USA > Massachusetts > Suffolk County > Boston > The memorial history of Boston : including Suffolk County, Massachusetts. 1630-1880, Vol. IV > Part 71
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The Winthrops, -to one of whom Dr. or Mr. Stafford's directions were given, - assisted their fellow-citizens with medical counsel as well as in many other ways. The Governor of Connecticut, John Winthrop, treated a great number of medical cases in Hartford, and left a record of his practice extending from 1657 to 1669. This manuscript was also intrusted to me. I examined it very carefully, and reported upon it in the lecture before the Massachusetts Medical Society to which I have already referred. From it we may get an idea of what was likely'to be the kind of treatment to which our Boston predecessors would be submitted. The excellent Gov- ernor seems to have been consulted by great numbers of persons, - to
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have had a wider circle of practice, it may be suspected, than many or any of those who called themselves doctors. The common diseases of all ages and both sexes appear to have come under his care. Measles and their consequences are at first most prominent, and fever and ague had often to be treated. He used the ordinary simples dear to mothers and nurses, - elecampane, elder, wormwood, anise, and the rest; and besides these certain mineral remedies. Of these, nitre (saltpetre) was his favor- ite. Another favorite prescription was spermaceti, which, like Hotspur's fop, he seems to have considered " the sovereign'st thing on earth " for inward bruises, and often prescribes after falls and similar injuries. Other remedies were antimony, now and then a little iron or sulphur or calomel, rhubarb, jalap, horseradish (which I remember Cullen recommends for hoarseness), guaiacum, and the old mithridate or farrago which, like so many foolish mixtures, owed all its real virtue to opium. He amused his patients with doses of coral and of amber, and sometimes gave them (let us hope without their knowing it) some of those unmentionable articles which insulted the senses and the stomachs of seventeenth and eighteenth century patients. One medicine which he very often prescribes he calls rubila. After long search I found that this consisted of four grains of dia- phoretic antimony, with twenty grains of nitre, and a little salt of tin. I do not remember that the Governor ever mentions bleeding or blistering. Whether busy practitioners found time to bleed their patients as readily as those who had little else to do might be questioned. One of my old friends told me that the Philadelphia doctors used to order blood-letting more frequently than the Boston ones, because there was in that city a set of professional bleeders.
Among my old books I found a small manuscript volume of Dr. James Oliver, a famous physician, who graduated at Harvard College in 1680, and died in 1703. It contains an account of the medicines he purchased and prescribed. The usual simples are mentioned, with certain warming elixirs and cordials ; and also iron and mercury.
By the kindness of the late librarian of the American Antiquarian So- ciety I had placed in my hands a manuscript of Cotton Mather, entitled " The Angel of Bethesda: an Essay upon the Common Maladies of Man- kind, offering, first, the sentiments of Piety," etc., and "a Collection of plain but Potent and Approved REMEDIES for the Maladies." His start- ing point is, of course, theological. " Sickness is, in Fact, Flagellum Dei pro peccatis mundi." The treatise is full of pedantry, superstition, decla- mation, and miscellaneous folly. Yet Cotton Mather's drag-net is always worth looking through. He prescribes euphrasia, eye-bright, in recogni- tion of the absurd old doctrine of signatures. For the scattering of wens " the efficacy of a Dead Hand has been out of measure wonderful." He apostrophizes the millipede, " Poor sowbug!" and then proclaims its heal- ing virtues. We are to take " half a pound, putt 'em alive into a quart or two of wine," with saffron and other drugs, and of this tincture the patient
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is to take two ounces twice a day. He speaks of some of the old rem- edies thus : -
" Among the plants of our soyl Sir William Temple singles out Five [six] as being of the greatest virtue and most friendly to health ; and his favorite plants, Sage, Rue, Saffron, Alehoof, Garlick, and Elder.
" But these Five [six] plants may admit of some competitors. The QUINQUINA, - How celebrated ! Immoderately, Hyperbolically celebrated !"
Of Ipecacuanha he says : -
" This is now in its reign ; the most fashionable vomit. ... I am not sorry that antimonial emetics begin to be disused."
Again : -
" Mercury, we know thee ! but we are afraid thou wilt kill us too, if we employ thee to kill them that kill us.
