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Title: Medicine in Virginia, 1607-1699

Author: Thomas P. Hughes

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Language: English

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MEDICINE IN VIRGINIA, 1607-1699



By

THOMAS P. HUGHES

Assistant Professor of History, Washington and Lee University



VIRGINIA 350TH ANNIVERSARY CELEBRATION CORPORATION
WILLIAMSBURG, VIRGINIA
1957

COPYRIGHT©, 1957 BY
VIRGINIA 350TH ANNIVERSARY CELEBRATION
CORPORATION, WILLIAMSBURG, VIRGINIA

Second Printing, 1958

Third Printing, 1963


Jamestown 350th Anniversary
Historical Booklet, Number 21


[Transcriber's Notes: Research indicates the copyright on this book was
not renewed.

The Table of Contents was not printed in the original text but has been
added here for the convenience of the reader.]




CONTENTS


CHAPTER ONE
European Background and Indian Counterpart to Virginia Medicine     1

CHAPTER TWO
Disease and The Critical Years At Jamestown                        12

CHAPTER THREE
Prevalent Ills and Common Treatments                               31

CHAPTER FOUR
Education, Women, Churchmen, and The Law                           60

CHAPTER FIVE
Conclusion                                                         73

Acknowledgements and Bibliographical Note                          77




CHAPTER ONE

European Background and Indian Counterpart to Virginia Medicine


EUROPEAN BACKGROUND

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

That physicians in England did possess a high social status as well as
more extensive formal education is evidenced by a precaution taken by
the Virginia Company, to avoid causing displeasure among men of rank,
in preparing letters patent. The Company requested of the College of
Heralds, in 1609, the setting "in order" of the names of noblemen,
knights, and Doctors of Divinity, Law, and Medicine so that their
"several worths and degrees" might be recognized when their names were
inserted on the patents. Surgeons received no mention.

On the other hand, physicians and surgeons in England might well have
come from similar social backgrounds and even on occasions from the
same families. When there were three or four sons in the family of a
country gentleman, he might have followed the custom of keeping the
eldest at home to manage and eventually inherit the estate. The second,
then, would be sent to one of the universities in order to follow a
profession such as that of physician, lawyer, or clergyman. The third
might be apprenticed to an apothecary, surgeon, or a skilled craftsman.
This practice should be borne in mind when former medical apprentices
are found in high offices in Virginia; their origins were not always
humble.

Although the physician enjoyed the greatest social and professional
prestige, he received the most verbal abuse and criticism. Perhaps the
most damaging and galling satire of the century flowed from the pen of
the French dramatist, Molière, who had a medical student--not
completely fictitious--swear always to accept the pronouncements of his
oldest physician-colleague, and always to treat by purgation, using
clysters (enemas), phlebotomy (bloodletting), and emetics (vomitives).
These three curative measures followed the best Galenic technique:
releasing corrupting humors from the body. Molière's _Le Malade
Imaginaire_ confronted the audience with constant purgings and
bleedings, and the caricature was not excessive.

The diseases of the century did not allow for the inadequacies of the
physician, and imparted a grim note of realism to the satire of the
dramatist. Infant mortality was high and the life expectancy low.
Hardly a household escaped the tragedy of death of the young and the
robust; historians have sensed the influence omnipresent death had upon
the attitudes and aspirations of the European and American of earlier
centuries. School children today learn of such a dramatic killer as the
bubonic plague, but even its terrible ravages do not dwarf the toll of
ague (malaria), smallpox, typhoid and typhus, diphtheria, respiratory
disorders, scurvy, beriberi, and flux (dysentery) in the colonial
period.

England, and especially London with its surrounding marshes, suffered
acutely with the ague during the century. Englishmen arriving in the
New World were well aware of the dangers of this disease and made some
effort to avoid the bad air, and the low and damp places. In 1658 the
ague took such a toll that a contemporary described the whole island of
Britain as a monstrous public hospital. Unfortunately, Thomas Sydenham,
whose prestige in England was great and whose works on fevers were
influential, paid scant tribute to cinchona bark (quinine) which was
known but thought of, even by Sydenham, as only an alleged curative
offering too radical a challenge to current techniques. According to
humoral doctrine, fever demanded a purging, not the intake of
additional substances.

Unfortunately, public hygiene and sanitation enlisted few adherents.
Epidemics of the seventeenth century have been judged the most severe
in history. In Italy physicians ahead of their times proposed the
draining of marshes and pools of stagnant water, and recommended the
isolation of persons with contagious diseases. But it was the great
London fire of 1666 that rid that city of its infested and infected
places, not an enlightened municipality.

Therefore Virginia, a colony of seventeenth-century Europe, started
life burdened with a heritage of deadly and widespread disease and
inadequate medicine. Not only did the ships that brought the settlers
to Jamestown Island bring surgeons and medical supplies but also
medical problems frequently more serious than the men and supplies
could cope with.

The European or Englishman, however, did not originate the practice of
medicine in Virginia for the Indian had had to struggle with the
problems of disease and injury long before the seventeenth century.


INDIANS AND THEIR MEDICINE

Seventeenth-century Americans found the medical practices of the
Indians interesting enough to include descriptions of them in their
accounts of the New World. The attitude of the authors of these early
observations is a mixture of curiosity, wonder, and--on
occasion--admiration.

Henry Spelman, one of the early colonists, wrote of Jamestown and
Virginia as they were in 1609 and 1610. He described the manner of
visiting with the sick among the Indians. According to Spelman, the
"preest" laid the sick Indian upon a mat and, sitting down beside him,
placed a bowl of water and a rattle between them. Taking the water into
his mouth and spraying it over the Indian, the priest then began to
beat his chest and make noises with the rattle. Rising, he shook the
rattle over all of his patient's body, rubbed the distressed parts with
his hands, and then sprinkled water over him again.

Like the colonist, the Indian tried to draw out blood or other matter
from the sick or wounded person. The method often used for releasing
the ill humor from a painful joint or limb must have caused
considerable suffering but may have offered certain advantages in
preventing fatal infection. If the affected part could bear it, the
Indian thrust a smoldering pointed stick deep into the sore place and
kept it there until the excess matter could drain off. Another
technique for burning and opening had a small cone of slowly burning
wood inserted in the distressed place, "letting it burn out upon the
part, which makes a running sore effectually."

Still another method for treating a wound was for the priest to gash
open the wound with a small bit of flint, suck the blood and other
matter from it, and finally apply to it the powder of a root. A
colonist in describing the practice wrote that "they have many
professed phisitions, who with their charmes and rattels, with an
infernall rowt of words and actions, will seeme to sucke their inwarde
griefe from their navels or their grieved places." Judging by other
accounts written during the century concerning Indian medicine, the
powdered root may well have been sassafras, of which there was an
abundance in the Jamestown area. The priest dried the root in the
embers of a fire, scraped off the outer bark, powdered it, and bound
the wound after applying the powder.

Not only did the native American resort to a crude form of bloodletting
but he practiced sweating as well--which was also common to
seventeenth-century European medical practice. In Captain John Smith's
description of Virginia it was noted that when troubled with "dropsies,
swellings, aches, and such like diseases" the cure was to build a stove
"in the form of a dovehouse with mats, so close that a fewe coales
therein covered with a pot, will make the pacient sweate extreamely."

Before lighting his stove, the Indian covered his sweating place with
bark so close that no air could enter. When he began to sweat
profusely, the sick Indian dashed out from his heated shelter and into
a nearby creek, sea, or river. An Englishman commented that after
returning to his hut again he "either recover[s] or give[s] up the
ghost."

The Indians, like Molière's stage physician, believed in the value of
the purge. Every spring they deliberately made themselves sick with
drinking the juices of a medicinal root. The dosage purged them so
thoroughly that they did not recover until three or four days later.
The Indians also ate green corn in the spring to work the same effect.

The Indian medicine man, like his European counterpart, frequently
dispensed medicines or drugs. As has been the custom among many men in
the medical profession, the medicine man would not reveal the secrets
of his medicines. "Made very knowing in the hidden qualities of plants
and other natural things," he considered it a part of the obligations
of his priesthood to conceal the information from all but those who
were to succeed him. On the other hand, the Indian priest showed his
concern for the health of his people--and the similarity of his
attitude to that of present day practices--by making an exception to
his canon of secrecy in the case of drugs needed in emergencies arising
on a hunting trip and during travel.

According to one early eighteenth-century history of Virginia, the
Indian in choosing raw materials for drugs preferred roots and barks of
trees to the leaves of plants or trees. If the drug were to be taken
internally it was mixed with water; when juices were to be applied
externally they were left natural unless water was necessary for
moistening. Whatever the drug and however utilized, the Indian called
it _wisoccan_ or _wighsacan_, for this term was not a specific herb,
as some of the earlier settlers thought, but a general term.

Besides sassafras, medicinal roots and barks, the Indian believed in
beneficial effects of a kind of clay called _wapeig_. The clay, in the
opinion of the Indians, cured sores and wounds; an English settler
marvelled to find in use "a strange kind of earth, the vertue whereof I
know not; but the Indians eate it for physicke, alleaging that it
cureth the sicknesse and paine of the belly." Insomuch as the Indian
priest preferred to keep his professional secrets, the colonist was
unlikely ever to learn the "vertue" of the clay.

