Ohio History Journal

METHODS OF TREATMENT OF SOME OF THE MORE

COMMON DISEASES BY THE PIONEER

PHYSICIANS OF OHIO

 

By DAVID A. TUCKER, M.D.

 

As a preface to the description of the treatment of some

common diseases in the Ohio Valley a century or more ago, I

should like to sketch briefly the knowledge with which the phy-

sician of that period was equipped.

First, he was familiar with the gross appearance of body in

health and disease as anatomical studies were greatly stressed,

but knew little or nothing of microscopic structure of tissues. His

knowledge of physiology was meager and had scarcely any prac-

tical application. He was familiar with a multitude of symptoms

to which undue diagnostic significance was often attached. The

art of percussion had been developed and auscultation was intro-

duced in the early 'twenties, forming a basis for a more scientific

method of diagnosis. Laennec's works were translated into Eng-

lish and then appeared in American editions. Indeed, extensive

excerpts with critical commentary appeared in Daniel Drake's

Western Journal of the Medical and Physical Sciences.

As a rule the doctor served both as physician and apothecary;

he prepared many of his own crude drugs, made tinctures and

effusions, put up his own prescriptions and in addition taught

simple nursing procedures to friends or relative of his patients.

To give a general picture of the diseases of the country as

described 100 years ago, I quote freely from Nathaniel Potter

as follows:

With regard to our diseases, pleurisies, rheumatisms, and inflamma-

tions generally prevail during the winter in the northern states. Catarrh,

too, is common, and often terminates in the consumption; which may be

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212    OHIO ARCHAEOLOGICAL AND HISTORICAL QUARTERLY

 

called the endemic of the country. In some districts and seasons, one

fourth in the number of deaths are from this cause. The various forms

of quinsy occur frequently; nor are local inflammations of the internal

parts of the body by any means uncommon. The eruptive diseases,--such

as the scarlet fever, the measles, &c., occur generally at the interval of

three, four, or more years:--but the smallpox, since the introduction of

the vaccine, has certainly been suppressed as far as the irregularities of

poverty, ignorance, and prejudice will permit. It is a lamentable truth,

however, that this loathsome disease is still seen in our cities. The plague,

exactly in the form which it wears in the old world, has seldom appeared in

our country. The disease of Pemphigus, and military fever, are not often

seen. Apthae and cholera, particularly among young children, appear in the

summer, when the heats are great. The nettle rash is common among the

adolescent,--but more rare in adults. Haemorrhages, both active and pas-

sive, are known in all climates of the country, and cannot perhaps be said

to belong to one district more than to another,--excepting that from the

lungs; which is not uncommon in the northern districts, and most generally

precedes the consumption. In the southernmost regions it is almost un-

known. Haemorrhoids are often an affection of the old; and perhaps,

indeed, it may be said that, with respect to this disease, as well as to others,

not immediately connected with our variable climate, we resemble the

inhabitants of Europe. With regard to the diseases peculiar to the sex

the same remark may be made.

Apoplexy and palsy are often the result of intemperate habits; in the

middle and southern states particularly. They are the diseases of which the

aged die, in the concluding months of the winter, as well as at the begin-

ning of spring or of autumn. The active habits of our countrymen render

hypochondria more rare than in Great Britain. In the northern states the

tetanus, or lockjaw, is uncommon, in summer, and never occurs in winter.

In the middle states, it is dangerous to receive a wound, particularly a

lacerated one, during the warm season, without using stimulating remedies

to prevent this dreadful disease. In the southern, it is not at all infrequent

in summer, and it sometimes occurs even in winter. In the former seasons

it often proceeds from a cause, viz., exposure to the night air, which in

the northern states is seldom or never known to produce it. Of epilepsy,

asthma, and St. Vitus's dance, there is nothing peculiar to be said with

regard to our country. Pyrosis and indigestion, are often the result of

intemperance: they are confined to no particular district, or tract; and may

be said to attack in the common forms and from the ordinary causes.