" And yet for the cleansing of the small Blood Vessels, and making way for the free circulation of the Blood and Lymph, there is nothing like Mercurial Deob- struents."
How far Cotton Mather represented the practice of the Boston physi- cians of his time I have not the means of determining.
In the year 1718 William Douglass, M. D., settled in Boston as a prac- tising physician. He was of Scotch birth, and educated partly in Paris, partly in Leyden. He is said to have been at one time the only practi- tioner in the town who had a regular degree. He was a man of learning and ability, eminently given to dispute, - a good instance of the perfervidum ingenium Scotorum. He at first opposed Dr. Boylston and Cotton Mather in their efforts to introduce the practice of inoculation, but afterward pro- nounced himself in its favor.
I suspect that medicine in Boston owed the reform of its Materia Medica largely to William Douglass. He mentions four remedies as the most im- portant ones in the hands of the physicians of his time. This was in the dedication of his quarrelsome treatise on inoculation, in the year 1730. Nearly seventy years after this Dr. Holyoke, who had then been in prac- tice for half a century, took a student just beginning his medical education with him, - young James Jackson, - into the room where he kept his medi- cines. Pointing to the drawers and bottles ranged around the room, he said to the young man : " I seem to have here a great number and variety of medicines ; but I may name four which are of more importance than all the rest put together; namely, Mercury, Antimony, Opium, and Peruvian Bark." Dr. Jackson gives these four remedies the same prominent place which his " old master " assigned them. Now these are the four remedies which Dr. William Douglass, practising a century before Dr. Jackson, con- sidered to be the most important articles of the Materia Medica. Dr. Dan- forth substituted ipecacuanha for antimony, retaining the other three articles
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with this as his chief reliance. We shall see presently what rank they hold in the practice of to-day. If Molière had restated the prevalent method of practice in acute diseases, as it was within my own memory, it would be saignare, purgare, et blisterizare. The object of these measures, aided by rest and low diet, was to subdue inflammatory action, and thus avert its destructive consequences. But as a series of restorative processes involves a sustained effort on the part of the living powers, and as these are liable to fail if not properly supported, and the patient to die of exhaustion, the fear of debility comes in to balance the fear of over-excitement. Medical prac- tice, therefore, always tends to vibrate between depleting and sustaining measures. The doctors have most commonly been for bleeding and starv- ing, the old women for feeding and stimulating " to keep up the strength," in such diseases as fevers and inflammation of the lungs. Dr. Fuller, who came with the Pilgrims of the " Mayflower," says, in 1630, " I have been to Matapan [now Dorchester] and let some twenty of those people blood." Dr. Benjamin Rush bled his patients like so many calves. Forty years ago, or later, a physician carried a lancet-case in his pocket almost as a matter of course. Still there were those who never used that little instru- ment. Our Boston Dr. Danforth was opposed to venesection. Dr. William Tully, of Connecticut, said, " The lancet is a weapon which annually slays more than the sword."
The old women have got the upper hand. Patients are fed diligently through the whole course of acute diseases. Blood-letting, as one of my friends in active practice tells me, " is almost getting to be a lost art." " My assistant," he says, " in the last year of his studies had never seen venesection performed, and did not know how to do it." I remember being told by a former medical student, who had been long a resident in the Bellevue Hospital of New York, that he had never seen a patient bled. Still it is advocated by Dr. Barker and others in puerperal convulsions; and I have seen a recent discussion in which it was maintained by some of the disputants that it was useful in some cases of pneumonia. The essay . of Louis on the effect of blood-letting in this disease did much to weaken the confidence long felt in its efficacy.
In order to know what drugs are most frequently prescribed at the present time, I applied to four physicians for a list of their favorite reme- dies, and to three apothecaries for the names of the medicines which they most frequently put up for regular practitioners. Opium and quinia were oftenest mentioned, being named by all of the seven gentlemen consulted. Next came bromide of potassium, mentioned by six of the whole number ; iodine, etc., by five; ipecacuanha, mercury, bismuth, salicylic acid and salicylates, and iron, by four; pepsin, rhubarb, and chlorate of potass, by three; arsenic, guarana, and phosphates, by two. Among the other rem- edies in the list I find ergot, chloral, strychnine, belladonna, pilocarpine, glycerine, podophyllin, coca, and the familiar old medicines, castor oil, squills, and nitre.