If the Indian medicine man had not believed that his gods would be
displeased--or his prestige lowered--by revealing the nature of the
_wisoccan_ he prescribed, it would have been possible for the early
Virginians to have drawn upon the Indian knowledge of, and experience
with, the simples and therapies of the New World. (Perhaps the
"vertues" of the clay would have cured the "paines" of the Jamestown
bellies.) As it was, the settlers make little mention of a reliance
upon the Indians for medical assistance.




CHAPTER TWO

Disease and The Critical Years At Jamestown


MOTIVES AND PROVISIONS FOR COLONIZATION

In 1606 King James of England granted a charter to Sir Thomas Gates and
others authorizing settlements in the New World. In 1609 this charter
was revised and enlarged, granting the privileges to a joint-stock
company. Among the merchants, knights, and gentlemen holding shares in
the company and among those particularly interested in the more
southerly areas of North America, including Virginia, were a number of
physicians. The instructions given to the first settlers reflect the
general concern of the London Company for the health of the colony and
perhaps the particular interest of the physicians. One of the
physicians, John Woodall, took especial care to urge that cattle be
sent to provide the settlers with the milk he considered essential to
their health.

Not only did the Company wish to lessen the dangers of disease in the
New World, but it also urged colonization as a means of reducing the
plague in England. In 1609 the Company advised municipal authorities in
London to remove the excess population of that great city to Virginia
as the surplus was thought to be a cause of the plague. There was
little danger of a surplus population during the initial years in
Virginia.

Before the colonists, or the Company, however, had to be concerned with
dangers from disease in Virginia, the colonists had to undertake an
extremely difficult and unhealthy voyage across the Atlantic.


DISEASE AND THE OCEAN VOYAGE

Ships plying the Atlantic at the beginning of the seventeenth century
were small and the voyage was lengthy. Four months passed before the
_Godspeed_, the _Discovery_, and the _Susan Constant_, carrying the
first permanent settlers to Jamestown, sighted the two capes at the
mouth of Chesapeake Bay in April, 1607.

Although these small ships carrying the first permanent settlers had a
stopover in the West Indies for rest and replenishment, there had been
debilitating months at sea and more than 100 emigrants to provide for
in addition to the crews. With limited cargo and passenger space, water
and food supplies could hardly satisfy the demand created by a hundred
persons at sea for hundreds of days. Several of the emigrants died on
the first voyage and the remainder disembarked poorly prepared for the
new tests their constitutions would soon endure.

The sea voyage of these first settlers probably exacted no heavier a
death toll and caused no more suffering because the ships went by way
of the Canaries and the West Indies instead of by the more northerly
route by-passing the islands. A contemporary described the advantages
thought to be had from the stopover in the West Indies (at the island
of Nevis):

    We came to a bath standing in a valley betwixt two hills, where wee
    bathed ourselves.... Finding this place to be so convenient for our
    men to avoid diseases which will breed in so long a voyage, wee
    incamped our selves on this ile sixe dayes, and spent none of our
    ships victuall.

Anchoring off other West Indian islands the ships were able to
replenish their stores with fresh meat and fish and to replace the
evil-smelling and foul water in their casks with fresh. By these
measures the colonists demonstrated a concern not only for comfort but
also for hygienic precautions.

Later voyages during the century took anywhere from two to three
months. Despite the precautions taken by some, of a rest, in the West
Indies to bring about "restitution of our sick people into health by
the helpes of fresh ayre, diet and the baths," the trip aboard the
pestered ships continued to exact a heavy death toll and to discharge
disease and diseased persons. Benefits resulting from the stopover in
the Indies were countered by the considerable exposure to tropical
infections. One convoy carrying colonists to Virginia in 1609 and
running a southerly course through "fervent heat and loomes breezes"
had many of the crew and passengers fall ill from calenture (tropical
or yellow fever). Out of two ships so afflicted, thirty-two persons
died and were thrown overboard. Another of these ships reported the
plague raging in her.

Irritated by frequent references to the unhealthy climate of Virginia
and fearful that the bad publicity would increase the difficulties in
obtaining colonists, officials of the London Company took pains to
expose the part that the ocean voyage played in bringing about the
deaths of newcomers. Musty bread and stinking beer aboard the pestered
ships, according to a contemporary, worked as a chief cause of the
mortality attributed falsely to the Virginia climate and conditions at
Jamestown. In 1624 Governor Wyatt and his associates recommended to
commissioners from England that "care must be had that the ships come
not over pestered and that they may be well used at sea with that
plenty and goodness of dyet as is promised in England but seldom
performed." Others complained of the crowding of men in their own
"aires," uncleanliness of the ships, and the presence of fatal
"infexion."

Insomuch as seventeenth-century medical theory paid scant attention to
sanitation and hygiene in the study of the causes of disease, it is
surprising to find the early Virginian rightly recognizing the ships as
sources of sickness. On the other hand, observation could not help but
lead passengers to conclude that sickness, such as flux or dysentery,
with which they had to suffer aboard ship, might have a causal
relationship to the ship. To have related the transmission of the
plague from epidemic centers in England via infected shipboard rats,
and transmission of tropical fevers, as well, by the medium of
shipboard water buckets infected with mosquito larvae from the tropics,
was beyond the capacity of both medical theory and of first-hand
observation.

Physicians or surgeons did ship aboard the seventeenth-century
ocean-going vessels, but Doctor Wyndham B. Blanton, the chief authority
on seventeenth-century Virginia medicine, concludes that most of them
probably had poor educations and little more to recommend them than "a
smattering of drugs, a little practice in opening abscesses and a
liking for the sea." A seventeenth-century contemporary recommended
that a ship's surgeon--surgeons went to sea far more often than
physicians--be the possessor of a certificate from a barber-surgeon
guild and be freed from all ship's duties except the attending of the
sick and the cure of the wounded. The ship's surgeon, then, crossed the
professional line between surgeon and physician, a line that necessity
would soon force so many medical men to cross in America.

Throughout the century ship's surgeons abandoned their shipboard duties
to settle in the Virginia colony, and there seems little reason to
doubt that those remaining aboard ship took advantage of the
opportunity when in port to help meet the medical needs of the
colonists, thus supplementing the medical talent which had taken up
residence in Virginia.

The labors of the ship's surgeon at sea, no matter how valiant, could
not offset the miseries of the long sea voyage, and the sight of
Virginia's coast greatly cheered all hands. After the foul air, crowded
quarters, and inadequate provisions of the ship, many settlers must
have reacted to the Virginia land as Captain John Smith did: "heaven
and earth never agree better to frame a place for man's habitation." It
is not surprising then that the first permanent settlers were somewhat
less than careful when evaluating, against standards of health, the
possible sites for settlement.


THE SELECTION OF SITES FOR SETTLEMENT

In a fairly extensive set of instructions "by way of advice, for the
intended voyage to Virginia," the London Company, in 1606, took into
account the part that disease and famine could play in the life--or
death--of the colony. Probably knowing that the chances for survival of
the Spanish conquistadors had been enhanced by their superhuman
qualities in the eyes of the Indians, the Company urged that no
information on deaths or sicknesses among the whites be allowed to the
natives. More important, as the course of events was to demonstrate,
was the advice not to:

    plant in a low or moist place, because it will prove unhealthfull.
    You shall judge of the good air by the people; for some part of
    that coast where the lands are low, have their people blear eyed,
    and with swollen bellies and legs: but if the naturals be strong
    and clean made, it is a true sign of wholesome soil.

The idea that climate had an influence upon human physiognomy did
not originate with the London Company. In an essay dating back to
the fifth century B.C. and preserved among the works of the
Hippocratic school the ancient--but in the seventeenth century
still influential--authorities argued that human physiognomies
could be classified into the well-wooded and well-watered mountain
type; the thin-soiled waterless type; the well-cleared and
well-drained lowland type; and the meadowy, marshy type.

The London Company's instructions to the first permanent settlers to
avoid low-lying, marshy land, if followed, might have saved the
colonists from some of the sicknesses they were to endure, but other
considerations dictated the choice of the Jamestown site; the
peninsular, about thirty miles upstream, provided natural protection
and a good view up and down the river. The danger from the ships of
other European peoples seemed more immediate and formidable than those
from the mosquito, with its breeding place in the nearby swamp, and
from the foul and brackish drinking water.

As the century progressed, the settlers pushed inland from Jamestown
and the low-lying coastal region, up onto the drier land. The danger
from typhoid, dysentery, and malaria grew steadily less. In choosing
home sites--once the confines of the peninsula were left behind and the
fear of attack from Indian or European was less--the early planters
took into consideration the dangers of the fetid swamp and muggy
lowland.

That the promotion of health did play a part in the selection of sites
for settlement is borne out by the re-location of the seat of
government from the languishing village of Jamestown to Middle
Plantation or Williamsburg. After an accidental fire destroyed a large
part of Jamestown at the end of the century, the people indicated a
desire to move away from an environment, recognized as unhealthful, to
Middle Plantation, known for its temperate, healthy climate as well as
for its wholesome springs. The inhabitants had contemplated a move
earlier in the century for health reasons but authorities in England
and governors in Virginia acted to prevent the abandonment of the only
community even approaching the status of a town.

The move away from Jamestown would probably appear a wise measure even
to the twentieth-century physician; to the seventeenth-century
physician, who often saw a close relationship between climatic
conditions and disease, the move seemed imperative. A man well-versed
in science and medicine, living in Jamestown a decade or so before the
town was abandoned, exemplified this medical theory when he wrote that
an area was unhealthy according to its nearness to salt water. He had
observed that salt air, especially when stagnant, had "fatal effects"
on human bodies. In contrast, clear air (such as would be enjoyed at
Middle Plantation) had beneficial effects.

