1. Small sassafras rootes to be drawen in the winter and dryed and none to be medled with in the sommer, and it is worthe 50 lb. and better per tonne.2. Poccone to be gotten from the Indians and put up in caske is worthe per tonne 11 lb. 4. Galbrand groweth like fennell in fashion, and there is greatest stoare of it in Warriscoes Country, where they cut walnut trees leaste. You must cut it downe in Maye or June, and beinge downe it is to be cut into small peeces, and brused and pressed in your small presses, the juice thereof is to be saved and put into casks, which wilbe worthe here per tonne, 100 lb. at leasts. 5. Sarsapilla is a roote that runneth within the grounds like unto licoras, which beareth a small rounde leafe close by the grounds, which being founde the roote is to be pulled up and dryed and bounde up in bundles like faggotts, this is to be done towards the ende of sommer before the leafe fall from the stalk; and it is worthe here per tonne, 200 lb. 6. Wallnutt oyle is worth here 30 lb. per tonne, and the like is chestnutt oyle and chechinkamyne oyle.
1. Small sassafras rootes to be drawen in the winter and dryed and none to be medled with in the sommer, and it is worthe 50 lb. and better per tonne.
2. Poccone to be gotten from the Indians and put up in caske is worthe per tonne 11 lb. 4. Galbrand groweth like fennell in fashion, and there is greatest stoare of it in Warriscoes Country, where they cut walnut trees leaste. You must cut it downe in Maye or June, and beinge downe it is to be cut into small peeces, and brused and pressed in your small presses, the juice thereof is to be saved and put into casks, which wilbe worthe here per tonne, 100 lb. at leasts. 5. Sarsapilla is a roote that runneth within the grounds like unto licoras, which beareth a small rounde leafe close by the grounds, which being founde the roote is to be pulled up and dryed and bounde up in bundles like faggotts, this is to be done towards the ende of sommer before the leafe fall from the stalk; and it is worthe here per tonne, 200 lb. 6. Wallnutt oyle is worth here 30 lb. per tonne, and the like is chestnutt oyle and chechinkamyne oyle.
The Company's plan for the gathering, storing, and shipping of drugs was supplemented by a project indicating foresight and an early form of experimental research for the development of new products. In 1621 it planned thorough tests of an earth sent from Virginia in order to determine its value as a cure for the flux. In addition, the Company planned to test all sweet gums, roots, woods, and berries submitted by the colonists in order to ascertain their medicinal values.
In regard to the sale and dispensing of drugs in Virginia, whether found locally or imported, frequent references to the apothecary supplies and utensils in the possession of Virginia physicians lead to the conclusion that they were usually their own druggists.
As has been noted, the sale and dispensing of drugs usually culminated in their use—in accordance with the theory of the period—as means of purging the body. Drugs, however, did not have a monopoly in this greatly emphasized aspect of medical practice because the clyster (purging of the bowels, or enema) and phlebotomy (bleeding of the vein) could be used as well. These two methods might be classified as mechanical in nature as contrasted with the essentially chemical action of the drugs.
Molière, in his seventeenth-century satires on the European medical profession, ridicules the excessive use of the clyster. The popularity of the phlebotomy then is attested to by the notoriety of this technique today. (Rare is the schoolboy who does not think that George Washington was bled to death.) There is no reason to doubt that the clyster and phlebotomy enjoyed as wide usage in colonial Virginia as in Europe, but the evidence surviving to prove this assumption is slight.
Dr. Blanton, the historian of medicine, could find only meager references to the use of clyster (or glyster) and he sums them up as follows:
Among the effects of Nathaniel Hill was '1 old syringe.' In York County records we find that Thomas Whitehead in 1660 paid Edmond Smith for '2 glysters.' George Wale's account to the estate of Thomas Baxter in 1658 included a similar charge. George Light in 1657 paid Dr. Modè fifty pounds of tobacco for 'a glister and administering.' John Clulo, Francis Haddon and William Lee each presented bills for similar services.
Among the effects of Nathaniel Hill was '1 old syringe.' In York County records we find that Thomas Whitehead in 1660 paid Edmond Smith for '2 glysters.' George Wale's account to the estate of Thomas Baxter in 1658 included a similar charge. George Light in 1657 paid Dr. Modè fifty pounds of tobacco for 'a glister and administering.' John Clulo, Francis Haddon and William Lee each presented bills for similar services.
The survival of such meager evidence for what was probably a common practice indicates the difficulties confronting the historian of medicine. Nor has Dr. Blanton been able to find, as a result of his research, any more evidence of phlebotomy although, again, its utilization must have been widespread. Blanton sums up his evidence for bleeding as follows:
Dr. Modé's bill to George Light includes 'a phlebothany to Jno Simonds' and 'a phlebothany to yr mayd.' Dr. Henry Power twice bled Thomas Cowell of York County in 1680, and Patrick Napier twice phlebotomized 'Allen Jarves, deceased, in the cure of a cancer of his mouth.' Colonel Daniel Parke in 1665 rendered John Horsington a bill for 'lettinge blood' from his servant; and we find Dr. Jeremiah Rawlins and Francis Haddon engaging in the same practice.
