanic              included provision for medical care,
healers, and new groups such as chiro-       though often medical charges were
practors and osteopaths, spinal mani-        deducted from the annual wage.
pulators from the Midwest. Patients          Sometimes city or county governments
continued to try home treatments,            provided medical care for indigent
patent medicines, and quack devices.         blacks either in almshouse hospitals
     Significantly absent from our dis-      or by hiring physicians.
cussions of late nineteenth-century              After the Civil War African-Ameri-
medicine to this point have been             cans did not rely solely on whites to
blacks. As slaves, African-Americans         provide for them medically. The sub
received at least a modicum of med-          rosa medical system of neighbors
ical care from their owners, overseers,      helping neighbors, of local herbalists
and hirers. As free people, however,         and midwives, and of conjurers still
they were on their own. Few had              existed. Both MCV and U.Va. refused
enough money to pay physicians for           to admit black students to their class-
needed medical care, so most did             rooms despite the tax support both
without it until emergencies arose. One      received from black and white citizens.
Richmond physician, David Shelton            Howard University Medical Depart-
Watson, wrote in January 1867 about          ment in Washington, D.C., Leonard
blacks in the area:                          Medical School of Shaw University in
                                             Raleigh, North Carolina, and Meharry
                                             Medical College in Nashville, Tennes-
     Of the dirty odd thousand cobred        see, all trained a number of black
     people in and around !&chrtwnd Z
                                             Virginia physicians.
     ampro6a6ly over the markinsaying            These doctors usually returned to
     that not even onefourth now receive
                                             the Old Dominion and practiced
     necessary Medicaf Attention, and
                                             among the black population. Excluded
     pro6a64 not one hacfof these have       from membership in the Medical
     the a6ibity topay thesmafktfees tf
                                             Society of Virginia, black physicians
     sickfor any length of time. ?liose
                                             formed a state-wide medical society
     who are a61e (from the wages they       that met regularly at the turn of the
     receive) to pay, now waste their
                                             twentieth century. (The Medical
     money in quack medicines, or are
                                             Society of Virginia admitted its first
     defrauded6y impostors.
                                             woman physician in 1895 and passed a

 rule admitting women equally with                  transitional physician was James
 men in 1897.) Virginia’ black physi-               Edward Copeland of Round Hill,
 cians and black patients had to cope               Loudoun County.
 with medical life in an era of increasing              Born in 1845 in Hillsborough,
 segregation and of mounting racism.                Copeland served with the Virginia
 They also faced, with their white                  cavalry during the closing days of the
 neighbors, an increasingly complex                 Civil War and remained a staunch
 medical world as the twentieth                     advocate and apologist of the southern
 century dawned.                                    cause throughout his life. After receiv-
     Science was not the only force                 ing his degree from Baltimore’   s
behind the changing face of medicine                Washington University School of
in late nineteenth-century   Virginia and           Medicine in 1876, he opened a practice
America. Technology had a profound                  in Rectortown, Fauquier County. By
 effect on the way doctors practiced                1890 Copeland had moved to Round
their profession and consequently on                Hill and remained there until his death
the relationship of doctors and pa-                 in 1937 at age ninety-one.
tients. Telephones allowed physicians                   This country doctor kept up with
instantly to discuss medical matters                new concepts in medicine by subscrib-
with patients and their families. The               ing to and reading professional medi-
automobile made it possible for the                 cal journals, but he applied what he
physician to meet with these people                 read with extreme circumspection.
more quickly and easily. Patients could             Typical of his reluctance to change in
now reach their doctors shortly after a             the face of the new medicine was his
medical situation arose and get advice              strong advocacy of bloodletting in
or care. House calls in horse and buggy             certain situations. In justifying its use
were not as efficient as in an automo-              for patients with acute pleurisy or
bile, unless the roads were impassable,             acute pneumonia, the Round Hill
something that could easily happen in               physician concluded, “How bleeding
rural Virginia. Physicians could live               affects the diplococcus of pneumonia
in town, enjoy the company of other                 [the bacterium that causes pneumonia],
physicians, share new ideas and                     we leave the pathologist to determine.”
methods of treatment at medical                         Copeland owned several pairs of
society meetings, and still see their               medical saddlebags containing bottles
rural patients in good time.                        and boxes of the usual medicines of the
     Some doctors managed to retain                 period. According to his daybooks, he
portions of the old medicine in their               drove out in his buggy in all sorts of
practice of the new, or perhaps they                weather and in all states of health: “I
integrated new medicine into their                  had no fever this A.M. but felt very
more traditional approach. One such                 weak and have some cough, and back
of neck (as grippe) pains. Did not                  E BEGAN   THIS ESSAY
go out until afternoon, and drove
around town only.” He saw ten
                                                How woufdyou respond to a
patients that day.
                                                physician 2 recommendation fir
     Copeland also owned a variety of
                                                6Coodlettin.g ffyou were sic@
plasters-strips     of gauze treated with
substances such as mustard to raise a            We suspect this booklet has not
blister or belladonna to cure intestinal     changed your mind and that your
upsets-and      at least four electrother-   answer remains a heartfelt “no!” We
apy machines. These latter were              hope, however, that you understand
popular among physicians and consid-         better why Virginians of European
ered a good form of treatment. The           descent, until the present century at
machines relieved physical discomfort        least, often said yes and meant it, why
by sending an electric charge through                s
                                             Virginia’ Native Americans would
all or part of a patient’ body.              have said no, and why Virginia’ s
     Copeland was considered an              African-Americans     might have been
excellent doctor both by his colleagues,     divided on the question.
who elected him president of the                 A medical exchange took place in
North East Virginia Medical Society in       Virginia when three cultures met.
1887 and vice-president of the Medical       Each group had its own medical
Society of Virginia in 1900, and by his      customs and healing practices, some of
patients, whom he served faithfully          which influenced the behavior of the
throughout his career. The contrast          other groups. Sometimes specific
between his persistent use of bloodlet-      practices disappeared, but always the
ting and his enlightened actions             approaches used fit with each group’  s
during a smallpox epidemic, when he          view of the world. They worked for its
took all the proper public health            members, though they seemed strange,
measures to prevent spread of the            even useless or dangerous, to outsid-
disease, illustrates the changing            ers. Who knows? We may find
medical times. Copeland resisted             ourselves judged harshly one hundred
many innovations in medical theory           years from now. Some of our current
and practice, but when convinced of          medical practices may appear odd, if
the necessity and convenience of new         not downright harmful, to future
procedures, he integrated them into          Virginians. It is easy but not always
his treatments. He represents well the       appropriate to judge the past through
state of medicine in the Old Dominion        the eyes of the present.
at the turn of the century, the dawn of
modern medicine.