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Thursday, July 19, 2012

What Ails You?

Journal Opinion
July 18, 2012

The headstone for Dr. Nathan McKinstry is located in the Oxbow Cemetery in Newbury.  One of Newbury's first doctors, he died Feb.6, 1815 at age 41.  The inscription on the headstone, worn by time and acid rain, reads: "In-urned beneath lies no poor worthless quack. But the ashes of good Dr.Mac, Whose talents, honors, virtues, could not save, His generous bosom from an early grave."

Dr. Nathan Smith, pictured in this painting, was the founder of Dartmouth Medical School.  This school was the 4th in the nation and recently changed its name to the Geisel School of Medicine (Courtesy of the Geisel School of Medicine)

This is one of serveral patent medicines developed by Dr. Samuel Hardy of Cornish Flats, NH.  This promotion dates to 1836.  Patent medicines such as this often contained morphine and alcohol.

Green Mountain Balm of Gilead: Developed by M.K. Paine of Windsor, VT, this cedar plaster was guaranteed "unequalied in removing pain, internal inflammations, curing lameness" and a whole list of additional aliments.  

Doctors in Vermont carry on a practice over a radius of twenty miles, frequently being obliged to drive through eight feet of snow in order to reach their patients and find it necessary at times to dig their horses out of drifts, before they could proceed.”

This is Rudyard Kipling’s description of the 19th century conditions facing some of the doctors he observed during his stay in Vermont. This column describes the medical practices in our region from the period of settlement to 1860. It draws on local histories, internet sources and the history of the medical profession found in The Vermont of Today by Arthur Stone.

Early residents of the area lived in constant fear of illness or accident. While not as frequent as in the South or in the nation’s cities, epidemics increased local death rates. Local cemeteries are filled with the victims of both epidemics and endemic diseases. The average life expectancy in 1850 was under 40 years of age, brought low by a high infant mortality rate. Poor sanitation practices spread many diseases. War injuries brought their own special problems, often overwhelming the medical help available.

Many believed that illness was a punishment for sin. Believers relied on prayers for God’s intercession as a cure. This was especially true in the face of epidemics when days of fasting and prayer were observed. Governors proclaimed fast days in New Hampshire as early as 1680 and although it had lost its original purpose, Fast Day remained an April holiday in that state until 1991.

Despite their best practices or because of them, physicians were largely helpless in the face of illness. Orthodox medicine was based on tenets passed down over the previous two thousand years. It was believed that illness was caused by an imbalance of the humors in the body. The doctor’s duty was to restore those humors by bleeding, blistering or purging, techniques that killed as often as cured. The number of medicines was few and the same medications were often used for a variety of afflictions.

Many doctors learned their profession by serving as an apprentice to a practicing physician. A few received their training in Europe or at one of three American colleges that offered medical schools. In 1797, Dr. Nathan Smith petitioned the Trustees of Dartmouth College for the establishment of a medical school.  Nathaniel Niles of West Fairlee was appointed as a committee of one to investigate the proposition and after one day of thought, recommended that the Board adopt the idea.  Smith remained the sole instructor at the school until 1810 and was recognized as being “well ahead of his time in insisting that doctors practice watchful waiting and emphasizing patient-centered care.”

In 1804, Dr. John Pomeroy began teaching medical students in Burlington, an effort that led to the establishment of UVM’s College of Medicine in 1822. Two other colleges offering medical degrees were Castleton Medical College (1818-1862) and Vermont Clinical School of Medicine in Woodstock (1827-1861). In 1887 a short-lived bogus medical school was organized in Newbury, VT, providing licenses that were sold to individuals hoping to practice medicine in the West.

Each town’s history mentions the physicians who served their community during the period following settlement. In some cases a single physician served alone whereas, in other towns there was competition. Some were well trained, competent for the times, highly respected and served their community for decades. Others were short on some or all of these characteristics. Early physicians included Drs. Samuel Putnam of Topsham, Bildad Andross, Frederick Aubry and John Poole of Bradford, Eli Perry of Ryegate, Eliphalet Kimball of Orford and Adoniram Smalley of Lyme.

Several local histories mention Dr. Samuel White of Newbury and Haverhill, who began his local practice in 1773, “and for years was the doctor of the Connecticut Valley, his ride extending from Newbury to the Canadian border.” He was dedicated to his practice. He was quoted as saying “he had poor luck with his patients in their last illness.”

White’s diaries mention his fees as follows: “The least charge for a visit is one shilling and the greatest (to Upper Coos) is sixty shillings…medicine was usually one shilling for each potion, occasionally two shillings; bleeding was always one shilling; tooth pulling, one shilling; dressing a wound, one shilling, lancing a sore, one shilling; setting an arm or a leg, six shillings; attendance on your wife in travel [travail] twelve shillings.” The weather, difficulty of the journey, urgency of the call and the financial condition of the patient played a role in the amount charged.

Actually the birthing process prior to the mid-19th century, was one with only female relatives, neighbors and midwives attending. No females were allowed to practice as a physician. Two midwives, Lydia Peters Baldwin of Orford and Bradford and Bathsheba Wallace of Thetford competently served the area for decades following settlement. Each assisted in the birthing of hundreds of babies, traveling by horseback to neighboring towns regardless of time or weather. They charged a few shillings and were often paid in goods or services rather than hard money. Their record of success was difficult for physicians to replicate when the practice of midwifery was replaced by the male-dominated medical profession’s control of delivery.

