Preventive medicine in the Golden Age

[Daniel]

Mission, or anyone who can chime in, were there popular quack medicines or magic charms (or possibly even something that worked?) that were popular by 1714 for preventing the scourges of the age like smallpox, yellow fever, typhus, gangrene, tetanus/lockjaw, etc.? I see no reference to the smallpox inoculation being used in America before 1721, but if I know anything about human psychology, I would guess something was used before then, even if it was completely ineffective, just to reduce the sheer anxiety of getting the disease.

[Elena]

camphor balls were used (yes, it is a resine and it can be got in balls which are worn at the neck... as a sort of charm protecting against epidemies. Other charm I heard about was a rabbit leg, for example...

[Mission]

You're correct about inoculation. Smallpox was the first inoculation understood and it was only done on a very small scale in the beginning. (And had a higher mortality rate than 'dead' strains of the virus, so there was much debate about it for quite some time.) Most (if any) sailors would not have had access to that.

I haven't really focused on this aspect of medicine, but I can tell you that there were scads of things - charms, specifics, patent medicines and so forth. Somewhere out there is an entire book containing quack medicine ads from around our period, although I've never read it. Since my interest does not lie in this direction, my notes don't contain much on it.

However, as it happens, I was yesterday entering the last few notes from John Atkins book The Navy Surgeon (published in 1742, although nearly all of his dated "case references" are from 1700-1720s) in and he has a whole chapter on Amulets. One thing I like about Atkins is that he believes somewhat in empirical methods (observation and experimentation), which is why I found his comments interesting for possible future re-posting when I read them. So here is some material which may be of use to you, some of which I had highlighted specifically to be posted on the forum when the subject of witchcraft, magic and other such nonsense came up. (I had actually forgotten I'd done this, so you hit upon this topic at the exact right time):

"Amulets bordering upon, if not the Patients of Empiricism, exact some distinct considerations. All Remedies working Sympathetically as it were, and plainly unequal to the Effect, may be stiled Amulets; whether used at a Distance by another Person, or immediately about the Patient; there being various. The common are understood of something worne at the Neck, Wrists, or other Parts. By the Jews, called Kamea. The Greeks, Phylacteries. By the Latins, Amuleta, or Ligatura. Catholicks, Agnus Dei, or consecrated Relicts. And, by the Natives of Guiney [Africa], Fetishes. Different Sorts of Materials had in great Veneration by those People, and are firmly believed to preserve from Danger and Infection, as well as remove their present Maladies.

Of very ancient Use I believe among all Nations: Plutarch relates of Pericles, an Athenian General, That when a Friend came to see him, and enquiring after his Health, reached out his Hand and shewed the Amulet; intimating the Truth of his Illness, and at the same Time, the Confidence he put in customary Remedies. They continue still, and even with us, who have thrown off Superstition, of frequent Use among the Populace: The Fanciful, the Timerous, or such who have nothing to spend in politer Physick [ie. many regular folk], or hate it [ie. people who would today believe in the healing power of crystals, magnets, phrenology and such other junk. Or perhaps I'm editorializing here...]. Mr. Phips, General in my Time for the African Company at Guiney, a Gentleman of good Understanding, and that could laugh at others Fetishing, when he ailed himself, could not help falling into the same Method with the Negroes at the first Appearance of Illness and Danger. They were not nauseous he said, cost nothing, and were at hand; a Mark, if we allow a Providence, that the Poor are equally his Care, who oftentimes cannot get, or cannot purchase other Means of Amendment. His

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Example with Good, constantly related from them, the propagated their Credit, I could see, with others of the Factory: And when many had apply'd them to their Fears some would succeed (as surely as if they had took Ward's Pill [Ward's Pill would be considered genuine medicine at this time. Follow the link to learn more about it.]; ) that Success tempted others and inspired Spirit and Courage to contend with Danger, a good Chance of itself to escape an Evil: And is very Ungracefully laughed at by Christians who think Salvation itself will be an Effect of their Faith.