Dr. Modé's bill to George Light includes 'a phlebothany to Jno Simonds' and 'a phlebothany to yr mayd.' Dr. Henry Power twice bled Thomas Cowell of York County in 1680, and Patrick Napier twice phlebotomized 'Allen Jarves, deceased, in the cure of a cancer of his mouth.' Colonel Daniel Parke in 1665 rendered John Horsington a bill for 'lettinge blood' from his servant; and we find Dr. Jeremiah Rawlins and Francis Haddon engaging in the same practice.
The horoscope often determined the proper time for bleeding and notations have been found in an early American Bible recommending the days to, and not to, bleed. Although medicine today looks askance at astrological medicine and bloodletting, it remains difficult to explain the widespread popularity of such practices unless the patients enjoyed some beneficial results, psychological or physical.
Drug therapeutics, clysters, and bloodletting did by no means exhaust the seventeenth-century physician's treatments and remedies. The works of European painters of the century remind us of uroscopy or urine examination. One of the outstanding paintings illustrating the technique is by artist Gerard Dou who has the young doctor intently examining the urine flask while taking the pulse of a pretty young lady. Unfortunately, such revealing pictorial representations of life and medicine in colonial Virginia do not exist.
On the other hand, in Virginia, the Reverend John Clayton displayed a distinct flair for the scientific method in his analysis of urine. It is safe to assume that his techniques were of a higher order than those usually associated with uroscopy. Clayton, not satisfied to practice just the art of observation, utilized the science of comparative weights hoping to find diseases distinguished by minute variations in the specific gravity of the liquid. He thought he could find manifestations of "affections in the head" by his careful weighing and study; manifestations not uncovered by visual observations alone.
In Gerard Dou's painting, it is to be remembered, the doctor not only examined the urine but also took the pulse—another common practice. This is not surprising insomuch as Galen—the great and ancient authority—had written enough to fill sixteen books on the subject of "pulse lore." Despite the facts that physicians centuries later continue to take the pulse, they would not find the theories behind the seventeenth-century practice acceptable. Galen's deductions have since been described as fantastic, and his attempt to associate a specific type of pulse rate with every disease futile. Yet the Virginia physician, when he did take his patient's pulses, certainly did not lose his or her confidence by gravely considering the mysterious palpitation.
The physician with his many techniques and remedies did not restrict himself solely to the illnesses of the sane for—contrary to popular belief today—some effort was made to treat and cure the mentally ill. America's first insane asylum was not established until 1769, but the insane had received, even before this, medical attention. If the case did not respond to treatment and took a turn toward violence, confinement under conditions that would now be considered barbarous often resulted. Before this extreme solution of an extreme problem recommended itself, however, the mentally ill might be purged. The intent was to relieve the patient of insanity-producing yellow and black bile. The belief that this type of sickness would respond to conventional treatment, however, did not completely dominate the theories on insanity; some seventeenth-century authorities considered insanity not an illness but an incurable, disgraceful condition.
One of the fullest accounts of a case of insanity in seventeenth-century Virginia describes the plight of poor John Stock of York who kept "running about the neighborhood day and night in a sad distracted condition to the great disturbance of the people." The court authorities ordered that Stock be confined but provided such "helps as may be convenient to looke after him." The court, in a sanguine mood, anticipated the day when Stock would be in a better condition to govern himself.
Housing of the Sick
If the doctor, surgeon, or nursing persons could come to the patient's home, little advantage could have been obtained in the seventeenth century by moving the patient. The need did arise, however, to care for persons outside the home. For example, an individual without family or close friends might find it more convenient to move in with those who would care for him on a professional basis, or newly arrived immigrants and transients might need housing.
Quite in harmony with the needs of the period were the men and women willing to take in a sick person in order to supplement their incomes. Illness forced one colonial Virginian to offer in 1686 to grant his plantation and his home to the person who would provide a wholesome diet, washing, and lodging for him and his two daughters. The beneficiary was also to carry the sick man to a doctor and to pay all of his debts. It is probable that the man provided these services only on this particular occasion, but by such special arrangements the century housed its sick. The number of ill persons provided for by relatives under similar arrangements or even without any compensation, must have been even greater in a period without hospitals and nursing homes.
On occasions, in the seventeenth century, the physician took the patient into his own home, but not always without some reluctance. Dr. Wyndham B. Blanton, in his search of the Virginia records for this century, found an interesting account of Dr. George Lee of Surry County, Virginia, who in 1676 had an unfortunate experience in letting accommodations to a pregnant woman. Living in a house she considered open and unavoidably cold, and having only one old sow for food, the sick and feverish woman pleaded with the doctor to take her to his home for the lying-in period. The doctor argued that the house could be made warmer, suggested that neighbors bring in food, and protested that he had only one room fit for such occupancy and that he and his wife used it. Dr. Lee said he would not give up the room for anyone in Virginia.
