Medicine in Virginia, 1607-1699

Chapter One

European Background and Indian Counterpart to Virginia Medicine

EUROPEAN BACKGROUND

The origins of medical theory and practice in this nation extend further than the settlement at Jamestown in 1607. Jamestown was a seed carried from the Old World and planted in the New; medicine was one of the European characteristics transmitted with the seed across the Atlantic. In the process of transmission changes took place, and in the New World medicine adapted itself to some circumstances unknown to Europe; but the contact with European developments in theory and practice was never--and is not--broken.

Because of this relationship between European and American medicine, an acquaintance with seventeenth-century European medicine makes it possible to give additional support to some of the information in the early sources about medicine in colonial Virginia. In addition, knowledge of the European background allows reasonable speculation as to what happened in Virginia when the early sources are silent.

In discussing the background for American medicine it is not necessary to make a firm distinction between England and the rest of Europe. As today, science--in this case, medical science--frequently ignored national boundaries. The same theories relative to the structure of the body (anatomy), to the functions of the organs and parts of the body (physiology), and to other branches of medical science were common to England and Europe. Medical practice, like theory, varied but in detail from nation to nation in Western Europe.

Seventeenth-century Europe relied heavily upon ancient authority in the realm of medical theory. The European and colonial Virginia physician, surgeon, and even barber (when functioning as a medical man) consciously or unconsciously drew upon, or practiced according to, theories originated or developed by Hippocrates (460-377 B.C.) and Galen (131-201 A.D.). Hippocrates is remembered not only for his emphasis upon ethical practices but also for his inquiring and scientific spirit, and Galen as the founder of experimental physiology and as the formulator of ingenious medical theories. Most often Hippocrates was studied in Galen's commentaries.

No longer do scholars or physicians scoff at the ancient authorities who dominated medical thinking for so many centuries. The seventeenth-century physician striving to reduce the frightful inroads that disease made into the colony at Jamestown may have been handicapped by the erroneous doctrines of the gossamer-fine a priori speculation of Galen, but the physicians to a large extent practiced according to a science rather than to superstition and magic--because the voluminous writings of Galen survived the centuries. Nor would the European physician, or his Virginia counterpart, have demonstrated the same appreciation for close observation if Hippocrates had not still been an influence.

In the realm of pathology (the nature, causes, and manifestations of disease) the humoral theory, with its many variations, was extremely popular. The humoral doctrines stemming largely from Hippocrates were made elaborate by Galen but were founded upon ideas even more ancient than either thinker and practitioner. As understood by the seventeenth-century man of medicine, the basic ideas of the humoral theory were the four elements, the four qualities, and the four humors. The elements were fire, air, earth, and water; the four qualities were hot, cold, moist, and dry; and the four humors were phlegm, black bile, yellow bile, and blood. From these ideological building stones a highly complex system of pathology developed; from it an involved system of treatment originated. In essence the practitioner of the humoral school attempted to restore the naturally harmonious balance of elements, qualities, and humors that had broken down and caused disease or pain.

The seventeenth-century, however, witnessed in medicine the trend, manifest then in so many fields of thought, away from an uncritical acceptance of the authority of the past. It also saw a defiant denial of ancient authority among those more radically inclined, such as the disciples of the sixteenth-century alchemist and physician, Paracelsus. Although some of his practices and teachings were based on the supernatural, Paracelsus stressed observation and the avoidance of a mere system of book-learning.

Practice lagged behind new scientific theory in medicine but Virginia must have felt at least the reverberations caused by the clash of the ancient and the new.

An important new school of medical theory was the iatrophysical or iatromathematical (iatros from the Greek--physician). This medical theory--as is the case with many scientific theories-was borrowed from another branch of science. The seventeenth century, the age of Isaac Newton, Galileo Galilei, Gottfried Wilhelm von Leibnitz, René Descartes, and other giants of physical science, was a period of remarkable progress in the field of physics. It is not surprising then that theorists in the field of medicine, noting the truths discovered by conceiving of nature as a great machine functioning according to laws that could be expressed in mathematical terms, should have attempted to explain the human body as a machine.