Lord Bacon says, If a Man were to wear a Bone Ring, or a Planet Seal, strongly believing he might by that obtain his Mistress, or it would preserve him unhurt at Sea or in Battle, it would probably make him more Active and Industrious upon all Dangers; and the Effect, especially in civil Business would answer: The Audacity he thinks in some Measure, conquering and binding weaker Minds.

The King's Pictures in Gold will act upon thousands; and inspire a Courage and Industry, to undertake or overcome any Sort of Danger -- So the Amulet or Fetish is a Sort of Armour to our Fears; and those who experience Success or fancy so, strengthens their Influence with others. The Way of redoubling their Virtues being to increase their Reverence, and bring them nigher and nigher to Infallibility." (Atkins, p. 274-5)

Atkins almost made it to explaining placebos, but not quite. That seems to me the most likely explanation here. But I am editorializing again.

[Mission]

Here's some more.

"Agues [Fevers with regularly alternating chills, fever, and sweating] have a great many [people]; and dispersed into many Hands, on Purpose as it were, to Relieve such common Objects of Pity. Succeeding often after the [Jesuit's] Bark [the active ingredient of which was quinine, it was used to treat Malaria] has failed, and when one Sort will not do, another has. Ague resisting Amulets, says Dr. [Thomas] Willis, have often been applied to the Wrist with Success. Abracadabra wrote on Paper conically {triangle} hung about the Neck, and repeated by a Patient, will have good Effect. The Herb Lunaria gathered by Moon-light, I have been assured by a Dignitary in the Church, not only cured him of an obstinate Dysentery made into an Ointment, and rubbed warm down the Spine three times [presumably he means the Lunaria, not the product of the Dysentery]... I had it from an old Gentleman of Eighty, who having spent all his Living upon Physicians, was at Length healed of a Strangury [painful urination], by procuring a new Glass-Bottle never wet

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inside or out; P[issin]g it full, and burying in the Earth." (Atkins, p. 275-6)

Ah, here is where he talks about Placebos! I thought he did. He is quoting Verulam (by whom I think he is referring to Francis Bacon again) here:

As this Gentleman is allowed by all, to have been one of the greatest Genuis's England ever produced, He may help to strengthen what has already said on the Power of Amulets. "After deep metaphisical Observations in Nature, and arguing in Mitigation of Sorcery, Witchcraft, and Divination, effects that far outstrip Amulets["]: He says, we should not reject all of this Kind, because it's not known how far these attributed to Superstition depend on natural Causes. "Charms have not their Power from Contracts with evil Spirits, but proceed wholly from strengthening the Imagination["]: In the same Manner that Images and their Powers have prevailed in Religion, being called from a different Way of Use and Application, Sigills, Incantations, and Spells."

Imagination works very powerfully upon Mind and Body, and no doubt the strongest Ingredients in these Cures, Dr. Strother says, the Influence of the Mind and Passions operates on the Body in sensible Operations like a Medicine, are of greater Force upon the Juices [this refers to humors, thought to be the source of all health and illness at this time] than Exercise." (Atkins, p. 277)

And that is more than enough of that.

[Mission]

Oh, and the actual treatment for fevers (which includes some of that stuff you listed - they didn't differentiate them very well) included the usual humoral treatments - bleeding, purging, sweating and herbal medicines. Even Sydenham, one of the 'great' physicians of the day, suggested that nature was often the best cure.

For gangrene there was amputation and there was death. That was pretty much it, although I can recite a list of herbal medicines that probably didn't help much once gg had set in.

I haven't come across a reference to successful treatment of lockjaw so far. (I do believe I saw something that sounded like lockjaw, but was thought to be a symptom of a fever or disease. However, I think the patient died.)

[Daniel]

Wow! Abracadabra amulets! I was expecting some primitive things would be used, but I confess I wasn't expecting quite that primitive. Thanks, this is very much the sort of thing I wnated to know.

I would think that the people who "hated" medicine in the Golden Age would largely be different from the crystal fans, magnet users and faith healers of today. In our age of medical wonders, I think people who use such things mainly do it from a desire to feel they are privy to secrets that ordinary people don't know. But back in the 1700s, magic charms and quack medicines were sometimes less harmful than the treatments used by real physicians or surgeons - notably bleeding and searing wounds, prescribing lethal doses of mercury for venereal disease, or, as you mentioned in the other thread, prescribing tobacco as a sight restorative or a dentifrice! The sailors' belief that scurvy could be cured by breathing from a hole in the ground was useless, but no more useless than oil of vitriol or sauerkraut, which was the best that any health care professional could recommend before Lind, and often after him as well.