Offering the opinion that the room was large enough for her, Dr. Lee, and his wife, the expectant mother had her servant take her by boat to Lee's where she remained, taking great quantities of medicine, until she delivered. The doctor then had to bring suit to collect his fees.
Another example of a medical man's housing the sick, is that of a surgeon promised 2,000 pounds of tobacco and "cask" if he cured the blindness of a person he had housed—but only modest compensation if he failed. The same surgeon received 1,000 pounds of tobacco in 1681 by order of the vestry of Christ Church parish for keeping "one Mary Teston, poore impotent person."
Much earlier, Virginia had what some authorities consider to be the first hospital built in America. While the colony was still under the administration of the London Company (1612), a structure was erected near the present site of Dutch Gap on the James river to house the sick. The hospital, which had provisions for medical and surgical patients, stood opposite Henrico, a thriving outpost of the settlement of Jamestown.
Evidence that the building was primarily designed for the sick and was not simply a public guest house is to be found in the statements of contemporaries. One described it as a "retreat or guest house for sicke people, a high seat and wholesome air," while another wrote that "here they were building also an hospitall with fourscore lodgings (and beds alreadie sent to furnish them) for the sicke and lame, with keepers to attend them for their comfort and recoverie." The use of the word "hospital," which had then a general sense, does not indicate any similarity to a present-day hospital as does the other information. Nothing more appears about this establishment for the sick and wounded, and it may well have been destroyed during the Indian uprising of 1622.
Plans for similar institutions in each of the major political and geographical subdivisions of the colony came from the London Company. Unlike the Henrico structure, these buildings bore the name "guest house" and were to harbor the sick and to receive strangers. Specifications called for twenty-five beds for fifty persons (which was in accord with custom in public institutions); board partitions between the beds; five conveniently placed chimneys; and windows enough to provide ample fresh air.
The Company repeatedly recommended and urged the construction of these guest houses not only as a retreat for the sick but also as a measure to prevent illness among the newcomers. In addition, the guest houses, if they had been built, would have saved the old settlers from being exposed to the diseases of the new arrivals who were taken into private homes. The colonists always had some excuse for delaying construction, and the Company in 1621 entreated to the effect that it could not "but apprehend with great grief the sufferings of these multitudes at their first landing for want of guest houses where in they might have a while sheltered themselves from the injuries of the air in the cold season."
That the London Company should have had the Henrico hospital built during its administration and made plans for the guest houses can be explained by the situation existing during the earlier days of the colony. The Company, engaged in a commercial venture and realizing by its own statement that "in the health of the people consisteth the very life, strength, increase and prosperity of the whole general colony," had sufficient reason to shelter and care for the colonists. Also, during the early days the number of incoming colonists was high relative to the number settled and with lodging to give or to let. The Company, in addition, knew that new arrivals fell victim most easily to seasoning and other maladies, and needed protection from the elements. Finally, the Company had to fill the void created by the absence of religious orders which, during prior European colonization and occupation of distant lands, had provided shelter and care. These hospitals are no longer mentioned after the dissolution of the London Company, nor were any other comparable measures taken during the century to institutionalize care for the sick.
Surgical Practice
Much has been made of the lower status held by the surgeon as compared with that of the physician—during the seventeenth century. On the continent and in England, at this period, membership in separate guilds in part distinguished doctor and surgeon; in England, after 1540 and until 1745, surgeons held common membership with barbers in one corporate organization. In America, historians agree, the differences based on specialization of practice between surgeons and physicians soon tended to disappear, a superior education often being the only attribute or function of a physician not shared by the surgeon. Barbers held a unique position, but in performing phlebotomies, a minor operation, they retained associations with health and disease. Both barber and surgeon shared a certain expertness with tools, as they do today.
Evidence abounds in the earlier records that the scarcity of medical men may have compelled surgeons in Virginia to practice internal medicine: surgeons prescribed medicine with the same frequency as doctors. The surgeons, however, did not abandon the treatment of wounds, fractures, and dislocations; notes on amputations during the century also exist.
Nor is it reasonable to assume that the isolated physician of the Virginia countryside would always insist upon referring a patient to a surgeon. Dr. Francis Haddon, who had a large practice in York County, Virginia, and who is not identified as a surgeon, left recorded the course of treatment for an amputation—cordials, a purge, ointments, and bloodletting—and a dismembering saw, as well.
Other recorded surgical treatments include care of dislocated shoulders; wounds in various parts of the body; sores of the feet and legs; cancerous ulcers in the instep; ulcers of the throat, and dueling wounds. One of the most unusual surgical measures of the period was the application of weapon salve for battle wounds; the salve was applied to weapon, not wound.
