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
(211)
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
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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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
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.
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.
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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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.