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The following list of the remedies most used at the Massachusetts General Hospital was kindly furnished to me by Dr. Whittemore, the Super- intendent of that Institution : Opium, iron, quinia, iodide and bromide of potassium, salicylic acid, subnitrate of bismuth, chloral hydrate, mercury (in specific disease). The cathartics most employed are sulphate of mag- nesia, castor oil, podophyllin, compound cathartic pill, aloes, compound colocynth pill, compound liquorice powder, various cathartic waters. "Lis- terism " is almost universally employed in surgical cases. Subcutaneous injections of morphia are extensively used, also of ether and alcohol when stimulation is demanded : apomorphia is employed in the same way to pro- duce immediate vomiting. Venesection is rarely practised; not a single case of it for medical disease during five years is remembered. Leeches are applied for contusions; cupping ordered once in a great while; blisters rather more frequently, but not very often.
Externally, I am told that ointments are much less used than formerly. Carbolic acid, as all know, is employed to a great extent. Liniments of opium, aconite, and chloroform are employed; also tincture of iodine. " Vaseline " and " cosmoline " are much used in place of the old ointments. It may be interesting by and by to note which of these various remedies passes out of general employment, and what others take their places. Leeching and blistering seem to share in some measure the disfavor of venesection. I have not spoken of the various anæsthetics, among which ether has from the first been preferred in Boston. Next to these in silenc- ing pain is the practice of subcutaneous injection of morphia, now com- monly employed and of great and speedy efficacy.
The most remarkable historical occurrences in the medical annals of Boston are these : -
The first introduction into America of inoculation for small-pox, by Zabdiel Boylston, in 1721.
The first introduction of vaccination into America, by Benjamin Water- house, in 1800.
The first introduction into the world of ethereal anæsthesia, by William Thomas Green Morton, in 1846.
The most important local events are : -
The founding of the Boston Dispensary (1796) and of the Massachusetts General Hospital (1811). The establishment of the City Hospital (1864) and that of the Eye and Ear Infirmary (1826), and other medical charities. The removal to Boston of the Medical School of Harvard University and the erection of the Massachusetts Medical College (1815), followed by that of the building in North Grove Street, and of the noble edifice now in course of construction at the corner of Boylston and Exeter streets. The formation of the Boston Medical Association (1806), of the Suffolk District Medical Society (1849), of the Societies for Medical Improvement (1839), for Medical Observation (1835 and 1846), of Medical Sciences (1869), and others.
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The most notable change in the conditions of the Profession is its sub- division into specialties. We have not only Oculists, Aurists, and Den- tists, but Gynæcologists, Dermatologists, Laryngologists, Orthopedists, practitioners devoted to nervous diseases, Alienists, and the guardians of public health, - Sanitarians.
Among the remarkable improvements of the present century, which have been taught and made practical here as elsewhere are the following: The introduction and perfection of instruments of research, -the stetho- scope, the medical thermometer, the sphygmometer, the ophthalmoscope, the laryngoscope; all showing us the condition of parts beyond the reach of the earlier and unaided methods of observation.
Our knowledge of the intimate organic changes connected with disease has been acquired to a great extent within the last half century by that signal improvement in the compound microscope which rendered it a trustworthy instrument. The almost entirely new science of Histology, or General Anatomy,-the broad idea of which is still to be found in the original work of Bichat, - owes its present condition entirely to the micro- scope, which is to the biologist what the telescope is to the astronomer. Out of its teachings have grown not only a new anatomy, but a new physi- ology and a new pathology.
In the mean time chemistry has not merely aided in the analysis of the material elements of the organism, but it has succeeded in eliminating great numbers of powerful principles from the compounds in which they were disguised by nature. Quinia, morphia, strychnia, and aconitia are ex- amples of isolated organic elements which have the essential virtues of the plants from which they were derived. Nor are we to forget our obligations to the pharmaceutists who have divested medicine of its horrors to such an extent that we no longer shudder as we see the physician writing his pre- scriptions.