Surgery has long been associated with the military, and much of the outstanding surgical work done in Europe during the fifteenth and sixteenth centuries was performed by military surgeons. Ambroise Paré (c. 1510-1590), remembered especially for the use of the ligature in amputations and the abandonment of the burning-oil treatment of wounds, held a position as a surgeon for the French army. Other surgeons of the period contributed to the improvement of medical practice by enlightened measures of quarantine to prevent contagious diseases from decimating armies.
Insomuch as the first settlers at Jamestown greatly feared attack from Indians and Spaniards and because the initial landings had the character of a military expedition, it is not surprising that the first two medical men to arrive, Will Wilkinson and Thomas Wotton, were surgeons. Captain John Smith on three occasions, it is to be remembered, emphasized the importance of the surgeon to pioneer settlers and explorers in the New World. When injured by the stingray in 1608, Smith's first thought was of his need for a surgeon and "chirurgery"; so the success of physician Russell's soothing oils came as a pleasant surprise. On a subsequent expedition he included the surgeon, Anthony Bagnall, rather than Dr. Russell, to treat the stingray wound; and in 1609 when he received the powder burn, he left Virginia "seeing there was neither chirurgeon nor chirurgery in the fort to cure his hurt."
Throughout the century surgeons rendered services to colonists engaged in fighting with, or defending themselves against, the Indians. When the Indian massacre of 1622 occurred, costing the lives of more than 350 colonists in the settlements, it is possible that the two surgeons who sailed to Virginia with Dr. Pott in 1621 gave assistance to the wounded. In 1644, when a retaliatory attack on the Indians was made by the settlers because of a recent massacre, the General Assembly provided for a surgeon-general to accompany the militia, at public expense.
Again, later in the century, the General Assembly gave evidence of recognizing the importance of surgical care for soldiers when it voted for supplying a surgeon with "a convenient supply of medicines & salves, etc. to the value of five pounds sterling for every hundred men" to each of eight forts planned to protect the settlements against Indian attacks. Throughout the last half of the century references were made to surgeons ministering to companies of soldiers or to various garrisons and forts. Judging by the consistent employment of surgeons for military duties, it would appear that the profession of surgeon during the century was much more intimately associated with the military than was that of physician. The relationship between the surgeon and the military is similar to the early one between civil engineer and the army in Europe.
Hygiene
The restoration of the patient to health is not the only important aspect of medical practice; the prevention of illness is also vital to the health of a community. Much more attention is given to preventive medicine in the twentieth century than in the seventeenth, but the value of cleanliness, fresh air, and quarantine was known. Hygienic measures taken, or recommendations made, by public authorities make clear the fact that the cause of disease was not commonly thought to be supernatural by the educated and responsible. Contemporary accounts make known the widespread disapproval of foul ships, crowded quarters, marshy land, stagnant air, bad food and drink, excessive eating, and exposure to a hot sun.
Lord De la Warr laid down regulations for Jamestown designed to eliminate the dangers of dirty wash water ("no ... water or suds of fowle cloathes or kettle, pot, or pan ... within twenty foote of the olde well"); and of contamination from sewage ("nor shall any one aforesaid, within lesse than a quarter of one mile from the pallisadoes, dare to doe the necessities of nature"). The order argued that if the inhabitants did not separate themselves at least a quarter of one mile from the palisaded living area that "the whole fort may be choaked, and poisoned with ill aires and so corrupt." The colonists by the same order had to keep their own houses and the street before both sweet and clean.
Any doubt that an awareness existed of the dangers of infection by contact, at least from diseases with observable bodily symptoms, should be dispelled by the quarantine measures taken by the colonel and commander of Northampton County in 1667 during an epidemic of smallpox. He ordered that no member of a family inflicted with the disease should leave his house until thirty days after the outbreak lest the disease be spread by infection "like the plague of leprosy." Enlightened authorities in Europe took similar precautions.
CHAPTER FOUR
Education, Women, Churchmen, and The Law
The Place of Women in Medicine
Women played a part in treating and caring for the ill and distressed in a number of ways during the century. A few women dispensed medicine and enjoyed reputations as doctors, but it was in the field of obstetrics and as midwives that they made their most important contributions. Although women did what might be described generally as nursing, their contribution in this area was relatively insignificant when compared with the importance of the female nurse today. Any discussion of the place of women in seventeenth-century medicine should note the relationship between women, witchcraft, and medicine.
