Let us return to the hypothetical situation with which this essay began. It is 1840, and you wake up feeling sick. What do you do? What are your options? Assume for now that you are a white adult and that you live, like the majority of white Virginians, with your spouse and four children on your small farm some fifteen or twenty miles from the county seat.
You are not entirely certain what causes disease, but you accept the idea that the environment in which you live, your diet, activities, emotional state, and developmental events such as puberty all affect your body's natural balance and therefore your health. You think about and describe sicknesses in terms of symptoms -- diarrhea, continued fever, ague -- and classify your remedies by their actions on the body -- cathartics for defecation, emetics for vomiting, anodynes to relieve pain, diuretics to induce urination. Your goal in treatment is to restore the natural balance of the body with its environment by adjusting your diet and activities and by taking medicines that promote recovery of that balance.
How did antebellum white Virginians care for their ailments within that basic medical framework? Like their colonial predecessors, they turned first to self-help. Medical recipes copied or pasted into diaries and commonplace books or remembered from previous illnesses served as the first line of defense. Patent medicines and some of the ingredients in homemade cures could be purchased from drug suppliers and stored in the family's medicine chest, while others were natural botanics that people could gather at appropriate times of the year and prepare as needed. Virginians grew their favorite herbs as well, both for medicines and seasonings.
Richmond resident and United States Chief Justice John Marshall suggested the use of a natural remedy to his son Edward in 1821: "I am very sorry to hear that you are afflicted with sore eyes. Your mother recommends it to you to get the small twigs of sassafras which have young pith, to strip off the outer bark & then split the twigs & cut them into tolerably short pieces & put them in a cup of water & stand there an hour or so when the water will become a jelly. Bathe your eyes in this jelly & [she] thinks it will be of great service."
In addition to medicines, white antebellum Virginians also owned certain implements they believed had medical value. Most had bloodletting instruments. George Washington and other Virginians used Perkins's Metallic Tractors. Interest in applying electricity to cure health problems persisted well beyond the life of Perkins's Tractors. A few decades into the nineteenth century the state's newspapers contained advertisements that often invoked the phrase "medical galvanism" to promote such things as "Dr. Christie's Galvanic Rings, Bands, Belts, Bracelets and Magnetic Fluid." More than one Virginia household owned a "Magneto-Electric Machine."
Not many households had madstones, however. These medical objects had nothing to do with electricity. They were harder to obtain because they derived, it was said, from small concretions in the intestines of cows and certain other herbivorous animals. Madstones, generally no more than an inch or two in any dimension, were applied to cure rabies and dangerous snakebites. They adhered to a wound for several hours and supposedly drew out the poisons from the body. When the stone fell off the leg, arm, or other part of the body it was soaked thoroughly in milk or some other alkaline substance to remove the poison to make the stone ready for the next person to use. Madstone owners generally shared them (for a fee) with neighbors.
For those who could afford it, the healing waters of western Virginia's world famous medicinal springs beckoned -- Warm Springs, Hot Springs, White Sulphur Springs, and Sweet Springs. Some people went to the resorts primarily for social reasons, to see and be seen; but others took the waters regularly to maintain health or went specifically to treat a troublesome ailment. R. E. Lee stated the prevailing view of the value of taking the waters in an 1838 letter to a cousin: "I am delighted to hear that Mrs. L. has gone to the Va. Springs and I anticipate from the trip the greatest benefit. I have lost a good deal of confidence in Drs. & medicine for any protracted sickness, and believe that an excursion to some healthy and interesting region will do more to renovate and invigorate the system and enable it to throw off any general or even local disease than any thing else in the world."
Taking advantage of people's normal desire to care for their own health problems, and continuing a tradition begun in England, a number of physicians on both sides of the Atlantic and on both sides of the Mason and Dixon line wrote domestic medical guides. Because the commonly held medical beliefs of the time correlated local environment and life-style with health, most of these books had regional circulation near the homes of the writers. James Ewell of Savannah, Georgia, for example, published a popular book, The Planter's and Mariner's Companion, in 1807 that discussed "the diseases common to warm climates."
In their attempt to appeal to a rural audience, the authors of these domestic medical guides included as much information as possible. Doctor Thomas Ewell of Virginia, who was "formerly Surgeon of the Navy Yards at New York and City of Washington," packed into his 1824 book, The American Family Physician, discussions of medical care "from infancy to old age," instructions for birthing women "and the diseases peculiar to the sex," and an appendix with "Hints respecting the Treatment of Domestic Animals, and The Best Means Of Preserving Fish And Meat." In the Valley of Virginia, Dr. Ralph Schenck of Botetourt County ("formerly of New Jersey") published The Family Physician in 1842. It covered not only "Diseases which assail the human system at different periods of life" but also chemistry, anatomy, physiology, and materia medica.
Virtually every antebellum domestic medical guide contained instructions for performing one of the most common and popular procedures of the time, bloodletting. Doctor James Ewell, author of one of the home medical guides, believed that everyone should know how to let blood, "since cases of emergency may happen, when the necessity of its being performed is evident, and where life may be lost before medical assistance can be obtained." Though the procedure goes back to ancient Greece and earlier, Philadelphia physician and signer of the Declaration of Independence Dr. Benjamin Rush was largely responsible for its continued popularity in nineteenth-century America. Rush, a student of William Cullen at the University of Edinburgh, maintained that hypertension or excess blood causing pressure in the circulatory system was the root of most ailments and that bleeding would effectively ease the problem. His ideas, expressed in books, essays, and lectures at the first medical school in the United States (what became the University of Pennsylvania) received wide distribution and acceptance.