I don't mean to say Golden Age physicians and surgeons were all bad. Surgeons at least could do episiotomies, set fractures, and their amputations reduced gangrene's death rate from 100% to 50% or so. On the other hand, I'm damned if I can think of anything physicians did that compensated for the harm they caused. Certainly you know more about physicians' and surgeons' overall effectiveness in the 18th century than I do; would you say they were a net benefit or a net harm to their patients?

[Mission]

I think you're being sort of harsh on the poor physicians of old. They were doing what they knew and were taught. The only way you can go beyond what you know is by taking risks - and we're talking people's lives here, so the concern about risk-taking would necessarily be heightened. Medicine was (and in some ways still is) a half-step behind other experimental pursuits, most likely because of this.

One of the great things about physician Sydenham is that he didn't just buy in wholesale to the idea that just because the 'ancients' (Hippocrates, Galen and so forth) said something that it was necessarily true. He tried small things in his treatments using a form of the scientific method. (Remember that this too was fairly new in human history at this time. We take the concept of scientific experimentation and control for granted today.)

As for all the 'treatments'...well there are lots of reasons that they were the way they were. Humoral theory really does seem sort of logical when you think about the necessity of fluids to our bodies and the ways they start behaving when we're sick. It just so happens that it was wrong for the most part.

The problem with Mercury and salivation is one of not understanding the disease. Syphilis goes into remission after each of the first two stages and someone unfortunately made a connection between the symptoms going away and salivation. I read that the second stage Syphilitic symptoms go into remission after 4 - 6 weeks. If you figure the time it took for a patient to need the doctor and the delay of Mercury getting 'effective' salivation working (a week or two), this may explain how we got the Mercury Syphilis cure. On the other hand, most physicians were very aware of the dangers of Mercury and cautioned strongly against its over-use and use in other cures. (Most of them...we won't talk about Dr. Dover. )

As for 'searing,' cauterization was actually falling out of favor for most wounds. In certain situations it was still used - particularly when bleeding could not otherwise be stopped. At least three of the authors I've read who recommend using cauterization in a specific situation also warn against using it unless absolutely necessary as well as advising the surgeon to keep the instruments out of sight of the patient until the last moment possible.

What I wonder is how many of the professed medicinal things we do today are unknowingly, absolutely useless. In the future they will no doubt look back upon our medical treatments and shake their heads. We like to think we know a lot, but I'll bet we're wrong about more than we would like to admit. I can't remember who it was who said it, but someone I was listening to said medicine today (this was in the 90s) is where industry was at the turn of the 20th century. And I don't doubt that that's true.

[Daniel]

I think you're being sort of harsh on the poor physicians of old. They were doing what they knew and were taught. The only way you can go beyond what you know is by taking risks - and we're talking people's lives here, so the concern about risk-taking would necessarily be heightened. Medicine was (and in some ways still is) a half-step behind other experimental pursuits, most likely because of this.

I agree. I'm sure the physicians were doing the best they could and knew how, and had good reasons for believing what they did It's just that the best they could do and knew how was, as we now know, worse than useless. A person back then who studied the outcomes of physicians' treatment versus magic and quackery could rationally conclude that the magic and quackery worked better. You couldn't come to the same conclusion about modern medicine; some individual treatments we use now will likely turn out to be harmful or useless, but medicine as a whole has worked huge reductions in morbidity and mortality.

On reflection, I guess there were a few things the physicians did that worked. As you mentioned below, they knew how to use Jesuit's bark for malaria; that's actually quite significant. And some of them stressed the importance of cleanliness, right? But is that enough to refute my statement that doctors on average harmed more than they helped, even if they had the best of intentions?

[Mission]

I don't say the harmed more than helped; I honestly don't know. I think it depends on what they were treating. Stephen R. Bown notes in his excellent book Scurvy: How a Surgeon, a Mariner, and a Gentleman Solved the Greatest Medieval Mystery of the Age of Sail.