Although the references leave no doubt of the existence of female doctors and dispensers of medicines, the mention of them is infrequent. Mrs. Mary Seal, the widow of a Dr. Power, for example, administered medicine to Richard Dunbar in 1700. The wife of Edward Good was sought out in 1678 to cure a head sore and another "doctress" impressed the Reverend John Clayton, who had some insights into medical science himself, with her ability to cure the bite of a rattlesnake by using the drug dittany. In the same year that Good's wife was sought to treat the head sore, a Mrs. Grendon dispensed medicine to an individual who had injured his eyes in a fight. The exact status of these women, however, is unknown; it is highly unlikely that the female practicing medicine enjoyed the professional standing of a Dr. Pott or a Dr. Bohun—an old female slave also appears in the record as a doctor.
With medical knowledge limited and antisepsis unknown, the expectant mother of the seventeenth century fared better with a midwife than she would have with a physician. The midwife, whose training consisted of experience and apprenticeship at best, allowed the birth to be as free from human interference as possible and did not do a pre-delivery infection-producing examination.
Both the fees and the prestige of the midwife, judging by contemporary records from other colonies, were high. Unfortunately, the early Virginia sources throw little light on the activities of the midwife in this colony. Among the scattered references from Virginia records are found charges of 100 pounds of tobacco for the service of a midwife; the presence of two midwives assisted by two nurses and other women at a single birth; the payment of twelve hens for obstetrical services; and the delivery of a bastard child by a midwife.
Nursing duties were probably taken on by both men and women in addition to their regular occupations. The duties consisted not only of tending the sick—and there is no reason to believe this was done under the supervision of a physician—but also of burying the dead and arranging the funerals. While the patient lived, the nurse prepared food, washed linen, and did other chores to make the patient comfortable. When death came, the nurse was "the good woman who shall dress me and put me in my coffin," and who provided "entertainment of those that came to bury him with 3 vollys of shott & diging his grave with the trouble of his funeral included."
The medical ramifications of witchcraft have been suggested. One of the most interesting Virginia court cases of the century had as its principal subject a woman accused of the power to cause sickness. In an age when weapon salve was wiped on the weapon and not the wound, and when astrology was intimately associated with the practice of medicine, it is not surprising to find, also, the witch and her power to cause disease. Goodwife Wright stood accused of such powers in the colony's general court on September 11, 1626.
Goodwife Wright had caused, according to her accusers, the illness of a husband, wife, and child out of a spirit of revenge; and she was able to prophesy deaths as well. The details of the case brought against this woman accused of witchcraft reveal the more bizarre medical practices of the time. Goodwife Wright expected to serve as the midwife but the expectant mother refused to employ her upon learning that Wright was left-handed. Soon after affronting Wright in such a manner, the mother complained that her breast "grew dangerouslie sore" and her husband and child both fell sick within a few weeks. With circumstantial evidence of this kind, suspicion had little difficulty in linking the midwife with the sicknesses.
Testimony revealed that on another occasion she had used her powers to counter the actions of another suspected witch. Having been informed that the other witch was causing the sickness, Wright had the ill person throw a red-hot horseshoe into her own urine. The result, according to witnesses was that the offending witch was "sick at harte" as long as the horseshoe was hot, and the sick person well when it had cooled.
Churchmen and Medicine
Medicine was associated in many minds not only with the powers of evil but also with the forces for good. The clergyman in colonial America often practiced medicine, and the layman in some localities of Virginia could turn to the local parson for medical assistance.
Throughout the early Christian era and the medieval period, medicine and religion had had a close relationship. The New Testament had numerous references to the healing of the sick by spiritual means, and a casual relationship between sin and physical affliction had been assumed by many persons for centuries before the seventeenth. The hand of God was still seen by many in physical phenomena, whether disease or the flight of a comet. Not only was there a supernatural relationship seen between the God of the church and disease, but also a natural one between medicine and the church clergy, for they had staffed the medical schools for centuries. It is not surprising, then, that the parson-physician was no stranger to the Virginia colony.
As early as 1619, Robert Pawlett, known to be a preacher, surgeon, and physician, came to Virginia. He was followed by other parson-physicians in Virginia and in other colonies. As late as the end of the eighteenth century, the wife of George Washington called on the Reverend Greene, M.D., for medical advice.
Among the most interesting in this long tradition of ministers who practiced medicine is the Reverend John Clayton whose activities have been noted. Other persons residing in Virginia and combining the role of clergyman with a considerable interest in medicine were Nathaniel Eaton, who had a degree in medicine, and John Banister who was an active naturalist. As a naturalist, he made an important study of the plants of Virginia (Catalogue of Virginia Plants) which added to the literature available for the dispenser of medicinal drugs. One of the founders of Presbyterianism in America, the Reverend Francis Makemie, who came to America in 1681 and died in Accomack County, Virginia, was described as a preacher, a doctor of medicine, a merchant, an attorney—and a disturber of government by the governor of New York.
Law and Medicine
Although the Crown did not follow the lead of the Company in providing care for the sick and unsheltered, the authorities after 1624 did have the state take an interest in medicine to the extent of passing laws dealing with medical problems and situations. These laws were primarily concerned with the collection and charging of fees, but also provided for the censure of the physician or surgeon neglecting his patient.