Hydrophobia appears not unfrequently; and is often symptomatic,--

though it most commonly arises from the bite of rabid animals. Madness,

indeed, may be supposed to arise in this country from the same occasional

causes, as in Europe. It appears in families and descends by hereditary

succession; often disappearing in one branch, or generation, and making

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PIONEER PHYSICIANS OF OHIO                      213

 

its appearance again in another. Sometimes high-toned pride, intemperance,

excessive headaches or eccentricity, in a parent, becomes mania in the next

generation; while on the contrary, they leave a family in a reverse order.

Religion, love, and losses in business, may perhaps be the most frequent

causes of this disease, though from its connection with hereditary perdis-

position, it is often difficult to trace them with accuracy.

Dropsy is believed to be less common, than formerly, and is now a

very manageable disease, where the constitution is not absolutely broken.

It generally occurs among the poor, the irregular, and the intemperate.

Rickets rarely appears; though it sometimes affects the negroes, and par-

ticularly negro children. Scrofula occurs more frequently; and is gen-

erally manifested in diseased mesenteric glandular swellings, and ulcers

of the soft parts, with carious bone. With regard to the disease resulting

from impure connexion, it may be supposed, that, in a country, where

population is extended on a scale unknown in any other quarter of the

globe,--where all the delights of life highly stimulate the system, the dis-

eases of a function so intimately connected with the general health would

naturally be common. Accordingly, it may be said, that among the labour-

ing classes, particularly in the cities, there are few individuals who have

not had their constitutions seriously affected by frequent contaminations,

by injudicious exhibitions of mercury, or by suffering the malady to go

imperfectly cured or totally neglected. To give the reader a general view

of the state of the disease in our country we would say, that malignant

bilious fevers of remittent or an intermittent type, prevail most in the sum-

mer and beginning of autumn; catarrhs, pleurisies, inflammations, rheuma-

tisms, typhous fevers, in the approach and progress of winter, as well as

in the commencement of spring--and that other diseases which have been

enumerated, are regulated in their appearance by irregularity of living, by

the decay of nature, and by the other numerous and varying accidents of

life and of climate. Accordingly in the north, where winter has the sway,

the remittent fevers of the north are more mild, and the inflammations

more severe. But in the south, the contrary takes place,--the feveres being

malignant and deadly; whilst inflammations, pleurisies, catarrhs, and con-

sumptions, seldom occur or are entirely unknown. In the mild states, on

the other hand, where the climate is alternately tropical and artic, we

have, accordingly as one or the other season prevails, the malignant fevers

of the south,--or the consumption, and the inflammations of the north.

From this view of the climate and diseases of our country, it need not

be said, that various districts have various degrees of health; that the sea,

lakes, marshes, highlands, and mountainous regions diversify the tempera-

ture of the air, as well as the character of disease; that epidemics appear

in districts, for many years blessed with health; and that while there are

endemics, which never leave particular regions,--there are others at all

seasons and in all years are comparatively free from disease of any kind.

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214   OHIO ARCHAEOLOGICAL AND HISTORICAL QUARTERLY

The Treatment of Pleurisy and Pneumonia

The diagnosis between these two conditions was not always

made clearly and the treatment was similar in each instance. John

Eberle states that "both in pleuritic and peripneumonic inflamma-

tion bleeding is the first and most important remedial means,

the extent to which it is to be carried must be entirely regulated

by the degree and obstinacy of the pains and the state of the

pulse." The same author recommends "gentle aperients" and

cautions against drastic purges; cooling diaphoretics such as

muriate of ammonia, nitrate of potash were indicated. Nauseating

doses of tartar emetic were prescribed by some in the belief that

the "undue action" of the heart and arteries were thus diminished,

expectoration increased, and absorption promoted. Calomel and

opium were given after the disease had continued for three or

four days, one grain of opium and two of calomel being ordered

every three hours until relief from the cough was obtained.