There were four ways to let blood, only three of which actually resulted in the removal of blood from the body. These methods were known as venesection, wet cupping, dry cupping, and leeching.
Venesection --cutting into a vein -- was usually done on the same arm vein where blood is taken today for bloodbank donations. The operator took a small, sharp knife known as a lances and incised the vein, taking care not to sever it and nick the pulsating artery beneath it. Blood flowed from the wound into a strategically placed bowl. Pressure applied to the incision stopped the bleeding when an appropriate amount had been removed.
Wet cupping was more complex. It required use of a scarifier or scarificator, a cube-shaped instrument three or four inches in every dimension. Inside the scarifier were six to thirty-two (and sometimes more) tiny blades attached to axles that rotated when a spring was released. The scarifier was placed on the chest, back, leg, or temple. When the spring was released, the rotating blades passed rapidly through openings in the casing and then back inside the instrument. For the instant they were exposed to the outside, the blades made multiple incisions in the skin under the scarifier, causing blood to flow. At that moment a glass cup that 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 counter-irritation.
Leeching seems the least pleasant technique because a living animal sucked the patient's 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's Family Physician or purchase them from suppliers who advertised regularly in the newspapers or from a local apothecary 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.
Simple, but not always easy to do. Some people preferred to have someone else perform the bloodletting, so they turned to "leechers and cuppers"who usually lived in Virginia's larger towns. "Mrs. Woolhouse offers her services to the Medical Faculty and the Ladies of Richmond, as Leecher and Cupper, and trusts by assiduous attention to merit their kind patronage," advertised one such person in the Richmond Dispatch in 1855.
When home treatments failed and the patient's condition worsened, it was time to call the physician. For rural Virginians this meant addressing a brief note to the doctor laying out the situation and all previous treatments, sending someone to the physician with the note, and either waiting for the doctor to write a response or escorting him back to the farm. If the messenger found the physician immediately, the process might take a few hours. If he was out on a call, it took much longer. "My Daughter Lucy has been extremely sick for three weeks of a constant fever," wrote William Fleming Gaines to Dr. Thomas Chrystie in 1805, "at the beginning common medicines were used to make way for the bark both of which have proved too weak for the enemy, for the fever continues accompanied with a sick stomach & depression of spirits. . . I depend on your goodness & friendship in riding up as soon as you can this morning to her relief."
Because physicians and patients shared a common approach to and understanding of medicine, both felt comfortable making patient-care decisions by exchanging notes when necessary. "For the first time we have the hooping cough in our family, and I don't know what to do with it," wrote the same planter four years later. "I send to you for advice. Be particular, if you please, as to diet, drink, exercise &c.... P.S. My stock of medicine is made up of Jalap, Rhubarb, Calomel, & ipecacuanha, so that you will have the goodness to supply whatever you may think wanting."
The term physician derives from the Creek word for nature. When the doctor entered a home he tried to help nature restore the body's normal balance. Physicians, as experts in natural diseases, used medicines to induce or assist "the healing power of nature." Alterations in discharges from body openings, in the blood removed during bloodletting, or in the skin showed that the prescribed regimen was working.
Sometimes, perhaps often, the regimen did not work, and the patient became sicker or even died. Then, as now, physicians could offer no guarantees that their services would indeed result in a cure. Patients might then move on to other healers or treatments, though they were still expected to pay the doctor.
Not all antebellum Virginians could afford care by a physician. The poor generally received medical treatment as part of the care counties provided all indigent residents. Since colonial days, Virginians supported those poor in their parish or county who were too sick, handicapped, mentally incompetent, young, or old to care for themselves. Sometimes officials paid a neighbor or friend to keep one or two such people. Many counties later bull poorhouses where the indigent and incapacitated could live. Children were often apprenticed to a craftsman or a household to learn an appropriate trade and gain an education. In all these situations the community paid for medical care as well. Regardless of their economic status, people preferred to care for their own ailments first, but the poor did not always have that freedom if they were wards of the county.
Other Virginians who had little control over the medical care they received were the insane. Most families cared for lunatics in their homes though not always under the best of circumstances. Because the "mentally deranged" did not respond as did other Virginians and could not communicate well, all too often their families and friends assumed they needed no heat, fresh air, good food, or companionship. Families did call in physicians in some cases of insanity, thinking that medicines might restore balance within the body and thus improve the patient's mental status.
If an insane person began to threaten the family or became uncontrollable or a wanderer, the family could turn him or her over to local authorities for confinement in the jail or poorhouse. Care there might be even worse than at home. One visitor to the Frederick County prison during the summer of 1841, for example found eight lunatics living in a small, dirty, unventilated portion of the building:
A third apartment which opened into a narrow passage, was if possible still more revolting than either of the former, not because it appeared more uncomfortable or cheerless. . . but because it was the abode of FIVE insane females, three of whom were white and two black; one of each color was chained in opposite corners of the room, whilst the remaining three were permitted during the day to exercise or labour in the adjoining passage.
Virginia supported two state institutions for the insane, one in Williamsburg and one in Staunton. They were called asylums because they provided a refuge from the harshness of the outside world and sometimes even an opportunity to recover one's senses and return to everyday living at home. Local authorities sent men and women declared legally insane to these institutions in hopes of curing them. Both the Eastern and Western Lunatic Asylums emphasized "moral treatment," a new approach to patient care that originated in Europe in the late eighteenth century. Patients were treated with respect and dignity but followed regular routines established by the physicians and their staffs and completed tasks that fit with their conditions and abilities. Eastern Asylum in Williamsburg, founded in 1773 and the oldest state supported mental institution 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.
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