It is but a fractional power that the physician has over disease, and a comparatively small fraction over the issues of life and death. But he can avoid the errors of the past, which. over drugged the sick in the belief that whatever was loathsome to the senses and. perturbing to the functions was likely to be useful in disease. Nor is the healing art to rest contented with simple expectation. The discovery of the efficacy of the bromide of potas- sium in epilepsy and other nervous affections, of salicylic acid and its salts in rheumatism, show us what may be expected before another half century has passed into history.
Of the triumphs of modern surgery, - Listerism and the rest, - of advances in the treatment of deformities and of various local diseases, I have not spoken. After what we have seen accomplished in the removal of abdominal tumors, we hardly know what limits to put to the happy audacity of the skilful operator. We ought not to forget here the import- ant contributions made by one of our own . townsmen, -Dr. Henry J. Bigelow, - to the successful treatment of dislocations of the hip, and to VOL. IV .- 71.
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the improvement of the operation of lithotrity. The greatest of all improve- ments since the first operator took a knife in his hand is unquestionably the discovery of the art of painless surgery at the Massachusetts General Hos- pital in Boston.
III. MEDICAL AUTHORSHIP. - Boston has not been so prolific of medi- cal publications as some other of our great cities, especially Philadelphia. A large part of our medical authorship has been in the form of contribu- tions to the publications of the Massachusetts Medical Society and to the two or three Medical Journals which have been published in Boston from the year 1812 to the present time. The principal writers of the first half of the present century were Dr. James Jackson, Dr. J. C. Warren, Dr. Bige- low, Dr. John Ware, Dr. Channing, Dr. Hayward, Dr. J. B. S. Jackson. The writers of the last thirty years have been very numerous, and are most of them still living and active. Of these I should make honorable mention if their names were ready for a place upon a public monument. Of those no longer living I will only name Dr. J. Mason Warren and Dr. Edward Ham- mond Clarke. An essay by Dr. Clarke, - Sex in Education, - was very widely read, and gave rise to a prolonged and animated discussion by vari- ous advocates and opponents of its doctrines.
I think it may be fairly claimed for the publications of Boston physicians that while they have not included many text-books and compilations, or been largely given to theoretical speculation, they have contributed in fair proportion to the practical knowledge of the profession ; and especially that the reports of cases, with the comments upon them which have been pub- lished in our local periodicals and in the catalogues of our museums, have a real and permanent value.
IV. PERSONAL RECOLLECTIONS OF NOTED PHYSICIANS. - The artist who paints a group of portraits often leaves some figures in the back- ground in shadow, or half averted, or at any rate too indistinct for easy recognition. He sometimes takes the liberty in painting an historical picture of introducing one or more personages whose right to be there might be disputed.
I claim a privilege like that of the artist in introducing the first personage of those I shall mention. Once only did my eyes fall upon the figure of the most venerable Dr. Edward Augustus Holyoke, who passed the greater portion of his life in Salem, but belonged in part to us as President of the Massachusetts Medical Society, to the whole community by his talents and virtues, and more singularly as one of the few centenarians whose age was so much a matter of public record that it could not be questioned by the most sceptical. He survives only as a shadowy silhouette in my memory, like the well known figure which a paper-cutting has preserved of him. His portrait at the ages of forty-five and of one hundred may be found in the memoir of him by his townsman, the late Dr. A. L. Pearson. Stat
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nominis umbra in my pages; but it pleases me to tell my reader that I remember the good and wise old patriarch who was born within the twelve- month in which Cotton Mather died, and who must have met in his daily walks many old persons who as children had witnessed the hanging of the witches.
My personal recollections of Boston physicians go back to Dr. John Jeffries, who died in 1819. He came, probably, to administer the profes- sional coup de grace to an aged relative of my own, who had been given up by his attending physician, and only awaited the final word of a skilled and ancient expert to authorize his departing in peace. Dr. Jeffries was ac- companied by his son " the young doctor," whom I lived to know as "the old doctor," and who died in 1876. I have very little to say of the impres- sion which the father made upon me, a boy eight years old, to whom an old physician was an object of personal dread and antipathy. Dr. Jeffries, or "Jeffers " as the old ladies used to call him, was always remembered in con- nection with his famous balloon ascent. It is not so generally known that he had the signal distinction of being recognized as a medical theorist by one of the best known of modern professional writers, Broussais, who devotes some pages to him in his Examen des Doctrines Médicales. The late Dr. Jacob Bigelow, in his last years, entertained me with personal anecdotes of the old Doctor which showed that he had his whims and peculiarities as well as his virtues and talents. This recollection is hardly worth preserving ; still it was something to have seen the man who first crossed the British Channel, not by water but by air; who walked among the dead of Bunker's hill battle and pointed out the body of Joseph Warren to those who were searching for it in the heaps of slain; and who helped to deprovincialize the medical science of Boston.