“The survival rate for serious injuries was very low, sterilization and anesthetics other than rum non-existent, and surgical techniques in their infancy.” (Bown, p. 93)

So complicated operations were often risky (although he doesn't actually provide proof of this, it does make sense.) I do recall reading that anyone with severe damage to their torso (the area protecting the organs) were usually thought to be beyond hope and the best remedy was to dress their wound and make them as comfortable as possible. On the other hand, they had procedures for repairing intestines and lithotomy. We don't really have collected data on survival rates or anything like that. (I had heard somewhere that someone was working on creating some sort of database of the results of 17th and 18th century medical treatments based on the naval surgeon's journals that the Royal Society has, but I don't know if that is still going on, abandoned, finished or what.) I do recall reading that 50% of the people being ...here it gets somewhat hazy... trepanned or perhaps amputated... survived, but I have not since been able to find that quote in my notes. (I used to use it in my presentations, but I stopped when I couldn't find the source. It was probably referring to trepanation because amputation was a pretty common operation at this point. A surgeon's worth was often judged by how fast he could do an amputation - 2 - 3 minutes being usual.)

From what I've read in the surgeon's books, most people survived bleeding, even if the procedure didn't do any real good. What it may have done was give the patient time to heal on their own - bleedings were usually prescribed to be spaced out over many days or weeks. I guess you could say this was doing more harm that good, but I don't think that many people were bled to death. (Although some certainly were.)

Keep in mind that many of the surgeons were acutely concerned of the amount of pain and suffering they caused a patient and that affected their treatments. There are also several references to not discrediting themselves or their profession by killing patients, so I doubt if a lot of people died from a popular treatment like bleeding they would have carried it on for two millennia based solely on tradition.

As for quacks, they also had medicines they peddled, the effects of which may or may not have been harmful. Their preparations were highly secret, so we can't really tell if they were better or worse than the herbal remedies employed by the physicians and apothecaries. Since quacks tended to be itinerant, they could not even be called to answer for any harm they may have done. Then there were borderline quacks who were physicians like Dr. Dover who prescribed Mercury for everything. Note that he was also ridiculed in print by other physicians and surgeons. (To his credit, Dover claimed to have taken Mercury every day. At least he believed in his product.)

We even have some evidence that sailors preferred a ship with a surgeon to one without, so the surgeon's work couldn't have been completely detrimental to the patient. As Dampier informs us in his book,

"[1687] It was only want of being busied in some Action that made them [the men who stayed on Captain Swan's ship while they were at Mindanao] so uneasie; therefore they consented to what [Captain] Teal proposed [mutiny, basically, leaving everyone on shore behind while those on the ship sailed away under Captain Teal], and immediately all that were aboard bound themselves by Oath to turn Captain Swan out, and to conceal this Design from those that were ashore, until the Ship was under Sail; which would have been presently, if the surgeon and his Mate had been aboard; but they were both ashore, and they thought it no Prudence to go to Sea, without a Surgeon: Therefore the next Morning they sent ashore one John Cooksworthy, to hasten off either the Surgeon or his Mate, by pretending that one of the Men in the Night broke his leg by falling in the Hold. The Surgeon told him that he intended to come aboard the next Day with the Captain [swan], and would not come before, but sent his Mate, Herman Coppinger...

…

But to proceed, Herman Coppinger provided to go aboard; and the next Day, being the time appointed for Captain Swan and all his men to meet aboard, I went aboard with him, neither of us distrusted what was designing by those aboard, till we came thither. then we found it was only a Trick to get the Surgeon off [the land and onto the ship]..." (Dampier, p. 253-4)

That's a lot of trouble to go to to get a skilled medical practitioner on board, which at least suggests that the surgeon did somewhat more good than harm. Sir John Keevil, author of Medicine and the Navy 1200-1900: Volume II – 1640-1714 says,

“Certainly the sea-surgeons of this period were more skilled and more highly esteemed than their predecessors, and in all the immense mass of records relating to the Commonwealth and Protectorate, none containing criticism of them has yet been discovered: the charlatans and mountebanks, against whom [William] Clowes had railed, had completely disappeared.” (Keevil, p. 34)

