Wednesday, March 7, 2018

Questions You Always Wanted To Ask About Life In Colonial New England: Doctors, Medicine and the Treatment of Illness

As a nurse, for more years than I'd like to mention, I marvel at the state of medicine and its frequent innovations. It is a great disappointment when illness cannot be cured or injuries repaired. Many people today live with chronic illnesses that would have resulted in death in the not so distant past. And it's the very distant past that I am interested in. What was the state of medicine in Colonial America? Was it accessible, was it affordable and was it effective? Let's take a look.

Doctor Who?
In 1776 the estimated population of the American Colonies was approximately 2.5 million. It is also estimated that in the 1770s there were only about 200 doctors with actual medical degrees. You don't have to do the math to see that the doctor patient ratio was extremely high. Why the dearth of degree'd doctors? The first medical school in the colonies did not open until 1765 in Philadelphia. English trained doctors were part of the early migration to New England but their numbers dropped rapidly. There was little profit and lots of hard work and they either returned to England or died and were not replaced. 

So, who did the doctoring? Ships surgeons, barber surgeons and apothecaries were all known as Doctor. They had little formal training, some were self taught others trained on the job, apprenticeship, with more experienced 'Doctors.' There were medical treatise that could be studied if one were literate. There were also plenty of quacks and charlatans, happy to sell you a cure for what ailed you. Midwives saw to childbirth, and often provided pediatric care for young children. They held a monopoly on women's reproductive health well into the 18th century. The average housewife would often have to rely on only her skills, or her neighbors skills at healing, apply any known herbal remedy they deemed effective. 

A hair cut and dental extraction-The Barber-Surgeon
The role of the barber surgeon in health care rose in prominence in the middle ages. They even formed their own guild to oversee their members. Typically the barber surgeon could give you a trim, pull your teeth, lance a boil or do a spot of blood-letting. The last barber-surgeon in England died in 1821. A barber surgeon with his own establishment would put out a red and white striped pole. Red represented blood and white bandages. The barber surgeon would also treat traumatic injuries received in battle or by accident. 

Blood-letting is one of the oldest medical treatments for illness. It is believed that the practice began in Ancient Egypt and spread to Greece and then on to the rest of Europe. Blood-letting was the treatment of choice for everything from the plague to gout, it might even be used to aid childbirth. It is possible that excessive blood-letting for a sore throat led to the death of George Washington. 

The reasoning behind blood-letting had to do with the belief in the four humors of the body. Black bile, yellow bile, phlegm and blood. If you had some sort of inflammation, like that caused by a sore throat, blood-letting would reduce it. 

Like the barber surgeon, the apothecary had a sign to identify his business; the mortar and pestle. An apothecary often compounded his own medicine. He would diagnose, prescribe and treat his patients. Treatment was based on folklore, tradition or gleaned from medical books. American apothecaries were also interested in the medicines used by Native Americans. Occasionally the treatment was actual beneficial to the patient. Chalk was given for heartburn and chinchona bark was used to treat fevers. Chinchona contains the active ingredient quinine, which was used to treat malaria. The apothecary arsenal included opium for pain, salves for skin conditions, poultices to reduce inflammation, tinctures of herbs and other ingredients, emetics that caused vomiting and cathartics that induced diarrhea and willow bark which actual did reduce fevers. More often than not, the treatment was likely worse than the illness or contributed to the death of the patient. 

Midwifery was the only recognized role for women in medicine. The first new Americans were born aboard the Mayflower, delivered by a midwife. Childbirth was a risky business no matter how many children one had, each time the mother's life was at risk. Midwives were trained by other midwives, learning on the job. Some towns hired women to work as midwives and even furnished them a house and paid them a stipend. She was a reassuring presence during a dangerous event. 

One unique role of the midwife was to press unmarried women into revealing the father of their child. It was believed that a woman in the throes of labor would not lie. Midwives might also baptize babies they deemed unlikely to survive, testified to dates of deliveries, and examine female prisoners who claimed pregnancy to avoid punishment. 

Life Expectancy
Although life was tough in New England, life expectancy rose for the early immigrants. Was it the cold weather, less crowded living conditions? The first hurdle to a long life was surviving childhood. Mortality rates were high for children. In 1800 40% of children died by their first birthday; a grim statistic if ever I've seen one. Once out of childhood men stood a good chance to live into their forties. Women faced the hurdle of surviving childbirth while men contended with farming accidents and during periods of conflict battle related injuries and deaths. Despite this, many New Englanders lived into their 70s, 80s and older. 

Common illnesses were lethal
In the days before antibiotics, many people died of infectious disease. Smallpox, measles, yellow fever, scarlet fever, influenza, pneumonia ravaged New England. Something as simple as appendicitis could take a life. Imagine having a UTI, and no antibiotics to stop it in its tracks. Diarrhea caused by any number of infectious disease was also a killer. Of course due to a shorter life expectancy and a more active lifestyle they did not have the level of chronic illness that we suffer from, but some did. 

Like other post that I have written on the everyday life of our ancestors, I thank my lucky stars that I did not live in a pre-antibiotic world. 