Expectorants while frequently used were not regarded as of

decisive benefit. Blisters and other methods of counter irritation

were considered to be effective methods of treatment. In pleural

effusion a combination of calomel, digitalis, and squills was widely

used. In empyema, paracentesis was recommended although the

procedure was considered by some writers to be extremely

dangerous.

Of consumption or "chronic inflammation of the substance

of the lung" George Gregory wrote in 1829 the following: "It is

melancholy to reflect how very little this disease is under the con-

trol of medicine." He advocated a less active treatment than some,

stating that "on the one hand we have to combat the actual pres-

ence of inflammation; and to bear in mind, on the other, the

danger of exhausting the constitution." On the cure of this dis-

ease he further writes:

The question has been frequently agitated whether tubercles can be

absorbed; and by what medicines that desirable object can be effected.

Emetics have been recommended by some; muriate of baryta by others;

but though there is every reason to believe that tubercles have in some

cases dispersed, yet the effect appears to be as completely out of our con-

trol as the manner of their formation is beyond our knowledge. All that

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PIONEER PHYSICIANS OF OHIO               215

 

can be reasonably expected from medicine is to keep them in a quiescent

state; and this is to be done by a strict attention to diet, air, exercise and

by avoiding all those causes which are likely to bring on haemorrhagy

of the lungs.

Not all authorities of the day were so rational as Gregory

however, and blisters, setons, and pustulation were advocated.

Bleeding was often done in the so-called incipient consumptive.

Likewise purgatives and emetics were used to rid the body of

"noxious material." Expectorants with opium were used to con-

trol the cough and lead acetate in doses of 4 or 5 grains each

night was given to control night sweats. A farinaceous and milk

diet was widely used, and the beneficial effects of a mild elimate

was universally noted.

 

The Treatment of Acute Bronchitis

In this condition bleeding was generally proposed only early

in the disease. Emetics, purgatives, and expectorants with external

counter irritation formed the basis of the treatment. Invariably

weak infusions of calumba, gentian, or the bark, were prescribed

during convalescence.

In chronic bronchitis in addition to the measures used in the

more acute process various inhalations such as tar fumes were in

vogue. Drugs used included prussic acid, digitalis, opium, quinine,

lead acetate, Dover powder, hyoscyamus, sulphur acid, and

mercurials.

Acute Nephritis

The diagnosis of this disease rested on the symptoms of local

pain, scanty urine, nausea and vomiting.

In this disease prompt and efficient bloodletting constituted

the primary remedy. Cupping or leeching over the lumbar region

was frequently done. Hot fomentations and vesiculation were

advocated. Purgation with calomel followed by the salines or by

castor oil was almost universally recommended. Enemas were

used. Drugs included opium, Dover's powder, uva-ursi, lime

water, and various antimonial preparations.

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216   OHIO ARCHAEOLOGICAL AND HISTORICAL QUARTERLY

 

Acute Rheumatism

The usual treatment consisted in bleeding, the prescription of

purgatives, emetics and diaphoretics. Opium alone or with either

calomel, colchicine and stramonium were used. Local treatment

with heat and blisters was advised at times.

In chronic rheumatism bloodletting was not commonly done.

The medical treatment was much the same as in the acute form.

Local rubefacients were usually used.

 

Diabetes

Concerning this disease Gregory in 1829 wrote, "Where

pathology is obscure the principles of treatment are necessarily

deficient." In 1776 Dr. John Rollo of England proposed a diet

consisting wholly of animal food and it was noted that there was

a marked reduction in the quantity of urine voided and an im-

provement in many of the symptoms of the disease. However

bloodletting and cupping were considered by many to be neces-

sary. Opium and cinchona were widely used as also various

mineral waters.

Fevers

The diseases which we now know as malaria, typhoid and

typhus fevers (and probably septicema), were responsible for a

large number of deaths and a great deal of disability. They were

known variously as periodical fevers (intermittent, remittent),

and continued fevers.

In the periodical or malarial fevers bloodletting was advised

during the so-called hot stage; cupping also was commonly done.