Life for doctors on the frontier was “fraught with many hardships, difficulties and even dangers.” It was not unknown for a doctor to become lost or attacked by wolves when traveling to a bedside in winter, often on snowshoes,. Doctors were not immune to the illnesses they treated. Dr. Nathan McKinstry, one of Newbury’s first doctors, died at 41 in 1815. His headstone in the Oxbow Cemetery bears the following epitaph: “In-urned beneath lies no poor worthless quack. But the dear ashes of good Dr. Mc, Whose talents, honors, virtues, could not save His generous bosom from an early grave.” That same year Dr. Lemuel Wellman of Piermont went to Warren to care for spotted fever victims, “took the disease and died in four hours.”

Because contagious diseases spread rapidly in early communities, quarantine was used. In 1792 a smallpox epidemic led Newbury to vote to “see if the town will open a pest house.” In many cases a family would be quarantined in their own home. In 1790, Dr. Isaac Moore of Haverhill attempted to open a house for smallpox inoculation in Bath. This technique used the smallpox virus to try to prevent the disease, but often caused a fatal case instead. At first there was such strong feeling against it that the half-completed building was torn down, but it was subsequently rebuilt.

From contact with Native Americans, both doctors and the general public learned of the medicinal properties of plants not found in Europe. Stone quotes one doctor who supplemented his pharmacology from the fields and woods and said “Indian hemp was good for dropsy, spigot root for internal bruises, the bark of the red willow a sure remedy for fever and ague, burdock root with black cherry and white ash bark steeped in cider the very best remedy for spring jaundice.”

Many residents also relied on home remedies, some of which may have actually had curative properties. Vinegar and honey were recognized as helpful both as a cure and for maintaining good health. Garlic clove for insect bite and spruce gum for a toothache were said to be helpful. Egg white was known for extracting a splinter.

On the other hand, cures for consumption did little good. Some Grafton County residents believed that if the lungs of a consumption victim were burned, the ashes will cure other members of the family with the disease. Carrying a small potato in your pocket or wrapping the affected limb in the skin of an eel to prevent rheumatism was equally unsuccessful. Binding a piece of peppered salt pork or a nutmeg to the throat was suggested to cure a sore throat. Skunk oil was touted as a cure for chest congestion for infants and adults. Asthma could be cured by using the root of skunk cabbage.

In 1805 the Boston Weekly Magazine reported that a Miss Everts in Vermont “was lately poisoned by a villainous quack” and that her death ought to be a warning to all persons who “are disposed to employ the numerous nostrum mongers with which our country is unfortunately swarmed.”

Bradford’s National Opinion in the 1860’s carried ads for locally produced Doty’s Mandrake Bitters. It was “warranted to be the best compound ever offered to the public for the cure of Dyspepsia, Jaundice, Costiveness, Piles, Sick Headaches, Morning Sickness, Humors Morning Sickness, Foul Stomach, Liver Complaints in all its forms; General Disability, Worms, etc. etc.”

Doty’s was one of many patent medicines to which many turned in the face of so many conditions that were not helped by the medicines available. While some may have actually helped, others were either harmful or harmless. Some, such as Doty’s, were produced by local pharmacists, but others were sold by quacks and fast-talking snake oil salesmen.

Medical Societies were formed in Vermont in 1784 and in New Hampshire in 1791. While their efforts encouraged better education and licensing they also supported orthodox medicine to the discouragement of other practices. Licensing became less popular in the 1830’s as many considered it a violation of the new spirit of personal freedom.

From 1838 to 1876 there was no licensing of doctors in Vermont. This reopened the door to a number of competing theories of medicine, some with a basis in the science of the day and others practiced by charlatans. The 1849 Medical and Surgical Reporter described a Vermont medical prophet who healed the disease of patients at a distance, “provided they send him their symptoms and the required fee.”

One alternative that had many followers during the period was Thomsonian medicine. It was developed by New Hampshire herbalist Samuel Thomson. His methods rejected the dangerous and futile methods used by “qualified” physicians in favor of botanical remedies coupled with water treatments. Despite being dubbed as quackery, it was very popular in the 1830’s and Thomsonian societies and periodicals were created.

Another alternative was hydropathy, the drinking or bathing in the waters of mineral springs. It almost seemed the worse the taste and smell, the more beneficial the waters were considered. In 1804 Newbury’s Spring Hotel allowed its patrons to take advantage of the adjacent Montebello sulphur and iron springs for “curative purposes.” Nearby, on Montebello Road, was the Newbury Sulphur Springs and Bathing Establishment.

It was not until the mid-19th century that general anesthesia was being used for surgery and even later before modern antiseptics were standard practice. There were no general hospitals in the area until Mary Hitchcock opened in 1897 and Cottage in 1903. Until the Vermont Asylum for the Insane opened in Brattleboro in 1843 and the New Hampshire Asylum opened in Concord in 1842 there was little help for the mentally ill. Health regulations were in the hands of local authorities until State Boards of Health were established in New Hampshire in 1881 and in Vermont in 1886.

Health issues and medical practices, and their availability, are uppermost in the minds of many in today’s world. Obviously much has improved since the years prior to 1860. We live longer and healthier lives. Modern science creates a vast array of weapons available to the modern physician and hospital. Bleeding of patients or brutal surgery without modern anesthesia or antiseptics are just two of the traditional medical practices we can be grateful that modern medicine no longer uses. Those who yearn for the good old days of times past would do well to recall that, at least in the field of health, they were not all so good.

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