Instruments of intervention in early American medicine - Cover Story

Magazine Antiques, July, 1999 by Nan Wolverton

In the winter of 1818 Mary Way (1769-1833), a painter of portrait miniatures, was working in New York City and going blind,(1) She was being treated by an orthodox physician and thus endured "the usual routine of bleeding, blistering, &c."(2) In December she described the pain of the blistering that was part of the treatment:

My neck is now broiling and smarting with blisters, and literally speaking I have my part in the lake that burns with fires and brimstone, for I can compare it to nothing else.(3)

Blistering was produced by a harsh irritant placed on the skin - most likely cantharides, or powdered Spanish flies - causing a second-degree burn.(4) The procedure was believed to draw disease from within the body to the surface of the skin in the form of blood and pus. Painful as it was, blistering was one of the common procedures early Americans endured in the hope of regaining health.

There were alternatives to such painful treatments. Americans in fact had a wide array of choices when it came to ministering to their health. Their own home remedies usually came first, but for serious illness they sought outside help. The healing properties of water, steam, vegetable compounds, patented nostrums, and electricity were some of the unorthodox methods of healing to which Americans subscribed (see Pls. V, VII, and VIII). In addition, there were many healers skilled in American Indian, African, and European traditions of folk medicine.

It was, however, practitioners of orthodox medicine who claimed the most prestige in healing - a claim that convinced many Americans and made others wary. The tools and equipment orthodox doctors used might today be viewed as curious, if not gruesome, but in their time they were widely believed to be essential. These instruments of intervention help give us some insight into the attitudes and values of early Americans regarding the care of their bodies before the development of X rays and antibiotics.

Most of the theory and virtually all of the practice of orthodox medicine in early America stemmed from the humoral theory of the body, which originated in ancient Greece. It was based on the correspondence between the four elements of nature (fire, water, air, and earth) and the four bodily fluids, or humors (blood, phlegm, yellow bile, and black bile). The humoral system was also correlated to the four primary qualities (hot, dry, cold, and wet), the four seasons, and the four temperaments.(5) A body was healthy, it was believed, as long as it maintained internal equilibrium among the four humors. Illness was caused by an imbalance among the humors. The role of medical treatment then was to restore the balance of bodily fluids - a notion that influenced medical thinking for centuries.

By the early nineteenth century some practitioners of orthodox medicine had taken the humoral theory to a new extreme in what was known as heroic medicine. Named for its boldly experimental methods, heroic medicine was promoted here by Benjamin Rush (1745-1813), the founding father of American medicine. A Philadelphia-born physician who had studied in Edinburgh, Rush believed that all disease was the result of tension and congestion in the arteries and that the key to relief was massive bloodletting, or phlebotomy (derived from the Greek words for "vein" and "to cut"). Other treatments used by heroic physicians were blistering, purging, and vomiting. Blistering was thought to bring up poisoned blood. Purging was achieved with laxatives such as castor oil or the more powerful calomel (mercurous chloride), a drug that often led to the loss of hair and teeth from acute mercury poisoning. Vomiting was induced by strong emetics such as ipecac or tartar emetic.

The administration of such foul-tasting physics was not easy, and sometimes force was needed. The medicine or invalid spoon shown in Plate I is a form designed by Charles Gibson in London in 1827 and was primarily used for difficult patients, children, or the insane. Made in the form of a wedge to force open the patients' teeth if they resisted, the spoon was filled with medicine through the hinged lid and held there by the doctor or caregiver covering the end of the hollow handle with his or her thumb. When the spoon was inside the patient's mouth, the thumb was removed and the medicine flowed out of the spoon.

The heroic regime of bleeding, blistering, purging, and vomiting was fashionable in the United States from the 1790s until the mid-nineteenth century.(6) It was Rush's zeal for bleeding that led to the widespread use of such implements as the spring lancet shown in Plate VI. Whether ornately engraved or plain, the razor-sharp blade was forced into the patient's vein by the spring mechanism. Unlike simple thumb lancets (see Pl. XI), spring lancets did not require the operator to use force and were easier to use by those less skilled in anatomy because the depth of the cut was controlled and the operator was less likely to sever the vein.

Physicians most commonly drew blood from the large vein in the crook of the elbow. The patient was given a stick to clasp while a tourniquet applied above the elbow enlarged the vein to be tapped. The expression "breathing a vein" was sometimes used to describe this process. The resulting blood was collected in a container as it flowed from the vein, and anywhere from several ounces to pints were collected, depending on the patient and the severity of the illness.