Purgatives were given at the onset, but the recognized remedy

was cinchona and its preparations. Unfortunately in the first part

of the century the cost of quinine in the United States was almost

prohibitive and the preparations of cinchona varied in alkaloidal

strength so that the latter was not entirely reliable. Other reme-

dies were opium, the bark of dogwood, the bark of the horse-

chestnut, the bark of different oaks, calumba, quassia and gentian.

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PIONEER PHYSICIANS OF OHIO              217

 

The black or cellar spider's web was recommended as a remedy

for intermittent fever. Arsenic and zinc were often used in con-

junction with cinchona. Tartar emetic was regarded as a cure in

some quarters. There was a great deal of difference in the method

of use of cinchona and quinine. Some advocated small doses,

such as two or three grains of the quinine, hourly, others gave

fifteen to twenty grains at a dose repeating in six to twelve hours.

One author, Dr. Perrine, in the Western Journal of the Medical

and Physical Sciences for 1833, wrote, "The medium dose of the

sulphate of quinine at any period of fever from its incipient to

its terminating symptoms is ten grains to be repeated every two

hours, whatever the state of the pulse and skin."

Eberle bases the treatment of the typhoid fevers on the re-

quirements:

1. To diminish the general momentum of the circulation.

2. To restore the natural actions of the various excretory

organs--above all those of the skin, liver, and kidney.

3. To equalize circulation and obviate local determination.

4. To remove from and out of the system, as far as may

be practicable, everything which has a tendency to irritate or

unduly excite the system.

 

To meet these indications Eberle recommends bloodletting

the use of such purgatives as the saline (sulphates of magnesia

and soda) or jalap and cream of tartar. Diaphoretics such as nitre

and antimony were advised and small doses of calomel and ipecac

and mucilaginous drinks were frequently given. Digitalis--one-

fourth to one-half grain every two hours--was administered until

the pulse was appreciably slowed. The diet consisted in demulcent

drinks, weak broths, barley or toast water, and during con-

valescence tonics.

Scarlet Fever

As an example of the treatment of this disease I quote from

a letter by Dr. George E. Conant of Windham, Portage County,

to Dr. Daniel Drake, March 20, 1833, as follows:

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218    OHIO ARCHAEOLOGICAL AND HISTORICAL QUARTERLY

 

In the commencement, I prescribed a cathartic of equal parts by

measure of jalap, sulphur, and cream of tartar. If the arterial action was

high and the skin hot, I made use of tepid affusions to the body and

extremities, with cold water and vinegar to the head. The external appli-

cation to the throat was flannel clothes wet in a strong decoction of red

pepper and vinegar. To those of the greatest severity, I made use of

mustard poultices, and plasters of cantharides with benefit. Internally the

mouth and fauces were gargled frequently with a decoction of blackberry

briar root, to which borax was added, and made sweet with honey. In the

most severe cases, myrrh, cayenne pepper and brandy were made use of

with the happiest effects. As expectorants, antimonial wine and vinegar of

squills were found to be of great service. But the remedy on which I placed

the greatest reliance, was a powder composed of carbonate of ammonia

and nitre. When the fever was the highest, and in the first stage of the

disease, I gave a greater portion of nitre with the addition of a little

ipecac; but as the fever began to subside the ipecac was entirely and the

nitre gradually withdrawn, while the ammonia was increased, and camphor

added, which were given freely during the remainder of the illness. Some

mild aperiento, such as magnesia and rhubarb or castor oil, was admin-

istered daily, if necessary, to keep the bowels loose and open. When the

fever began to abate, I found superior advantage from the application of

bass-wood leaves wilted in warm water to the surface generally. They

produced a gentle perspiration, and broke up the fever at once. As soon as

the favrile action was gone, a decoction of cinchona, orange peel and

chammovaile flowers was given with advantages. For drinks I made use

of milk and water, toast and water, apple water and hot tea, as best suited

the patient. Rubefacients were applied to the feet throughout the disease.

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