On four occasions during the century the Assembly attempted to regulate the excessive and immoderate rates of physicians and surgeons. The chief example used to convey the injustice of fees for visits and drugs was that many colonists preferred to allow their servants to hazard a recovery than to call a medical man. Although an inhumane attitude, the colonists reasoned that the physician or surgeon would charge more than the purchase price of the servant.
The act of 1657-58 reveals this attitude and throws some light on the medical practice of the century. (Similar acts had been passed in 1639 and in 1645 and would be passed in 1661-62.) By the will of the Assembly, the layman had the right to bring the physician or surgeon into court if the charge for "paines, druggs or medicines" was thought to be unreasonable. The surgeon or physician had in court to declare under oath the true value of drugs and medicines administered, and then the court decided the just compensation.
The law went on to declare that:
Where it shall be sufficiently proved in any of the said courts that a phisitian or chirurgeon hath neglected his patient, or that he hath refused (being thereunto required) his helpe and assistance to any person or persons in sicknes or extremitie, that the said phisitian or chirurgeon shall be censured by the court for such his neglect or refusall.
Where it shall be sufficiently proved in any of the said courts that a phisitian or chirurgeon hath neglected his patient, or that he hath refused (being thereunto required) his helpe and assistance to any person or persons in sicknes or extremitie, that the said phisitian or chirurgeon shall be censured by the court for such his neglect or refusall.
The legislators also gave the physician or surgeon protection by providing that their accounts could be pleaded against and recovered from the estate of a deceased patient—suggesting that patients were not prompt enough in paying their bills (or perhaps did not survive treatment long enough to do so). Court records show that the medical men often took advantage of this provision for collection.
A measure enacted in 1692 indicated a more sympathetic attitude on the part of the legislators toward the physicians and surgeons. While in the earlier acts preventing exorbitant fees the court had been ordered to decide upon just compensation, the later act allowed the physician or surgeon to charge whatever he declared under oath in court to be just for medicines. Nor did the act of 1692 make reference to "rigorous though unskilful" or "griping and avaricious" physicians and surgeons as had the earlier laws.
References by the colonial Assembly to exorbitant fees were not without a basis in fact. The conventional charge for the physician's visit, according to Dr. Wyndham Blanton, was thirty-five to fifty pounds of tobacco and on occasions the physician, or surgeon, must have exceeded this fee. An approximate estimate of the value of these visits in present-day terms would be between twenty and twenty-five dollars. The cost of medical care was even greater when an unusually large amount of drugs was dispensed. It is not surprising that many masters did not provide the services of a physician or surgeon for their servants; nor that medical attention was given by persons without professional status. Although these charges seem high, it must be taken into account that because of the great distances between communities and even between homes, the physician or surgeon could make only a small number of visits each week.
County records give many examples of the fees of physicians and surgeons. Of 145 medical bills entered in the York County records between 1637 and 1700, the average bill was for 752 pounds of tobacco, or a little less than one laborer could produce in a year. Other fees were: 400 pounds of tobacco for six visits; 300 pounds of tobacco for three visits and five days attendance; 1,000 pounds of tobacco for twenty days of attendance "going ounce a weeke ... being fourteen miles"; and 600 pounds for twelve daily visits. At the time these charges were made, tobacco brought between two and three cents per pound, or the equivalent of approximately fifty cents today.
The surgeon administering the clyster or phlebotomy, those commonly resorted to "remedies," could be expected to charge thirty pounds of tobacco for the first and twenty pounds for the second. The surgeon, and the physician, often charged from twenty to fifty pounds of tobacco for a drug prescription.
In 1658, Dr. John Clulo presented a bill to John Gosling in York County which he itemized as follows (in pounds of tobacco):
Not only does Dr. Clulo's bill give examples of fees charged, but it supports the contention that the substance of medical treatment during the century was bloodletting, purging, and prescribing drugs.
Although the physicians of colonial Virginia did charge well for their services, it should be noted that they were in demand. Their patients, this would indicate, considered their services of great value, any subsequent protests notwithstanding.
The Education of Physicians and Surgeons
Since the physicians and surgeons did make substantial charges and since the educated layman could buy his own books on medicine and practice what he read or since the uneducated could turn to a neighbor with medical knowledge or to a quack, the question arises as to why the services of professional surgeons and physicians were in such demand. Part of the answer lies in the professional's experience, but even in a colony without a medical school it also lies in the education and training received by the professional.
There were several ways in which a seventeenth-century Virginia physician could acquire his education or training. He could have received a medical degree in England or on the continent and then gone to America. On the other hand, he might have learned without formal education—perhaps by attending lectures and by experience—and then established himself in Virginia where he was accorded professional status. A man born in Virginia could return to the Old World for training or formal education and then practice in Virginia. Also, a common manner of becoming a physician or surgeon in Virginia, which was without medical schools, was by apprenticeship. Finally, the importance of books—imported from Europe—as a means to medical education should not be minimized.