Considerations of health and the effects of disease not only influenced
the settlers in their choice of living sites but also in many of their
other activities. Political, economic, and social history in
seventeenth-century Virginia was determined in part by health and
disease.


DISEASE AS A DETERMINING FACTOR IN THE EARLY YEARS OF THE COLONY

Death from disease and incapacitation from disease are challenges to
which every civilization--and human community--must successfully
respond in order to survive. Historian Arnold J. Toynbee has emphasized
the vital character of the challenge and response relationship in the
history of all communities. A particular challenge to which early
Jamestown almost succumbed was disease. The actions--or inactions--of
the settlers under the London Company, 1607-1624, demonstrated
especially well the influence of the challenge of disease upon the
early history of Virginia.

During the first year of the settlement at Jamestown, disease worked as
an important factor in the realm of politics. In this connection,
Edward Maria Wingfield, chosen first president of the governing council
in Virginia, found himself removed from office, imprisoned, and sent
home by the spring of 1608, all as a result of charges brought against
him that for the most part were petty and contradictory. Pettiness and
contradictions, in this instance, were rooted in the miserable
conditions which the colonists had to endure their first summer: famine
and sickness not only demoralized the colonists but were killing them
faster than they could be buried.

Wingfield left office as president of the council after the first
summer spent in Jamestown. The sickness that caused much tension during
his tenure was probably the malady loosely described by early
Virginians as the "seasoning." The complex of symptoms ascribed to the
seasoning bothered the settlers throughout the seventeenth century.
Even as late as 1723 a recent arrival in Virginia wrote that "all that
come to this country have ordinarily sickness at first which they call
a seasoning of which I shall assure you I had a most severe one."
During the first two summers, 1607 and 1608, however, this seasoning
inflicted the most distress, judging by the seriousness with which
contemporaries described it.

One of these contemporary accounts, written by George Percy who sailed
to Virginia with the first settlers in 1606-07, described the distress
caused by seasoning and famine during the summer of 1607. The awfulness
of that summer is made more dramatic by the manner in which Percy
introduced the subject. Having described the voyage over, which was
relatively pleasant with the stopover in the beautiful West Indian
islands, and having entertained the reader with startling accounts of
the habits of the savages in Virginia ("making many devillish gestures
with a hellish noise, foming at the mouth, staring with their eyes,
wagging their heads and hands in such a fashion and deformitie as it
was monstrous to behold"), Percy abruptly began listing the names of
the dead as his narrative moved into the late summer months:

    The sixt of August there died John Asbie of the bloudie flixe. The
    ninth day died George Flowre of the swelling.... The fifteenth day,
    their died Edward Browne and Stephen Galthorpe. The sixteenth day,
    their died Thomas Gower Gentleman. The seventeenth day, their died
    Thomas Mounslic....

The remainder of the description of the significant events of the month
of August is given over entirely to the listing of the deaths. Seldom
did Percy give the cause of individual deaths, but as the narrative
moved into September and near the end of the seasoning period, Percy
stopped his grim listing to comment in general terms upon the unhappy
experience.

According to his diagnosis--and perhaps he was enlightened by Thomas
Wotton and Will Wilkinson, the two surgeons who arrived with the first
settlers--the heavy death toll of August resulted from such ailments as
fluxes, swellings, and burning fevers as well as from famine and
attacks by the Indians.

Percy was of the opinion that the colonists at Jamestown suffered more
during the summer and winter of 1607 than any other Englishmen have
during a colonization venture. Weakened by the debilitating summer and
unable during that period to make the necessary provisions for the
winter, the settlers, their ranks depleted, also fared poorly during
the next five months.

In describing their distress, he revealed the conditions that bred the
diseases and illnesses to which the colonists fell prey. They lay on
the bare ground through weather cold and hot, dry and wet, and their
ration of food consisted of a small can of barley sod in water--one can
for five men. Drinking water came from the river which in turn was salt
at high tide, and slimy and filthy at low. With such food and drink,
the small contingent within the fort lay about for weeks "night and day
groaning in every corner ... most pittifull to heare."

Fortunately during the course of the winter the Indians did come to the
relief of the colonists with provisions, but before this help was
substantial, Percy observed:

    If there were any conscience in men, it would make their harts to
    bleed to heare the pitifull murmurings and out-cries of our sick
    men without reliefe, every night and day, for the space of sixe
    weekes, some departing out the world, many times three or foure in
    a night; in the morning, their bodies trailed out of their cabines
    like dogges to be buried.

Over one-half (approximately 60) of the original settlers perished
during the summer of 1607 and the seasoning was to prove a hazard
throughout the remainder of the century. Its effects became less
serious, however, as the Company and the colonists, profiting from the
earlier experiences began to plan departures from England so that the
immigrants would arrive in Virginia in the fall: another example of the
influence of disease.

Governor Yeardley, writing some years later--in 1620--reminded the
Company's officials in England of the advantages of a fall arrival. He
had just witnessed the distress of immigrants from three ships that had
arrived in May:

    had they arrived at a seasonable time of the year I would not have
    doubted of their lives and healths, but this season is most unfit
    for people to arrive here ... some [came] very weak and sick, some
    crazy and tainted ashore, and now this great heat of weather
    striketh many more but for life.

At least twenty more immigrants died during the second summer (1608)
and the misery and discontent of the survivors of the summer's
sicknesses account--in part, at least--for the disposal of another
council president, John Ratcliffe. Returning to Jamestown after an
exploratory trip up Chesapeake Bay, Doctor Walter Russell, one of the
company, found the latest arrivals to Virginia "al sicke, the rest,
some lame, some bruised, al unable to do any thing but complain of the
pride and unreasonable needlesse cruelty of their sillie President."
The wrath of these sick--and doubtless somewhat querulous and
irrational men--was appeased by the removal of the "sillie" president.

The ability of Captain John Smith, who succeeded to the presidency of
the council in the fall of 1608, to impose his strong will upon the
inhabitants of the peninsula, and to exert such a great influence upon
the course of events is explained, in part, by the depletion of ranks
and the demoralization of spirit caused among them by the dreadful toll
of disease. When other members of the council died, Smith did not
replace them and, rid of strong opposition, he ruled as a benevolent
despot.

Smith's departure from the colony in October, 1609, had as its
immediate cause--according to Smith--the impossibility of his obtaining
proper medical attention in Virginia for burns acquired from a
gunpowder explosion. When Smith sailed, his enemies, of which there
were a considerable number, breathed freer air, but the colony
subsequently suffered without his strong, authoritative voice.

Supporters of Smith argued that if that "unhappy" accident had not
occurred, he could have stayed on and solved the many problems that
were to beset the colony. On the other hand, it is pointed out that the
wound would have been better treated at Jamestown than on board ship,
and that Smith used the wound, which was not too serious, as an excuse
to escape from the administrative troubles that plagued him.

The powder blast was described by friends of Smith as tearing a nine or
ten-inch square of flesh from his body and thighs, and as causing him
such torment that he could not carry out the duties of his position.
The wound was probably complicated by the fact that the accident had
occurred when Smith was in a boat many miles from Jamestown. He had had
to cover the great return distance after having plunged into the water
to ease his agony, and without having the assistance of either
medicines or medical treatment. Whatever the seriousness of the wound,
supporters of Smith maintained that he was near death and had to leave
Jamestown in order to secure the services of "chirurgian and
chirurgery... [to] cure his hurt."

Twice in 1608, Captain Newport had brought immigrants and supplies to
the colony and, in the summer of 1609 about 400 passengers had landed
at Jamestown. These new arrivals, some of them already afflicted with
the plague, others victims of various fevers, and all suffering from
malnutrition, needed strong leadership to force them to plant busily
and to lay in food supplies for the winter ahead. Supplies brought over
aboard the ships could not possibly furnish nourishment for the coming
months. Malnutrition as a factor contributing to sickness, and sickness
as a factor preventing the labor necessary to circumvent starvation,
constituted a vicious relationship.

The winter of 1609-10 after Smith's departure is remembered as the
"Starving Time." During this period the number of colonists dropped
from 500 to about sixty. Men, women, and children lived--or
died--eating roots, herbs, acorns, walnuts, berries, and an occasional
fish. They ate horses, dogs, mice, and snakes without hesitation after
Indians drove off hogs and deer belonging to the colonists. The Indians
also kept the settlers from leaving the protection of Jamestown to go
out and hunt for food. When hunting was not made impossible by Indians,
the settlers' own physical weaknesses often precluded energetic action.

The notorious, and possibly untrue, incident of the man whom hunger
drove to kill and to eat the salted remains of his wife, is from the
accounts of the Starving Time. Although this story had the support of a
number of colonists, others maintain that it, and the entire episode of
the famine, came out of the exaggeration of colonists who abandoned the
venture and returned to England. Yet the verdict of historians
establishes a Starving Time, and the high mortality of the winter must
have an explanation.

To argue that all those who died, died of starvation would, on the
other hand, be a distortion. Food deficiencies did not always lead
directly to death but in many cases to dietary disease. These dietary
diseases often terminated in death, but their courses might well not
have been fatal if proper medical attention could have been given. In
other cases food deficiency resulted in so weakened a physical
condition that the body fell prey to infectious diseases which, again,
could not be cured with the limited medical help available.