[Daniel]

ISo complicated operations were often risky (although he doesn't actually provide proof of this, it does make sense.) I do recall reading that anyone with severe damage to their torso (the area protecting the organs) were usually thought to be beyond hope and the best remedy was to dress their wound and make them as comfortable as possible. On the other hand, they had procedures for repairing intestines and lithotomy. We don't really have collected data on survival rates or anything like that. (I had heard somewhere that someone was working on creating some sort of database of the results of 17th and 18th century medical treatments based on the naval surgeon's journals that the Royal Society has, but I don't know if that is still going on, abandoned, finished or what.) I do recall reading that 50% of the people being ...here it gets somewhat hazy... trepanned or perhaps amputated... survived, but I have not since been able to find that quote in my notes. (I used to use it in my presentations, but I stopped when I couldn't find the source. It was probably referring to trepanation because amputation was a pretty common operation at this point. A surgeon's worth was often judged by how fast he could do an amputation - 2 - 3 minutes being usual.)

I may be confused here, but I thought that lithotomies (Samuel Pepys was successfully cut for a kidney stone), intestinal repairs, trepannings, and amputations were all done by surgeons, not physicians, and that the social and professional gulf between physician and surgeon was huge. There's no doubt surgeons did a huge amount of good: setting broken bones, relieving concussions, lithotomies and trepannings as you mentioned, amputating gangrenous limbs, extracting bullets and arrowheads, even pulling teeth in some cases. The surgeons' operations were extremely dangerous and painful, but a lot of them clearly worked.

But I thought physicians didn't do any of that; they prescribed drugs or therapies, like cupping, bleeding, mineral baths, etc. And it's in the drugs/therapies department that I have a really hard time thinking of anything effective Western physicians did before the smallpox inoculation.

[Mission]

I may be confused here, but I thought that lithotomies (Samuel Pepys was successfully cut for a kidney stone), intestinal repairs, trepannings, and amputations were all done by surgeons, not physicians, and that the social and professional gulf between physician and surgeon was huge. There's no doubt surgeons did a huge amount of good: setting broken bones, relieving concussions, lithotomies and trepannings as you mentioned, amputating gangrenous limbs, extracting bullets and arrowheads, even pulling teeth in some cases. The surgeons' operations were extremely dangerous and painful, but a lot of them clearly worked.

But I thought physicians didn't do any of that; they prescribed drugs or therapies, like cupping, bleeding, mineral baths, etc. And it's in the drugs/therapies department that I have a really hard time thinking of anything effective Western physicians did before the smallpox inoculation.

You got me there. Physicians were the medical theoreticians of the day and they generally looked down upon surgeons for getting their hands dirty. I have been quoting you info about surgeons because I don't have much on physicians. I have only partially read one physician's book (Sydenham). I quite like the guy's philosophical outlook so I guess that's why I'm sort of defending it. I half-intended to read Dover's autobiography because he's the only physician I know of who served with anything close to pirates (privateer Woodes Rogers), but he is kind of an odd duck as I have suggested.

In the balance, I guess I'd have to agree with you, based on my somewhat limited knowledge, that much of what the physicians were doing was sort of useless for the most part. (Reading urine, prescribing things like herbals, bleeding, purging and so forth.) However, keep in mind that the surgeons did a lot of the bleeding, cupping, purging and Mercury administration, so when you complain that these things did more harm than good, you're also talking about surgeons. On ships, they also made the medicines because they were the only ones capable of doing so. (Curiously almost every surgical manual I've read has prescriptions included in it, so I really wonder how strictly the separation between the surgeon and physician was observed on the subject of medicines.)

I have sort of shied away from the subject of herbal medicines, partially because it's not the surgeon's most important job, partially because I can't fully understand the abbreviated Latin the surgeons use in their books (although I'm very slowly getting better at that) and partially because it just flat doesn't interest me much. But I do wonder about the healing properties of some of these herbal remedies. Even today there is some evidence that some herbal remedies have healing powers. On top of that, there is great likelihood that they would have worked well as placebos if nothing else.