William Harvey (1578-1657), whose name looms great in the history of seventeenth-century medicine, explained the circulation of the blood in mechanical terminology. To Harvey, working under the influence of the great physicists, the heart was a mechanical force pump and the blood was analogous to other fluids in motion. How many physicians, practicing in the same intellectual environment as this Englishman, must have carried the mechanical analogy to the extent of thinking of the teeth as scissors, the lungs as bellows, the stomach as a flask, and the viscera as a sieve?

The iatrochemical school existed alongside the iatrophysical. Whereas the iatrophysical thought primarily in terms of matter, forces, and motions, the iatrochemical thought chemical relationships were fundamental. One of the founders of this school, the Dutch scientist Sylvius (1614-72), explained diseases chemically (an approach not completely unlike the humoral of Galen) and treated them on the basis of a supposed chemical reaction between drug and disease. Another leading figure in the iatrochemical school, Thomas Willis (1621-75), was an Englishman. These two advocated the use of drugs at a time when their respective nations were developing great colonial empires rich with the raw materials of pharmacology.

However, it would be an error to think of the medicine of the period, either European or Virginian, only in terms of rational or scientific theories. Treatment was too often based on magic, folklore, and superstition. There were physicians relying upon alchemy and astrology; the Royal Touch was held efficacious; and in the materia medica of the period were such substances as foxes' lungs, oils of wolves, and Irish whiskey. Nor should it be forgotten that many of the sick never saw a medical man but relied upon self-treatment.

With theories from the ancient authorities and from experimenting scientists to draw upon, the practicing physicians could deduce therapeutic techniques or justify curative measures, but the emphasis on theory brought with it the danger of ignoring experience and abandoning empirical solutions. Aware that many of his fellow physicians tended to overemphasize theory Thomas Sydenham (1624-89), who received his doctorate of medicine from Cambridge University, recommended personal experience drawn from close observation. He scoffed at physicians who learned medicine in books or laboratory, and never at the bedside. His study of epidemics, his emphasis on geography and climate as casual factors in the genesis of disease, make this Englishman's views and practices especially relevant to the medical history of Virginia where geography and climate did play such important roles in the life of the colony.

The history of surgeons and surgery during the century is less distinguished than that of the physician and his practice. Surgery produced no individuals of the stature and significance of Sydenham nor any revolutionary theories as important as Harvey's. Dissections were made but the knowledge acquired was not applied; amputation was common but not always necessary or effective.

Battle wounds and injuries lay in the province of the surgeon. While the surgeon was primarily concerned with the military, using mechanical force (cutting, tying, setting, and puncturing) in his treatment of body wounds and injuries, physicians on the Continent and in England also filled these functions. For example, physicians in Italy sometimes performed surgical operations they considered worthy of their dignified positions, and in England the licensed physician could practice surgery. On the other hand, surgeons licensed by Oxford University were bound not to practice medicine. Both in France and in England surgeons and barbers held membership in the same guild or corporation, and physicians considered them of inferior social status. The American frontier tended to reduce such professional and social distinctions.

In Europe and England, where medical education was institutionalized to a far greater extent than in colonial Virginia, education explains much of the difference in social status between physician and surgeon. The surgeon learned by apprenticeship to an experienced member of his guild while the physician had to meet certain educational and professional requirements, depending upon local or national law. The best medical education of the period could be had at the great centers of Leyden, Paris, and Montpellier. Cambridge and Oxford also offered a degree in medicine.

Englishmen preferred to study medicine abroad--according to a recent study made by Phyllis Allen and printed in the Journal of the History of Medicine and Allied Sciences--because a better education could be obtained there in the same number of years. The Doctorate of Medicine required fourteen years of undergraduate and post-graduate study at Oxford; the Cambridge requirement was similar. Despite reforms during the seventeenth century, education at these universities remained dogmatic and classical. Students usually found their studies dull and their social life stimulating. The more enterprising students could find the new ideas of the period in books not required in their course of study. Cambridge, Oxford, and the Royal College of Physicians all licensed physicians who had survived their education, met certain professional requirements, and passed an examination.

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