I might well have seen Dr. Samuel Danforth, -" Danfurt " as the com- mon speech would have it, - who died ten years after the time when I looked upon Dr. Jeffries. I used often to hear him spoken of as being asked in " consultation," as the extreme unction of the healing art is called. If " old Dr. Danfurt " or "old Dr. Jeffers" was seen entering a sick man's door, it was very likely to mean nothing more or less than a nunc dimittis. Dr. Dan- forth's handsome features are well known to us in the fine portrait painted by Stuart and lithographed in Thacher's American Medical Biography. It is a pity that we do not know more about him. He was very positive, some- what passionate ; swore like our army in Flanders, and did not care much for other people's beliefs. Of course he was an interesting personage; but he has special claims to professional remembrance as having anticipated the practitioners of our own time in entirely giving up blood-letting. His materia medica was very limited, having as its leading articles the same four remedies which, as has been mentioned, were most relied upon by Dr. Holyoke and his pupil Dr. James Jackson. These he supplemented by rubbing, blistering, and the warm bath. He quarrelled with Dr. James Jackson, with whom it was very hard to quarrel, and must, a fortiori, have
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had difficulty with others of the profession, for he could not bear opposition. But he was a great favorite with his patients, and commanded their entire confidence.
Still in the background, and a little at one side, - for they were not Boston physicians, but lived on the other shore of the river at Cambridge, - are three figures belonging to three physicians, each of whom is a typical representative of a class; all distinct images in my memory.
Benjamin Waterhouse, whose name stands on his title-pages over an in- verted pyramid of titles of great dimensions, studied in London, Edinburgh, and Leyden, at the last of which places he took his medical degree in the year 1780, - the same in which died the learned Professor Gaubius, a pupil of the world-renowned Boerhaave. He was a relative of the excellent Dr. Fothergill of London, with whom he used, as he tells us, to drive upon his rounds of medical visits. He will be long and deservedly remembered as having introduced vaccination into the Western world. He was for some years Professor of Theory and Practice in Harvard University. He speaks of himself as Director of the Military Department comprehending the States of New Hampshire, Massachusetts, Rhode Island, and Connecticut. He may have voluntarily relinquished practice; but whether this were so or not, I never remember hearing of any patient under his care. He had however vaccinated great numbers of persons, myself among the rest. He probably liked to write and lecture and talk about medicine better than to practise it .. A brisk, dapper old gentleman, with hair tied in a ribbon behind and I think powdered, marching smartly about with his gold-headed cane, with a look of questioning sagacity, and an utterance of oracular gravity, - the good people of Cambridge listened to his learned talk when they were well, and sent for one of the other two doctors when they were sick. Two brief extracts from an essay of his will sufficiently show his way of thinking and prescribing : -
" As to planetary influence, mentioned by Boerhaave and Mead, - the various aspects of the sun and moon ; their accessions, recessions, perpendicular or oblique irradiations, conjunctions, and oppositions ; and their effects on us through the me- dium of our atmosphere, - we are not prepared to express a decided opinion. . . . Millipedes have been given with good effect in whooping cough. ... Physicians in the last century thought they could not practise without millipedes ; while too many in this day believe them good for nothing."
. All this was rather too mediaval for Cambridge in the nineteenth century.
While Dr. Benjamin Waterhouse was walking about with his gold-headed cane, like a London physician minus his chariot and his patients, Dr. William Gamage was riding round on a rhubarb-colored horse with his saddlebags behind him, and stopping at door after door. Grim, taciturn, rough in as- pect, his visits to the household were the nightmare of the nursery. He would look at the tongue, feel of the pulse, and shake from one of his phials a horrible mound of powdered ipecac, or a revolting heap of rhubarb, -
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