Saturday, February 10, 2018

Questions You Always Wanted to Ask About Life in Colonial New England: Did they Bathe?

Mary Cassatt The Child's Bath
Ah, there is nothing better than a steaming hot shower or, more relaxing than a long soak in a tub full of hot water. We view a lack of hot water on par with a constitutional crisis, a lack of running water is unimaginable. A day or two without the ability to bathe reduces us to a stinking, nasty haired mess, unfit for public consumption. What then was life like for our ancestor who lived without running water hot or cold. How did they bathe? Did they bathe? How bad did they smell? I imagine they stunk pretty bad.  

Our ancestors faced multiple obstacles in the pursuit of bathing, if indeed they did pursue a bath. The early New England homes were only one or two rooms, full of large families and servants. The lived in a world almost devoid of privacy. Who wants to strip down in front of an audience, well back then anyway. Eventually houses expanded, but the heating did not. A New England bed chamber might be little warmer than the outside temperature in the dead of winter. Not much incentive remove any clothing, not to mention all your apparel. 

The next stumbling block is the lack of an adequate tub. Not everyone had a waterproof container large enough to accommodate a fully grown adult and if they did it was likely the washtub for doing laundry. The tub would have to be moved into the house for the bather. Then, adequate hot water would have to be heated to ensure at least a lukewarm experience. A bath required a lot of work and logistics, so how often did it happen? Did our Colonial ancestors even want to take a bath? It seems that many did not. 

The Romans, loved to bathe. They built large public baths so that everyone, rich or poor could be clean, at least once a week any way.  In the Middle Ages, bathing, as in fully immersing ones body in water, was almost unheard of. The Native Americans, first encountered by our English immigrant ancestors, bathed regularly, albeit in rivers, steams, lakes and other bodies of water. They found our ancestors a smelly bunch. Indeed, our earliest American ancestors may have gone their whole lives with a decent bath. In 1872 Mary Baker Eddy wrote a book, Science and Health, in which she said that "washing should be only to keep the body clean," and indicated that a less than daily scrubbing was all that was necessary. When bathing in tubs finally became acceptable, it was done once a week, on a Saturday. 

So what did these people do. The most common method of cleaning oneself was with a rag and a bit of water. Washing one's hands and face before eating was popular. The housewife might even have a basin of warm water ready before serving her meals. She might have a bar of soap, but it was used for laundry not for washing human skin. So the average person, when wanting to clean up a bit, gave themselves a sponge bath. 

Under clothes were laundered frequently. Made of linen they lay next to the skin. The other clothes, dresses and breeches were usually made of heavy wool, which could only be brushed but not washed. Wealthy people had several sets of clothes, but those on the poorer end of the spectrum might have only the one. They wore their clothes until they fell apart. Many a will included distribution of articles of clothing, described as my best dress, or my best suit of clothes. Because these items were never laundered, only aired out, they took probably smelled  pretty bad after a while. 

How did women keep clean while on their menstrual cycle? You were hoping I'd ask, right? Can you imagine dealing with that mess without all our current 'feminine hygiene products,' I can't.   Some historians put forward the idea that women just bleed into their clothes, but this does not ring true to me. Imagine walking around with blood running down your legs and into your shoes seems too gross to be real. I have to believe that they used something to absorb the blood. Rags seem to be the answer. Since women didn't wear 'underwear' I'm not sure how they remained in place, but I could probably make a guess. Imagine going through that every month. However, I think for most women back then, once they were married, a period was not as frequent an event as it is for today's women who can control their ability to conceive. Once a menstruating women got married she quickly found herself pregnant. After she gave birth she might nurse the baby for a year or more, her period would not resume until the baby was weaned. The next pregnancy put an end to her cycle again. Most women gave birth every two or so years, so between the pregnancies and the nursing there were very few menstrual cycles.

Of lice and men. Yes, you read it right. Lice were a bane of the colonial housewife. Just as contagious as today, those nasty, itchy creatures inhabited the heads of our ancestors. Lice combs, just as today, were used to scrape the nits from the hair. It is suggested that wigs became popular as a way to shave your head, and avoid lice, who did not live in wigs.  These pesky creatures afflicted people of all social classes, and along with fleas and bed bugs were a bane to be born. 

Go swimming! One way to get clean, sort of, was to go swimming. This was easier to do the further south you lived, but people did swim, not necessarily to get clean, but it was a by-product of the act. This was likely an activity enjoyed by men, so for a brief moment they smelled slightly better than the women folk. 

In conclusion, our ancestors made some attempt to be clean but fell well short of modern standards of hygiene. We could likely smell them coming and going with a bit of gagging when they got too close. That being said, these people lived in an intensely smelly world. Smoke from the chimney, rancid oil from lamps, farm animals and dung, privies, and chamber pots, food odors and midden heaps all contributed to the miasma of smell in which they lived. 

For a peek into the lives of our New England ancestors, read my book, Weave a Web of Witchcraft. Set in Springfield, Massachusetts in the year 1651, it follows the story of Hugh and Mary Parsons who were accused and tried as witches. More than just a story of witchcraft, the book describes daily life in Puritan Massachusetts and the struggle to survive. 

Have a great day!