To be officially licensed for practice, the requirements in England were high—those in London especially so. The following excerpt from the statutes of the College of Physicians of London demonstrates how demanding the educational standards for seventeenth-century English physicians could be:
First, let them be examined in the physiologick part, and the very rudiments of medicine, and in this examination let questions be propounded out of the books concerning elements, temperaments, the use of parts, anatomy, natural powers and faculties, and other parts of natural medicine.Secondly let him be examined in the pathologick part, or concerning the causes, differences, symptoms and signs of diseases, which physicians make use of to know the essence of diseases; and in this examination let questions be proposed out of books concerning the art of physick, of the places affected, of the differences of diseases and symptoms, of feavers, of the pubes, of the books of prognosticks of Hippocrates, &c.Thirdly let him be examined concerning the use and exercise of medicine, or the reason of healing; and let that be done out of the books concerning preservation of health, of the method of healing, of the reason of diet in acute diseases, of simple medicines, of crises, of the aphorisms of Hyppocrates, and other things of that kind, which relate to the use of healing; for example sake, what caution to be observed in purging? in what persons? with what medicine? and in what vein, those things ought to be done? Likewise, what is the use of narcoticks and sleeping medicines? and what caution is to be observed in them? what is the position and site of the internal places? and by what passages medicines come to there? what is the use of clysters, what kind of vomits, the danger, kind and measure?
First, let them be examined in the physiologick part, and the very rudiments of medicine, and in this examination let questions be propounded out of the books concerning elements, temperaments, the use of parts, anatomy, natural powers and faculties, and other parts of natural medicine.
Secondly let him be examined in the pathologick part, or concerning the causes, differences, symptoms and signs of diseases, which physicians make use of to know the essence of diseases; and in this examination let questions be proposed out of books concerning the art of physick, of the places affected, of the differences of diseases and symptoms, of feavers, of the pubes, of the books of prognosticks of Hippocrates, &c.
Thirdly let him be examined concerning the use and exercise of medicine, or the reason of healing; and let that be done out of the books concerning preservation of health, of the method of healing, of the reason of diet in acute diseases, of simple medicines, of crises, of the aphorisms of Hyppocrates, and other things of that kind, which relate to the use of healing; for example sake, what caution to be observed in purging? in what persons? with what medicine? and in what vein, those things ought to be done? Likewise, what is the use of narcoticks and sleeping medicines? and what caution is to be observed in them? what is the position and site of the internal places? and by what passages medicines come to there? what is the use of clysters, what kind of vomits, the danger, kind and measure?
Under the London Company, the physicians and surgeons in Virginia had the same education, training, and met the same standards as their counterparts in England. This was, in part, because the Company had good reason to supply adequate medical service, and because the men sent were but Englishmen transplanted to America. Walter Russell, who came to Virginia in 1608 was a "Doctour of Physicke" and Lawrence Bohun, De la Warr's physician, had the same degree. Pott, who succeeded Bohun as physician-general of Virginia in 1621, came recommended as a Master of Arts well-practiced in surgery and physics.
After the Company's charter was annulled, few physicians or surgeons with the advanced medical degrees came to Virginia. Some of the persons, however, who practiced medicine in Virginia without medical degrees had acquired skills and knowledge in Europe or England before coming to the New World.
Patrick Napier who came to Virginia about 1655 as an indentured servant and subsequently had a large medical practice, probably learned his profession in England or on the Continent, as might have Francis Haddon, another who came under terms of indenture and who later, also, had a considerable medical practice. To these two examples of persons with training and experience acquired prior to their arrival in America might be added the similar experiences of John Williams and John Inman.
Medical knowledge and practices brought over from England were cross-fertilized with the European even in the New World. While the majority of newcomers were Englishmen, French, German, and other European physicians and surgeons came to Virginia. These European medical men appear, in general, to have prospered in Virginia and were anxious to become naturalized "denizens to this country."
George Hacke, born in Cologne, Germany, settled in Northampton County, Virginia, in 1653 and was known as a doctor and practitioner of medicine. He was typical of the European-trained medical man settling in Virginia in becoming naturalized and in leaving a considerable estate, including thousands of acres of land. Little is known of his medical activities and interests except that he was summoned to treat the victim of a duel and that he left a large library which probably included volumes on medicine.
Paul Micou, a young French physician who seems to have acquired his education abroad, settled on the shores of the Rappahannock river, near a place afterward called Port Micou, during the last decade of the seventeenth century. Cultured and educated, he soon won prominence and wealth as a physician (and surgeon), attorney, and merchant. County records in Virginia make numerous references to suits brought by him for nonpayment of fees, suggesting an extensive practice.