The Starving Time did not stand out as a time of want to be contrasted
with a normal time of plenty. For many the winter of 1609-10 only
brought to a crisis dietary disorders of long standing. One account of
the early years describes the daily ration as eight ounces of meal and
a half-pint of peas, both "the one and the other being mouldy, rotten,
full of cobwebs and maggots loathsome to man and not fytt for
beasts...."

Nor was the Starving Time the last time that the colonists would have
to endure famine and privation. Although written to discredit the
administration of Sir Thomas Smith as head of the Company during the
years from 1607-19, an account of the hunger of these twelve years
should be accepted as having some basis in fact. The account, written
in 1624, reported as common occurrences the stealing of food by the
starving and the cruel punishments meted out to them (one for
"steelinge of 2 or 3 pints of oatemeal had a bodkinge thrust through
his tounge and was tyed with a chaine to a tree untill he starved");
and the denial of an allowance of food to men who were too sick to work
("soe consequently perished").

The starving colonists during these twelve years, according to the
report, often resorted to dogs, cats, rats, snakes, horsehides, and
other extremes for nourishment. Many, in those hungry times, weary of
life, dug holes in the earth and remained there hidden from the
authorities until dead from starvation. Although the report maintained
that these events occurred throughout the twelve-year period, it is
likely that many were concentrated during the Starving Time.

Famished, disease-ridden, demoralized, with many mentally unbalanced,
the settlement at Jamestown languished in a distressful condition after
the winter of 1609-10. Jamestown, in May, 1610 appeared:

    as the ruins of some auntient [for]tification then that any people
    living might now inhabit it: the pallisadoes... tourne downe, the
    portes open, the gates from the hinges, the church ruined and
    unfrequented, empty howses (whose owners untimely death had taken
    newly from them) rent up and burnt, the living not hable, as they
    pretended, to step into the woodes to gather other fire-wood; and,
    it is true, the _Indian as fast killing without as the famine and
    pestilence within_.

The Indians, however, would not make a direct assault on the fort; they
waited on disease and famine to destroy the remaining whites. How many
of the graves now at Jamestown must have been dug during that terrible
winter? The Starving Time has been characterized by historian Oliver
Chitwood as "the most tragic experience endured by any group of
pioneers who had a part in laying the foundations of the present United
States."

By spring of 1610 the challenge of famine, pestilence, and disease had
proven too great; the warfare of Europeans and savages, for which the
settlers had made provisions in the selection of the Jamestown site,
had not proven as great a threat as disease and famine. Under the
command of Sir Thomas Gates and Sir George Somers, who had only just
arrived with plans for the future of the settlement, the small band of
survivors boarded ship to abandon an abortive experiment in European
colonization.

Before leaving, the survivors of the winter had had a consultation with
Gates and Somers about future prospects for the colony. Chiefly fear of
starvation determined the decision to abandon the settlement: the
provisions brought by Gates and Somers would have lasted only sixteen
days. The colonists could hold out no hope of obtaining food from the
Indians. ("It soone then appeared most fitt, by general approbation,
that to preserve and save all from starving, there could be no readier
course thought on then to abandon the countrie.")

After embarking, the settlers, with Gates, Somers, and the new
arrivals, had reached the mouth of the river when they met Lord De la
Warr, the new governor of the colony, coming from England with fresh
supplies and settlers. Heartened, the survivors of the Starving Time
turned back to try the New World again.

In Lord De la Warr's company was Dr. Lawrence Bohun, a physician of
good reputation, who subsequently distinguished himself serving the
medical needs of the settlement. He could not, however, even in his
capacity of personal physician, prevent Lord De la Warr from falling
victim to the common ailments.

In 1610, Lord De la Warr wrote: "presently after my arrival in
Jamestowne, I was welcomed by a hot and violent ague, which held mee a
time, till by the advice of my physician, Doctor Lawrence Bohun I was
recovered." Bohun, in the seventeenth-century tradition of treatment by
clysters, vomitives, and phlebotomy, resorted to bloodletting. The
letting, believed to free the body of fermented blood and malignant
humors, probably gave the governor a psychological lift, if only a
temporary one.

De la Warr, who blamed the distress of the colony upon the failures of
the settlers, soon had another taste of the illnesses which so many of
the colonists endured during their first months in the New World. In
his report to the Company explaining his early departure from the
colony, he included one of the fullest surviving accounts of sickness
at Jamestown during the first few years of settlement:

    That disease [the hot and violent ague] had not long left me, til
    (within three weekes after I had gotten a little strength) I
    began to be distempered with other greevous sicknesses, which
    successively and severally assailed me: for besides a relapse into
    the former disease, which with much more violence held me more than
    a moneth, and brought me to great weakenesse, the flux surprised
    me, and kept me many daies: then the crampe assaulted my weak body,
    with strong paines; and afterwards the gout (with which I had
    heeretofore beene sometime troubled) afflicted mee in such sort,
    that making my body through weakenesse unable to stirre, or to use
    any maner of exercies, drew upon me the disease called the scurvy;
    which though in others it be a sicknesse of slothfulnesse, yet was
    in me an effect of weaknesse, which never left me, till I was upon
    the point to leave the world.

When a person of strong constitution, living under the best conditions
the colony could provide, and accompanied by a well-trained physician,
found himself thus incapacitated, it is no wonder that the rank and
file of the colony failed to pursue energetically by hard work and
exemplary conduct their own best interests.

The firmness of De la Warr, who was much more indulgent of his own than
of others' disorders, brought additional stability to the colony, but
the attack of scurvy, which current opinion believed could be relieved
only by the citrous fruits of the West Indies, caused him, accompanied
by Dr. Bohun, to set sail from Virginia in the spring of 1611 for the
same island of Nevis praised so highly for its baths by the first
settlers of 1607. Disease had robbed the colony of another outstanding
leader during a period when strong leadership on the scene was
imperative.

Although the colony had experienced its worst years of hardship before
De la Warr departed and the worst years in the New World had been
caused by famine and disease, sickness and starvation were still to
have a noteworthy effect. Disease no longer threatened the colony's
life, but it shaped its history.

In 1624 the charter of the Company was annulled and, in explaining this
major development, account must be taken of the cumulative effects of
sickness and hunger upon the Company's fortunes; the first summer's
seasoning and the Starving Time, for example, had long-term economic
repercussions as well as short-term results in human suffering.

The Company had been in financial difficulties for some years and by
1624 the treasury was empty and the indebtedness heavy. If the
mortality rate had not been so high and the level of energy of the
colonists so reduced, the Company might have prospered. For example,
local trade with the Indians necessitated small ships for the effective
transportation of cargo, but several attempts by the Company to send to
America boatwrights to construct such ships failed because of the
deaths of the boatwrights. The Company had hoped in 1620 to better its
financial condition by developing an iron industry in the colony, but
this project suffered from the effects of disease, too, as the chief
men for the iron works died during the ocean voyage. The remainder of
the officers and men sent to establish the works died in Virginia
either from disease or at the hands of the Indians. The high cost to
the Company of the labor and services lost because of the early deaths
of persons still indentured for a period of years cannot be estimated.
Nor can the number of goals set by the colonists and the Company but
never fulfilled because of sickness be tabulated. As late as 1623 a
colonist wrote that "these slow supplies, which hardly rebuild every
year the decays of the former, retain us only in a languishing state
and curb us from the carrying of enterprise of moment."

In suggesting the part that famine and disease played in the annulment
of the Company's charter, the effects of one more period of intense
suffering must also be considered. In March, 1622, a bloody Indian
massacre occurred in which more than 350 white men, women, and children
died. Not only did the massacre cause a subsequent period of disease,
famine, and death among the survivors, but the heavy casualties
inflicted directly by the Indians can be explained, partially, by the
weakened condition and depleted ranks of the colonists before the
massacre.

So tenuous was the colony's ability to maintain an adequate and
healthful living standard, that the destructive and disrupting impact
of the massacre brought a period of severe famine and sickness. After
the raid the surviving colonists had to abandon many of the outlying
plantations with their arable fields, livestock, and supplies. And
having had the routine of life interrupted, the settlers--their numbers
unfortunately increased by a large supply of new immigrants, sent by
ambitious planners in England--came to the winter of 1622-23 poorly
provisioned.

Toward the end of this winter, famine reduced the settlers to such
conditions that one wrote to his parents that he had often eaten more
at home in a day than in Virginia in a week. The beggar in England
without his limbs seemed fortunate to the Virginian who had to live day
after day on a scant ration of peas, water-gruel, and a small portion
of bread. Another wrote that the settlers died like rotten sheep and
"full of maggots as he can hold. They rot above ground." As in 1609-10,
inadequate diet weakened the body and made it easy prey to infection.

During this winter the colonists--in addition to suffering from want of
food--had to endure a "pestilent fever" of epidemic proportions matched
only by the seasoning of 1607. About 500 persons died in the course of
the winter.

The origin of the winter's epidemic, according to contemporaries, lay
in the infectious conditions of numbers of the immigrants who had been
poisoned during the ocean voyage "with stinking beer" supplied to the
ships by Mr. Dupper of London. It is more likely that the pestilent
fever of the winter was a respiratory disease rather than a disorder
resulting from "stinking beer." Another commentator on the winter
called attention to the continued "wadinge and wettinge" the colonists
had to endure, bringing them cold upon cold until "they leave to live."

Whether continual wadings and wettings brought on respiratory diseases,
or bad beer dietary, is debatable, but the critics of the Company used
the dreadful winter of 1622-23 to discredit its administration. They
pointed out that the Company had sent large numbers of immigrants to
Virginia without proper provisions, and to a colony without adequate
means of providing food and shelter for them. Many of these persons had
subsequently died during the winter of 1622-23.

The Company, embarrassed by failures in Virginia--many of which
resulted directly from unhappy combinations of famine and disease--and
plagued by political dissension and economic difficulties, had its
charter annulled in May, 1624. One of the most adversely critical--and
somewhat prejudiced--tracts written against the Company summed up
conditions in the colony after fifteen years under its direction:

    There havinge been as it is thought not fewer than tenn thousand
    soules transported thither ther are not through the aforenamed
    abuses and neglects above two thousand of them at the present to be
    found alive, many of them alsoe in a sickly and desperate estate.
    Soe that itt may undoubtedly [be expected that unless the defects
    of administration be remedied] that in steed of a plantacion it
    will shortly gett the name of a slaughterhouse....

The Company did not live on after 1624 to acquire such a name, but
during its short--and unhealthy--existence the effects of disease on
history were manifest. Company instructions gave attention to health
requirements; ocean sailings depended upon health conditions; famine
and disease almost caused the early abandonment of the colony; strong
administrators left, for reasons of health, a Virginia sorely in need
of leadership; poor health conditions resulting in lowered morale
undermined local leaders; and the over-all economic welfare of the
colony suffered from the long-term and short-term effects of famine and
disease. The intimate or personal hardships endured by the individual
settlers because of disease and famine cannot be enumerated, but the
persistent influence that the summation of all the individual suffering
had on the general spirit and ethics of early Virginia cannot be
overlooked.

Disease and famine did not cease to influence Virginia history in 1624,
but their great importance during the first two decades has been
emphasized because they were then a factor exerting a major influence,
perhaps the predominant one.




CHAPTER THREE

Prevalent Ills and Common Treatments


COMMON AND UNCOMMON DISEASES

As has been noted, the seasoning caused great distress and a high
mortality among the new arrivals to the colony throughout the
seventeenth century. These Virginians--authorities on medicine or
not--had, for the origins of this malady, their own explanations which
furnish clues for more recent analysis. The general term "seasoning" is
of little assistance to the medical historian attempting to understand
three hundred year-old illnesses in twentieth-century terms.

According to seventeenth-century contemporaries, the pathology of
seasoning might be described as follows. The immigrants disembarked
from their ships tired and underfed--generally in poor health. From
their ships they took up residence in a Jamestown without adequate food
supplies of its own, and without shelter for the new arrivals. Many of
the new settlers had to sleep outside, regardless of the weather, for a
number of days after arrival. Then they exposed themselves to the
burning rays of the sun, the "gross and vaporous aire and soyle" of
Jamestown, and drank its foul and brackish water.

The foul and brackish drinking water would seem to be the most probable
casual agent in the opinion of more recent medical authority. In this
water, Dr. Blanton believes, lurked the deadly typhoid bacillus--the
killer behind the mask of the seasoning. Typhoid is not the only
possibility, but burning fever, the flux (diarrhea), and the
bellyache--symptoms listed in the early accounts--indicate typhoid.
Other diseases that may have caused the seasoning were dysentery,
influenza, and malaria; and these may have been the seasoning during
some of the later summers of the century.

Whatever diseases may have caused the seasoning, it plagued the colony
summer after summer. A Dutch ship captain wrote of it as it was in
Virginia in the summer of 1633:

    There is an objection which the English make. They say that during
    the months of June, July, and August it is very unhealthy; that
    their people, who have then lately arrived from England, die during
    these months like cats and dogs, ... when they have the sickness,
    they want to sleep all the time, but they must be prevented from
    sleeping by force, as they die if they get asleep.

Sir Francis Wyatt, twice governor of Virginia wrote, "but certaine
it is new comers seldome passe July and August without a burning
fever--this requires a skilful phisitian, convenient diett and lodging
with diligent attendance." The skillful physician could not limit
himself, however, to the curing of the seasoning; he had many other
maladies in Virginia with which to contend: dietary disorders, malaria,
plague, yellow fever, smallpox, respiratory disorders, and a host of
other diseases.

Beriberi and scurvy, both dietary diseases, handicapped the colony
throughout the century, and probably had acute manifestations during
the Starving Time of 1609-10. The colonists during the early years at
Jamestown often boiled their limited rations in a common kettle, thus
destroying what little valuable vitamin content the food may have had;
eggs, vegetables, and fruits which would have countered the disease
were not available. The swellings and the deaths without obvious cause
described by the early commentators may have resulted from beriberi
(the disease did not have a name until the eighteenth century).

Another dietary disease troubling the colonists but, unlike beriberi,
known by name and at times properly treated, was scurvy. Mention has
been made of the outbreak of this disease aboard the ships, and of the
stops made in the West Indies to eat the health-restoring citrus
fruits, but in the case of the colonists at Jamestown the fruit was
non-existent. A belief, also held, that idleness caused the disease did
little to bring about measures to promote proper treatment. Because the
incapacitating aspects of the disease could produce the appearance of
idleness, numerous ill persons must have been innocently stigmatized.
Their situation became hopeless when denied rations because the
authorities wished to discipline the apparently lazy.

Insomuch as the ague (or malaria) exacted a high toll in
seventeenth-century Europe--especially in England--it would be
reasonable to assume that, with typhoid and dietary disorders, this
disease caused most of the illness in Virginia. When emphasis has been
placed, by authorities, upon the location of Jamestown as a
disease-producing factor, the implication has often been that the
swampy area was a mosquito and malaria breeding place. A number of
historians have asserted that malaria produced the highest mortality
figures at Jamestown. Much is also made of the tragic circumstance that
the arresting agent for the disease, cinchona bark or quinine, was
known on the European continent by mid-seventeenth century but that
little use was made of it.

Dr. Blanton, the authority on seventeenth-century Virginia medicine, in
contrast argues that "there is not evidence ... that malaria was
responsible for a preponderating part of the great mortalities of the
Seventeenth Century in Virginia." He bases this conclusion on a number
of facts: he has been able to find only five or six references to the
ague (malaria) in the records of the century; because the ague was
well-known he does not believe its symptoms, such as the racking chill,
would have escaped notice. On the other hand, he does not doubt the
presence of the ague in Virginia throughout the century even though it
did not cause the most distress.

As in the case of the ague, a reasonable assumption would be that the
plague existed in seventeenth-century Virginia. The Great Plague of
London (1665) carried away 69,000 persons, and other cities of Europe
had even more disastrous epidemics. During the two years before the
first settlers arrived at Jamestown, over 2000 victims were buried in
London. The accounts of the ocean voyage indicate rat-infested ships.
Ships of the London Company reported plague and death aboard.
Virginians took pains to describe their illnesses, and there would have
been little difficulty in recognizing this well-known killer. Yet
little evidence of the presence of the plague appears in the
seventeenth-century Virginia record; cases are reported but the number
is small. Why Virginia should have been spared--especially in view of
the known rat-infestation aboard ship--remains a question.

The evidence relative to yellow fever, or calenture, during this period
in Virginia is contradictory. Early sources do make reference to
numerous deaths from it at sea and even to an epidemic of it at
Jamestown before 1610, but subsequent notices are infrequent and of
questionable validity. Prevalence of the disease in the earlier years
and its comparative infrequency in later is not a likely circumstance
because with the increase of commerce, especially from tropical ports,
an increase of the disease should have followed.

Smallpox, the mark of which is seen in early portraits, emerges from
the colonial record with a more reasonable history. Its incidence in
Virginia during the first half of the seventeenth century was small,
and this might be expected in view of the fact that there were few
children in the colony and that most of the adults had been infected
before they left the Old World. The number of smallpox epidemics in
Virginia did increase--again, as might be expected--later in the
century as the number of children and of native-born unimmunized adults
multiplied.

Smallpox caused such a scare in 1696 that the assembly, in session at
Jamestown, asked for a recess--another example of the influence of
disease upon political history. Earlier, in 1667, a sailor with
smallpox, if the contemporary account can be accepted, landed at
Accomack and was solely responsible for the outbreak of a terrible
epidemic on the Eastern Shore of Virginia. A measles epidemic during
the last decade of the century may actually have been smallpox as the
two diseases were often confused by contemporaries.

Respiratory disorders, as has been noted, caused much distress for
great numbers of early Virginians during the winter months. Influenza,
pneumonia, and pleurisy must have reached epidemic proportions on
numerous occasions in Virginia as elsewhere in America (influenza
epidemics are recorded for New England in 1647 and in 1697-99). One
note from a Virginia source for the year 1688 describes "a fast for the
great mortality (the first time the winter distemper was soe very
fatal... the people dyed, 1688, as in a plague... bleeding the remedy,
Ld Howard had 80 ounces taken from him...)." (If "Ld Howard" gave
eighty ounces, it means that he lost five pints of blood from a body
that contained approximately ten--perhaps the "letting" was over an
extended period.)

In a century in which numerous diseases had not been identified, many,
known today, must have occurred that were diagnosed in general terms.
Appendicitis, unrecognized until later, must have been common, and
heart disease probably went undiagnosed. Distemper, a general term,
often was used when the physician could not be more specific ("curing
Eliza Mayberry and her daughter of the distemper").

Other prevalent disorders were over-eating ("hee died of a surfeit");
epilepsy ("desperately afflicted with the falling sicknesse soe that he
requires continuall attendance"); and the winter cold ("our little boy
& Molly have been both sicke with fever & colds, but are I thanke God
now somewhat better").

The continued presence of deadly disease throughout the century shows
itself in the population figures for the period. Over 100,000 persons
migrated to Virginia before 1700 and numerous children were born, but
only 75,000 people lived in Virginia in 1700. Many returned to Europe,
many emigrated to other parts of America, and Indians accounted for
some deaths, but the chief reason for the decline in population was the
high mortality prevailing throughout the century.

Health conditions, however, did not deteriorate as the century passed.
By 1671 Governor Berkeley could report generally improved health
conditions; for example, newcomers rarely failed to survive the first
few months, or seasoning period, which had formerly exacted such an
awful toll. How much these improved conditions were due to better
provisioned ships, to a better diet in Virginia, and to the movement of
the settlers out from Jamestown is open to question, but in any
consideration of the explanations for the promotion of health,
prevention of illness, the restoration of health, and the
rehabilitation of the sick, the seventeenth-century Virginia physician
or surgeon must be considered.


PHYSICIANS AND SURGEONS IN SEVENTEENTH-CENTURY VIRGINIA

The first English medical man to set foot on Virginia soil visited the
Chesapeake Bay area in 1603. Henry Kenton, a surgeon attached to a
fleet exploring Virginia waters, joined the landing party that perished
to a man at the hands of the Indians. Next to arrive in Virginia were
the two surgeons who accompanied the first settlers in 1607 and
attended their medical needs.

One of these, Thomas Wotton, was classed as a gentleman, while the
other, Will Wilkinson, was listed with the laborers and craftsmen, a
reminder of the varied social backgrounds of surgeons. Captain John
Smith complimented Wotton in the summer of 1607 for skillful diligence
in treating the sick; but Edward Maria Wingfield, when council
president at Jamestown, criticized him for remaining aboard ship when
the need for him ashore was so great. Because of this reputed
slothfulness, Wingfield would not authorize funds for Wotton to
purchase drugs and other necessaries. The colony could only have
suffered from such a misunderstanding.

Further activities of Wotton and Wilkinson have faded into the mist of
time past, but Captain John Smith recorded for posterity the names and
deeds of other surgeons and physicians who came to Virginia before
1609. Dr. Walter Russell, the first physician--as distinguished from
surgeon--to arrive, came with a contingent of new settlers and supplies
in January, 1608. Post Ginnat, a surgeon, and two apothecaries, Thomas
Field and John Harford, accompanied the physician. Also in Smith's
record is the name, Anthony Bagnall, who has been identified as a
surgeon and who came with the first supply.

Unfortunately, neither contemporaries of Russell, Ginnat, Field, and
Harford--nor the men themselves--found reason to record the medical
assistance they rendered during a time of great need. Russell is
remembered only for the assistance he gave Smith when the Captain was
severely wounded by a stingray, Post Ginnat and the apothecaries leave
their names only, and Bagnall is remembered for his part in the
adventures encountered on one of Captain Smith's exploratory journeys.

Russell's services to Smith deserved note because the Captain was
expected to die from the stingray wound. It is an interesting comment
on the medicine of the time that Smith's companions prepared his grave
within four hours after the accident. "Yet by the helpe of a precious
oile, Doctour Russel applyed, ere night his tormenting paine was so wel
asswaged that he eate the fish to his supper."

The same stingray also assured the surgeon Bagnall a place in history.
Mention of Bagnall by Captain Smith followed the surgeon's exploits on
another expedition when he went along to treat the Captain's same
stingray wound. The party, attacked by savages, shot one Indian in the
knee and "our chirurgian ... so dressed this salvage that within an
hour he looked somewhat chearfully and did eate and speake."

How unfortunate that other exploits of these physicians and surgeons,
not involving Captain Smith--or the stingray--did not cause him to make
a record. Dr. Lawrence Bohun, however, who accompanied Lord De la Warr
to the colony in 1610, evoked comments of a more general nature in the
accounts of contemporaries.

Dr. Bohun ministered to the settlers who had been ready to abandon
Jamestown in 1610. A letter from the governor and council to the London
Company, July 7, 1610, describes his problems and his efforts to meet
them. Insomuch as the letter gives one of the fullest accounts of early
Jamestown medical practices and because Bohun is one of the most
renowned of seventeenth-century Virginia physicians, it deserves a
lengthy quotation:

    Mr. Dr. Boone [Bohun] whose care and industrie for the preservation
    of our men's lives (assaulted with strange fluxes and agues), we
    have just cause to commend unto your noble favours; nor let it, I
    beseech yee, be passed over as a motion slight and of no moment to
    furnish us with these things ... since we have true experience how
    many men's lives these physicke helpes have preserved since our
    coming, God so blessing the practise and diligence of our doctor,
    whose store has nowe growne thereby to so low an ebb, as we have
    not above 3 weekes phisicall provisions; if our men continew still
    thus visited with the sicknesses of the countrie, of the which
    every season hath his particular infirmities reigning in it, as we
    have it related unto us by the old inhabitants; and since our owne
    arrivall, have cause to feare it to be true, who have had 150 at a
    time much afflicted, and I am perswaded had lost the greatest part
    of them, if we had not brought these helpes with us.

Dr. Bohun sought medical supplies from abroad, but he also experimented
with indigenous natural matter such as plants and earths in an effort
to replenish his dwindling supplies and to discover natural products of
value in the New World. Judging by a contemporary account, Bohun,
professionally trained in the Netherlands, used drugs therapeutically
according to the conventional theories of the humoral school. Despite
the disfavor in which frequent purgings are held today, it must be
allowed that those being treated then sounded a plaintive call for more
of Bohun's "physicke."

The colony lost his services when he left to accompany Lord De la Warr
to the West Indies. His connection with the London Company and its
colony did not lapse, however, for Bohun received an appointment as
physician-general for the colony in December, 1620. At sea, on the way
to fill his post, the physician-general found his ship engaged with two
Spanish men-of-war. In the course of battle, an enemy shot mortally
wounded the man who had survived great hazards at Jamestown.

After the departure of Bohun with Lord De la Warr, no physician or
surgeon of equal stature or reputation took up residence in Virginia
until Dr. John Pott arrived almost ten years later. It is likely that
there was a shortage not only of outstanding medical men during these
years, but also of medical assistance in general. Sir Thomas Dale,
acting as deputy governor in the absence of De la Warr, wrote in the
spring of 1611 that "our wante likewise of able chirurgions is not a
little." Other requests for physicians and for apothecaries were
dispatched to the London Company during this period.

However, despite the seeming shortage of medical assistance, the
colonists survived such disorders as the summer seasoning much more
frequently than in the first years at Jamestown. An account of Virginia
written between 1616 and 1618 noted of the settlers that:

    They have fallen sick, yet have recovered agayne, by very small
    meanes, without helpe of fresh diet, or comfort of wholsome
    phisique, there being at the first but few phisique helpes, or
    skilful surgeons, who knew how to apply the right medecine in a new
    country, or to search the quality and constitution of the patient,
    and his distemper, or that knew how to councell, when to lett
    blood, or not, or in necessity to use a launce in that office at
    all.

Bohun died in March, 1621, and the Company named his successor as
physician to the colony in July. The conditions under which Dr. John
Pott accepted the post reveal the qualifications and needs of the
seventeenth-century medical man on his way to the New World, and the
inducements offered by the Company. He was a Cambridge Master of Arts
and claimed much experience in the practice of surgery and "phisique."
In addition, he made much of his expertness in the distilling of water.
The company allowed Pott a chest of medical supplies, a small library
of medical books, and provisions for the free passage of one or more
surgeons if they could be secured.

Additional economic inducements helped persuade Pott--and other
physicians--to make the arduous journey to America. In the eyes of the
Company, physicians could render especially valuable services to the
colony, and ranked with other persons of extraordinary talent such as
ministers, governors, state officers, officers of justice, and knights.
These individuals received special compensations in the form of land
and profits, in accord with the estimated value of services to be
rendered. In 1620, Dr. Bohun had had a promise--for taking the position
of physician-general for the colony--of an allotment of 500 acres of
land and ten servants; Pott accepted the job under about the same
conditions as had Bohun.

These inducements offered physicians to persuade them to go to Virginia
indicate the great need for, and the high value attached to, their
assistance in the seventeenth century. With the population in the
colony growing so great Dr. Pott's services were in considerable
demand; several years after his arrival a certain William Bennett built
the doctor a boat as he by then had a relatively large area to cover
and most of the outlying plantations stood on the rivers and creeks.

In the colony, Pott won recognition for his professional proficiency.
Even a political enemy, Governor Harvey, described him as skilled in
the diagnosis and therapy of epidemic diseases. Because he alone in the
colony was considered capable of treating epidemic diseases, a court
sentence against him for cattle theft stood suspended early in the
1630's and clemency was sought on his behalf.

Pott had become involved in other legal difficulties before 1630. In
1625, a case having medical and humorous implications brought him into
court. A Mrs. Blany maintained that Doctor Pott had denied her a piece
of hog flesh, and that his refusal had caused her to miscarry. The
court accepted Mrs. Blany's contention that she believed the denial of
the hog flesh caused her distress, but did not hold Pott guilty of
willful neglect.

Since the biographical material on Pott's non-professional life reveals
so many intellectual and political interests, it would be surprising if
he had not occasionally neglected his medical practice. He gave
considerable time to the colony's administration and he served in 1629
as the elected temporary governor of the colony after having previously
been on the governor's council. His activities in politics and affairs
brought him political enemies and explain, in part, the cattle theft
charge and the court's finding of "guilty" (although this was later
found "rigorous if not erroneous"). He died in 1642, having been
intimately involved in the life of the colony for twenty years.

Pott was the last of the outstanding figures who practiced medicine
under the direction of the Company, but Dr. Wyndham B. Blanton has
found mention of over 200 persons who served as physicians or surgeons
during some portion of the century. With only one exception, however,
none of these achieved as prominent a place in history as Bohun,
Russell, or Pott. Not only is the number of outstanding individuals in
the field of medicine less, but the general quality of medical
practice, in the opinion of Dr. Blanton, was not as high again during
the last three-quarters of the seventeenth century as it had been
during the administration of the Company (1607-1624) when Virginia
medicine included a representative cross-section of English medicine.

Any survey--no matter how brief--of the medical profession during the
century, however, should include mention of a man who, although not a
full-time professional physician, proves to be the exception to Dr.
Blanton's generalization about the prominence of individual medical men
and the quality of medical practice during the late 1600's. This man,
the Reverend John Clayton, is a noteworthy example of the intellectual
level an individual could attain and maintain while living in an area
that was still remote from European civilization.

Clayton, who is known to have been at Jamestown between 1684 and 1686
as a clergyman, also practiced medicine in addition to pursuing his
scientific interests. As a prolific writer he has left some of the
fullest and most interesting accounts of contemporary treatment and
diagnosis. His knowledge and methods cannot be taken as typical,
however, because his intellectual level was considerably above the
average in the colony.

This minister-scientist-physician wrote an account of his treatment of
a case of hydrophobia resulting from the bite of a rabid dog. With its
accomplished style, Clayton's account of his treatment of hydrophobia
is worthy of attention as an example of contemporary theory and
practice of the more learned kind. He wrote:

    It was a relapse of its former distemper, that is, of the bite of
    the mad-dog. I told them, if any thing in the world would save his
    life, I judged it might be the former vomit of volatile salts; they
    could not tell what to do, nevertheless such is the malignancy of
    the world, that as soon as it was given, they ran away and left me,
    saying, he was now certainly a dead man, to have a vomit given in
    that condition. Nevertheless it pleased God that he shortly after
    cried, _this fellow in the black has done me good_, and after the
    first vomit, came so to himself, as to know us all.

Subsequently, Clayton "vomited him" every other day and made him take
volatile salt of amber between vomitings. The patient also drank
"posset-drink" with "sage and rue," and washed his hands and sores in a
strong salt brine. Cured by the "fellow in the black," the patient had
no relapse.

Clayton reveals more of his medical theory in another passage from his
writings. He observed:

    In September the weather usually breaks suddenly, and there falls
    generally very considerable rains. When the weather breaks many
    fall sick, this being the time of an endemical sickness, for
    seasonings, cachexes, fluxes, scorbutical dropsies, gripes, or the
    like which I have attributed to this reason. That by the
    extraordinary heat, the ferment of the blood being raised too high,
    and the tone of the stomach relaxed, when the weather breaks the
    blood palls, and like overfermented liquors is depauperated, or
    turns eager and sharp, and there's a crude digestion, whence the
    name distempers may be supposed to ensue.

In this passage Clayton's medical theory resembles closely the orthodox
medical beliefs of the century. The great English practitioner
Sydenham, for example, emphasized the relationship between the weather
and disease. Also the analogy between the behavior of blood and wine
was then conventional, and the supposed connection between the "sour"
blood and indigestion with the resulting acid humors is in accord with
Galenism. The remedy--and a most logical one--was medicine to combat
the acidity and to restore the tone or balance to the stomach. Acid
stomach has a long history.

The reasonableness of Clayton's pathology is impressive, but reason did
lead to some bizarre--in the light of present-day medical
knowledge--conclusions. Aware of the value to the scientist of close
observation and of the necessity to reason about these observations,
Clayton was in the finest seventeenth-century scientific tradition.
Observing a lady--for example--suffering from lead poisoning, he noted
that her distress, judging by her behavior, varied directly with the
nearness and bigness of the passing clouds; the nearer the clouds, the
more anguished her groans. Reason dictated to Clayton that such a
phenomenon stemmed from a cause-effect relationship.

Although the twentieth-century physician would deny the cloud-suffering
association, he would not deny Clayton's propensity for observation and
his attempts to discern relationships. The approach of the better
seventeenth-century Virginia physician can be labeled scientific even
if his facts were few.


DRUGS AND OTHER REMEDIES

No seventeenth-century physician could function without a variety of
drugs (medicines) to dispense. Dr. Pott made special arrangements--for
example--to have a chest of drugs transported with him from England to
America, and the effectiveness of Dr. Bohun's "physicke" drew the
praise of the colonists. Drugs were essential to the physician and a
valuable commodity for export, as well. The subject of drugs must then
include a discussion of their use as medicines and their importance as
items of trade.

A study of the drugs in use and the occasions of their utilization
makes manifest the great part that freeing the body from corrupting
matter played in the treatment of disease. The theorists and clinical
physicians of the century placed such faith in the humoral doctrine
that, on the basis of this predilection, much of the opposition to
cinchona, or quinine, in a period greatly troubled by malaria, can be
explained. Cinchona, discovered in Spanish America and known in
seventeenth-century Europe, had demonstrable effects in the treatment
of malaria but, because it was an additive rather than a purgative,
physicians rejected it on theoretical grounds. Its eventual acceptance
later revolutionized drug therapeutics, but this revolution did not
affect seventeenth-century Virginia.

The emphasis that the contemporary medical men placed upon the purging
of the body--the vomiting, sweating, purgings of the bowels, the
draining, and the bleeding--cannot be considered irrational or quaint.
In the light of observation and common sense, to purge seemed not only
reasonable and natural but in accord with orthodox doctrine as well.
Observation revealed that illness was frequently accompanied by an
excess of fluid or matter in the body, as in the case of colds,
respiratory disorders, swollen joints, diarrheas, or the skin eruptions
that accompanied such epidemic diseases as the plague or smallpox.
Common sense dictated a freeing of the body of the corrupt or
corrupting matter; drugs were a means to this end.

The use of drugs for vomiting, sweating, and other forms of purging
seems excessive in the light of present-day medical knowledge, and at
least one seventeenth-century Virginia student of medicine also found
such use of drugs by his contemporaries open to criticism. In the
opinion of the Reverend John Clayton, Virginia doctors were so prone to
associate all drugs with vomiting or other forms of purging that they
even thought of aromatic spirits as an inferior "vomitive." He
concluded that these physicians would purge violently even for an
aching finger: "they immediately [upon examining the patients] give
three or four spoonfuls [of _crocus metallorum_] ... then perhaps
purge them with fifteen or twenty grains of the rosin of jalap,
afterwards sweat them with Venice treacle, powder of snakeroot, or
Gascoin's Powder; and when these fail _conclamatum est_."

The list of drugs used was extensive and each drug had a considerable
literature written about it explaining the various sicknesses and
disorders for which it was a curative. Libraries of the Virginia
physicians and of the well-to-do laymen usually included a volume or
two on the use of drugs. Among the most popular plants, roots, and
other natural products were snakeroot, dittany, senna, alum, sweet
gums, and tobacco.

Dittany drove worms out of the body and would also produce sweat
(sweating being another popular method of purging the body of
disease-producing matter). The juices of the fever or ague-root in beer
or water "purgeth downward with some violence ... in powder ... it only
moveth sweat." (Following Galen's system of classifying by taste, this
root was bitter, therefore thought dry. The physician would administer
such a drying agent when attempting to reduce excess moistness in the
body--and thus restore normal body balance, in accord with contemporary
humoral theory.) Snakeroot, another of the popular therapeutics,
increased the output of urine and of perspiration; black snakeroot,
remedying rheumatism, gout, and amenorrhea, found such wide usage
during the last half of the seventeenth century that its price per
pound in Virginia on one occasion rose from ten shillings to three
pounds sterling. Although King James I of England saw much danger in
tobacco, others among his subjects attributed phenomenal curative
properties to it. One late sixteenth-century commentator on America
recommended it as a purge for superfluous phlegm; and smokers believed
it functioned as an antidote for poisons, as an expellant for "sour"
humors, and as a healer of wounds. Some doctors maintained that it
would heal gout and the ague, act as a stimulant and appetite
depressant, and counteract drunkenness.

The full significance of these drugs in the medicine of the period can
be better appreciated by reference to a prescription for their use, in
this instance a remedy for rickets, thought typical by historian Thomas
Jefferson Wertenbaker:

    Dip the child in the morning, head foremost in cold water, don't
    dress it immediately, but let it be made warm in the cradle & sweat
    at least half an hour moderately. Do this 3 mornings ... & if one
    or both feet are cold while other parts sweat let a little blood be
    taken out of the feet the 2nd morning.... Before the dips of the
    child give it some snakeroot and saffern steep'd in rum & water,
    give this immediately before diping and after you have dipt the
    child 3 mornings. Give it several times a day the following syrup
    made of comfry, hartshorn, red roses, hog-brake roots, knot-grass,
    petty-moral roots; sweeten the syrup with melosses.

But drug therapy was not always as simple as that recommended for
rickets, although the evidence is that in Virginia the high cost of
importing the rarer substances inclined local physicians toward the
less elaborate compounds. Venice treacle, recommended by the Reverend
Clayton's imaginary purge enthusiast consisted of vipers, white wine,
opium, licorice, red roses, St. John's wort, and at least a half-dozen
other ingredients.

Because their use was so extensive in Europe and because many brought a
good price, any discussion of drugs in seventeenth-century Virginia
should take note of the efforts in the colony to find locally the raw
materials for the drugs both for use in Virginia and for export. The
London Company actively supported a program to develop the drug
resources of the New World, and the hope of finding them had originally
been one of the incentives for the colonization of Virginia. Even as
early as the sixteenth century, authors and promoters in England of the
American venture had held up the promise of a profitable trade in
drugs--sassafras, for example--as a stimulus for exploration and
colonization. Sassafras had market value as it was widely used in cases
of dysentery, skin diseases, and as a stimulant and astringent; French
warships searching for loot off the shores of the New World had often
made it the cargo when richer prizes were not to be had.

Like gold, sassafras diverted labor during the crucial early period at
Jamestown from the tasks of building and provisioning. Sailors and
settlers, both, took time off to load the ships with the drug which
would bring a good price in England.

The belief that the exporting of drugs would prove profitable for the
colony in Virginia and for the Company may explain why two apothecaries
accompanied the second group of immigrants who arrived in 1608. Someone
had to search out and identify possible drugs, and a layman could not
be expected to perform a task requiring such specialized knowledge. The
apothecaries could further serve the new settlement by helping to
supply its medicinal needs.

Before the drug trade in Virginia could be developed, and at the same
time adapted to the over-all needs of the colony, attention had to be
given to the use of drugs to meet the immediate needs of the settlers.
Dr. Bohun, who had brought medical supplies in 1610 and soon found them
exhausted, turned resourcefully to an investigation of indigenous
minerals and plants. He investigated earths, gums, plants, and fruits.
A white clay proved useful in treating the fevers (the clay of the
Indians used for "sicknesse and paine of the belly"?); the fruits of a
tree similar to the "mirtle" helped the doctor to face the epidemics of
dysentery.

The colonists also needed a wine which could be produced cheaply and
locally. Many of them, accustomed to beer and wine regularly,
complained of having to rely upon water as a liquid refresher.
According to one of their number, more died in Virginia of the "disease
of their minds than of their body ... and by not knowing they shall
drink water here." One enterprising alchemist and chemist offered to
sell the London Company a solution for this problem: the formula of an
artificial wine to be made from Virginia vegetables.

After the colony seemed no longer in danger of perishing from its own
sicknesses--or going mad from having to drink water--the Company urged
the settlers to develop an active trade in medicinal plants, in order
to help cure the diseases of England and the financial ills of the
Company. The London Company, in a carefully organized memorandum,
advised the colonists what plants had export value and how these plants
should be prepared for export:

    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.

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.

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.

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):

    For 2 glisters [clysters]          040
    For a glister                      030
    For a potion cord.[ial]            036
    For an astringent potion           035
    For my visitts paines & attendance ...
    For a glistere                     030
    For an astringent potion           035
    For a cord. astringent bole        036
    For a bole as before               036
    For a purging potion               050
    For a [cordial julep]              120
    For a potion as before             036

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?

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 chose _The French
Chirurgerye_, published in English in 1597, and the _Enchiridion
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:

    dressed in knee breeches and jerkin, perhaps adorned with periwig
    and cap; not given to church-going, but fond of ale, horse-racing
    and cuss words; husband of a multiparous wife; owner of a log cabin
    home or at best a frame cottage which he guarded with gun, pistol
    and scimitar; his road a bridle path and his means of conveyance a
    horse or boat ... reading ... by candle light, without spectacles;
    writing with a goose quill pen; sitting on a rough stool or bench;
    eating at a crude table from pewter dishes, without fork or table
    knife; having no knowledge of bath tubs; keeping his clothes in
    trunk or chest; sleeping, night-capped, on a flock bed in a bedroom
    shared by others; dividing his time, which he measured with
    hour-glass and sundial, among medicine, politics and farming; often
    in court, often a justice, member of Council or Burgesses, and
    subject, like his neighbors, to military service.


SUMMARY

Englishmen and Europeans planted Virginia in the New World and brought
the Old World's medical knowledge and medical practices with them. In
Europe and England, the seventeenth century witnessed the perfection of
new and scientific theories in medicine--it was the century of
Harvey--but little original and fruitful in the field of practice--Dr.
Sydenham might be considered an exception.

In Virginia, the prior occupants had accumulated medical knowledge,
too, and the Indians practiced in a manner not completely unlike that
of the whites: bloodletting, purging, and sweating (all to the end of
relieving the body of ill humors or morbid matter). The Indians,
however, did not believe it right or good to impart their knowledge to
the layman, Indian or European; therefore, cross-fertilization between
the two schools of medicine was limited.

In planning for the colony, the London Company took into account that
health would influence the fortunes of the new settlement. The Company
warned the original settlers to choose a site in a healthful location,
but the colonists elected Jamestown Island which was low and moist.
Provided two surgeons by the Company, the original settlers needed not
only more surgeons but physicians as well: the surgeons could treat the
wounds, sprains, and breaks of a military-colonizing expedition, but
physicians were needed to meet conditions that developed in Jamestown.

In subsequent boatloads of settlers, physicians did come--and some were
well-trained and experienced--but the small number that arrived during
the period when the London Company administered the colony (1606-24)
could not meet the demands of disease and famine. During the first
summer more than one-half the original settlers perished: during the
Starving Time (1609-10) the population dropped from 500 to 60 and in
the spring these 60 almost abandoned Virginia. A deadly combination of
new environment, famine, and epidemic disease, such as typhoid, played
a major part in determining the course of events during the first two
decades of the colony's life, and near death.

After Virginia became a Crown colony, famine and disease no longer
influenced affairs so greatly, not because of the wise administration
of the Crown, but because the colonists had better learned what was
necessary to cope with health conditions in the New World. No longer
did they consider disease and famine minor threats compared to those
from the Indians and Spaniards. They planned their ocean voyages so as
to arrive in the fall and thus avoid the dread summer sickness while
still too weak from the voyage to resist it; they located their outer
settlements on higher and drier land, at the end of the century even
moving their capital to Williamsburg, known for its temperate and
healthful climate.

The physicians and surgeons, however, who came later in the century
were not as distinguished as their earlier counterparts. As the century
passed, many men trained by apprenticing themselves in Virginia.
Whether immigrant or indigenous, the medical men used orthodox European
techniques: they bled and purged, sweated and dispensed drugs, to
obtain these ends. Some of the drugs were native to Virginia and the
colonists exported them for a profit, but the more expensive--and
efficacious--had to be imported. There is evidence that the level of
medical excellence in Virginia lowered during the century; many of the
planters avoided the expensive visits and drugs, even passing laws to
regulate fees and chastise lax and inadequate practitioners.

Women, clergymen, and laymen all treated the sick and wounded of the
period, with the women especially active as midwives; with the clergy
producing such an outstanding medical man as the Reverend John Clayton;
and with the laymen acquiring enough information, perhaps from a few
medical books, in order to practice, themselves, in case a doctor were
unavailable or undesired.




ACKNOWLEDGEMENTS AND BIBLIOGRAPHICAL NOTE


Dr. Wyndham B. Blanton kindly gave permission for the use, in the
preparation of this booklet, of his definitive and authoritative volume
on the history of seventeenth-century Virginia medicine. Dr. Blanton's
work--based on extensive research in the sources--has proved of great
value, but he should not be held responible for any weaknesses in this
essay, as the author assumes full responsibility. The author also
wishes to take this opportunity to express his appreciation for the
numerous suggestions and improvements made by his wife who spent many
hours assisting in the preparation of the manuscript.

The books and articles that proved most helpful were:

Allen, Phyllis, "Medical Education in 17th Century England," _Journal
of the History of Medicine and Allied Sciences_, I (January, 1946),
115-143.

_American History Told by Contemporaries_. Edited by Albert B. Hart.
New York and London, 1908-1909. 4 vols.

Beverley, Robert, _The History of Virginia_.... (Reprinted from the
author's 2d rev. ed., London, 1722.) Richmond, 1855.

Blanton, Wyndham B., _Medicine in Virginia in the Seventeenth Century_.
Richmond, 1930.

Brown, Alexander, _Genesis of the United States_. Boston and New York,
1890. 2 vols.

Castiglioni, Arturo, _A History of Medicine_. Translated from the
Italian and edited by E. B. Krumbhaar. New York, 1941.

Chitwood, Oliver P., _A History of Colonial America_. New York, 1948.

Craven, Wesley F., _Dissolution of the Virginia Company: the Failure of
a Colonial Experiment_. New York, 1932.

_Southern Colonies in the Seventeenth Century_, 1607-1689. Baton Rouge,
1949.

Duran-Reynals, Marie Louise, _The Fever Bark Tree_. New York, 1946.

Garrison, Fielding H., _An Introduction to the History of Medicine_....
Philadelphia, 1929.

_Narratives of Early Virginia_, 1606-1625. Edited by Lyon G. Tyler. New
York, 1907.

Packard, Francis R., _History of Medicine in the United States_. New
York, 1931. 2 vols.

Sigerist, Henry E., _American Medicine_. Translated by Hildegard Nagel.
New York, 1934.

Smith, John, _Travels and Works_. Edited by Edward Arber. Edinburgh,
1910. 2 vols.

Tyler, Lyon G., "The Medical Men of Virginia," _William and Mary
College Quarterly_, XIX (January, 1911), 145-162.

Wertenbaker, Thomas J., _The First Americans, 1607-1690_. New York,
1944.






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