Chapter 3

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.

Moliere, 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. Mode 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. Mode'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 Pare (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.