Because so many of the doctors and surgeons of seventeenth-century Virginia are given only slight mention in the records, it is impossible to know whether, in most cases, they had acquired their skills and educations before coming to Virginia, or even whether they were born in the New World. Nor is it known how many young men born in Virginia went back to England or Europe to study medicine; a reference made by the famous English surgeon, John Woodall, indicates that a Virginian named Wake may have studied under him in London.
Within the Virginia county records, however, can be found evidence indicating that a common method of learning the profession was by apprenticeship. One interesting example of the contract between apprentice and surgeon survives in the records of Surry County, Virginia; made in 1657, it bound Charles Clay to Stephen Tickner, surgeon, for a term of seven years. Clay swore to serve his master in whatever surgical or medical duties he was assigned, and Tickner promised to use his best skill and judgment to teach his apprentice whatever he knew of the art. Another contract for apprenticeship was made between Richard Townshend and the London Company's well-known Dr. Pott. This relationship included a breach of contract that occurred not infrequently between master and apprentice: Townshend argued in court that Pott was not teaching him the "art & misterye" for which he was bound.
As an apprentice, the would-be physician or surgeon could gather herbs for his master and assist him in treating the sick. If the apprentice could read, or if the master would teach him, then the novice could study the medical books in the doctor's library. Not only were volumes on medicine available, but in the libraries of the better-educated medical men, the apprentice could also familiarize himself with other fields of learning.
Dr. Pott had a reputation for knowing Latin, Greek, and Hebrew, and must have imparted much of his learning to Richard Townshend, his apprentice. Such would seem to be the case in view of the facts of Townshend's life. He became an apprentice to Pott in 1621 and by 1636 he was a member of the colony's highest political body, the council, and at the time of his death he possessed a considerable amount of land. In a day when schooling was hard to come by, apprenticeship to an educated man held great advantages.
Unfortunately catalogues of the libraries of medical men have not survived. There is proof, however, that physicians and surgeons did not neglect opportunities to collect volumes on medicine published in England and Europe. If utilized, these books could have helped offset the lack of a formal education in a university or medical school. Dr. Henry Willoughby of Rappahannock County, Virginia, left forty-four books on "phisick" in his estate. Dr. John Holloway, a leading physician of Accomack County, Virginia, from 1633 until his death in 1643, left thirteen books on surgery and medicine, all in English or Latin. Dr. Henry Andrews of York County had twenty books in Latin on medicine.
A great number of Virginians—some of them prominent—who did not practice medicine had, nonetheless, large collections of books on the subject. This would indicate that many persons resorted to medical treatment without the help of a professional. With fees high, distances great, and well-trained doctors scarce, self-reliance is not surprising. Many planters and their wives must have made a superficial study of medicine; certainly the mistress of the house visiting sick servants and slaves is a familiar historical picture.
Among the medical books in such libraries were volumes on the general subjects of medicine (physick) and surgery, anatomy, gout, scurvy, distillation, and natural magic. Common in the libraries of the laymen were books recommending specific drugs for various symptoms of diseases. The long title of one volume in a Virginia library read, "Method of physick, containing the causes, signes, and cures of inward diseases in man's body from the head to the foote. Whereunto is added the forme and rule of making remedies and medicines, which our physitions commonly use at this day, with the proportion, quantity, and names of each medicine."
The importance of medical volumes to the lay library is indicated by the inclusion of two in the supplies provided by a London agent for a Virginia plantation in 1620-21. William S. Powell, in a recent study of books in Virginia before 1624, found that the agent choseThe French Chirurgerye, published in English in 1597, and theEnchiridion Medicinae, first published in 1573.
In spite of medical books, the apprenticeships, training in Europe or England, and the demand for medical services despite a high fee, it is possible to overestimate the competence of the seventeenth-century Virginia doctor even by the standards of his own century. An observation made by William Byrd II early in the next century tends to reduce the stature of the medical man.
"Here be some men," Byrd wrote, "indeed that are call'd doctors; but they are generally discarded surgeons of ships, that know nothing above very common remedys. They are not acquainted enough with plants or other parts of natural history, to do any service to the world...." Byrd may have been prejudiced by his father who, although believing himself facing death, still did not call a physician.
CHAPTER FIVE
Conclusion
Portrait of a Seventeenth-Century Virginia Physician
Historical evidence does not support Byrd's description of the typical physician as a discarded ship's surgeon. In contrast, the physician, whatever his competence may have been, emerges from the sources as a respected member of the colony who, besides his medical practice, engaged in farming sizable holdings of land and took part in the civic life of the colony. His private life was not unlike that of the other planters who enjoyed some wealth and professional standing. The reputable surgeon, who could also supplement his income from farming, probably enjoyed an existence not unlike that of the physicians, considering that the distinction between them in the New World was slight.
Dr. Blanton, in his volume on medicine in Virginia, created a lively portrait of what he imagines from his researches to be the seventeenth-century Virginia doctor. The doctor is seen: