Ira Rutkow, September 15, 2012

In 1721 Boston, Dr. Zabdiel Boylston, feared for his life for experimenting with small pox inoculation. He said, “I resolved to carry it on for the saving of Lives, nor regarding any, or all the Menaces and Opposition that were made against it.” During the Summer of 1721 an “attacker threw a bomb through Cotton Mather’s (a local preacher who supported Boylston), but it failed to explode. The assailant had tied a chilling message around the device: “COTTON MATHER, You Dog, Dam you: I’ll inoculate you with this, with a Pox to you.”

Of the approximately 5,800 Bostonians who contracted the disease naturally (total population around 12,000), about 850 died, a death rate of almost 15%. Of the 247 people that Boylston inoculated, only six dies, a death rate of less than 3%.

Boylston had a significant influence on Benjamin Franklin. Franklin said of Boylston, “I was saved from the abyss of destruction by Boylston.”

Boylston’s relationship with Franklin had a huge impact on the Revolutionary war as well. In March of 1776, British troops were placing blankets of previously infected blankets in various neighborhoods. “Washington, in the face of public criticism and a stalled war effort, yielded to the wishes of Franklin and others and had mass inoculations performed on troops in Morristown and Philadelphia and new new recruits from new England. Inoculation was carried out at Valley Forge a yar later. The decision to have the Continental Army inoculated against smallpox was one of the greatest strategic and medical decisions ever conceived by a wartime general. It changed the outcome of the conflict and secured the beginnings of a new country by improving the health of soldiers.”

Smallpox was described as, “purple spots, convulsion fits, bloody urine, violent inflammations int he eyes, throat, and other parts. In some, the pock runs into blisters, and the skin stripping off, laves the flesh raw, like creatures flayed. Some have burning, others a smarting pain, as if in the fire, or scalded with boiling water.” * At that time, minister physicians were the norm. “America’s preachers, the colonies’ best educated and most well-read individuals, found that their book knowledge of medicine provided an effective way to establish rapport with congregants an the general public. since religion and medicine had been interwoven for centuries, especially through the view that illness was the work of the devil and punishment for religious transgressions, it was a de rerigueur for colonial clergymen to attend to flocks’ medical needs as part of pastoral care.

Medical organizations, another important symbol of colonial doctor’s emerging awareness, first came into existence around this time as well. In 1755, for example, physicians in Charleston, South Carolina, announced in the city’s newspaper that they were banding together to protect their financial interests. “We are called out under the greatest inclemencies of the weather, sometimes merely to gratify the Patient, and are often slowly and seldom sufficiently paid.”

In 1757, John Morgan, became the father of modern medicine. He attended medical school in Edinburgh. Formal university education along with legally respected medical diplomas would be necessary to transform American medicine into a learned profession. These British-educated elite physicians understood that their long-term socioeconomic interests benefited from a well-regulated and organized profession. Morgan took on the apprenticeship system by attacking the majority of American physicians as incapable of acquiring up-to-date medical information. Morgan noted that nothing less than a medical school’s direct relationship with a university could provide academic prestige, legal authority, and administrative capability. Morgan could have allied his Philadelphia school with the Pennsylvania Hospital, a thriving health care facility and America’s first permanent hospital for the care of needy sick, but he decided against it.

Many colonialists in Morgan’s day probably knew about hospitals, but only a small minority had intimate knowledge of one. America’s hospitals were few in number, poorly managed, and unable to provide administrative support to a medical school. Only two general hospitals, the Pennsylvania Hospital and the Charity Hospital in New Orleans, were functioning at the end of the Revolution. They were facilities of last resort, ignominious places to receive medical care. these institutions were no more than shelters for those who could not afford treatment at home, had no family to provide nursing needs, or lived in such adverse conditions that there was no space in their house for the sick or dying.

Morgan’s efforts to transform medicine into a licensed profession divided the medical community. “Nobody of men are less in concert, or seem less influenced by the espirit de corp, than physicians. The quarrels of physicians are proverbially frequent and bitter, and their hatred, in intensity and duration, seems to exceed that of other men.” (“Remarks on medical fees,” New York Chronicle of Medicine and Surgery, 1824-1825)

Democratization of Healing

In 1813, Benjamin Rush lay dying on his bed at the age of 68. A physician friend arrived at his house to perform bloodletting, the era’s most common medical therapy, the very treatment Rush had popularized. With a few swift cuts along Rush’s arm, the doctor opened the veins like spigots and collected 10 ounces of blood. Rush grew faint and fell asleep. Several hours later Rush insisted that the treatment was working and asked to be bled again. Rush cautioned everyone in the room that unless the therapy continued, “the disease will take hold of my lungs, and I shall go off in a consumption.” The physician removed 3 more ounces of blood. The patient insisted that he felt fine, then fainted again. This time the doctors believed that Rush had entered, in their words, a “refreshing sleep.” In fact, they weakened the patient into irreversible circulatory shock and he soon died. The irony was that Rush hastened his own death by unwavering commitment to the doctrine he was convinced would heal him. * Several decades before he died, Rush has stated the defining clinical principle of his era–the post Revolutionary era–in one sentence: “There is but one exciting cause of fever and that is stimulus, and that consists in a morbid excitement and irregular action of the blood vessels.” This “bleed, blister, puke, and purge” gambit had a several millennial history, but Rush formalized the treatment and educated thousands on the practice.

Heroic therapy bled adults and children alike. “As a general rule we need not be afraid of vomiting the youngest child,” wrote one advocate.

Benjamin Rush was an abolitionist, advocate for the mentally ill, anti-death penalty activist, environmentalist, founder of the Philadelphia Bible Society, prison reformer, protector of Tories, and treasurer of the US Mint. Rush, along with 4 other physicians, was a signer of the Declaration of Independence.

Doctors and laymen idolized him and constantly sought his advice. The answer was always a simple, declarative demand: bleed, blister, puke, and purge each and every patient.

Although some of Rush’s contemporaries found his fondness for the bleeder’s lancet unconscionable, and they disagreed with other aspects of heroic therapy, none ever developed a more widely accepted scheme of clinical therapeutics.

It was a time of medical anarchy, in which physicians pursued their own individualistic style of unregulated and untested doses of Rush’s depletive therapies. * When Rush died in 1813 to his own treatment, his critics were quick to point out the problems with heroic therapy. By the 1850s heroic therapy was no longer considered the gold standard for medical treatment.

Much of the discontent with heroic therapies started when France replaced Great Britain as the educational mecca for ambitious and well-heeled American medical students. With the influence of French medical training, it seemed as if an underlying philosophy of medical care in mid-nineteenth century America was that for the public to remain healthy they should avoid doctors.

The Anti-Rush movement included many alternative options including: * The Thomsonianism movement based on the theory that most maladies were due to excess of cold in th body. Thomsonians treated the sick with hot baths while employing a vegetable-based remedy to induce perspiration. * Sylvester graham, a dietary reformer, and his followers championed vegetarianism as teh basis for healing and maintaining good health. This nutritional regimen centered around the ingestion of whole wheat flour biscuits. Adherents claimed that a steady use of these “Graham Crackers” not only controlled onanism (masturbation) but could cure indigestion, inadequate circulation, and insanity. * The competition from the new irregular physicians forced the more traditional physicians to formalize their group and create evidence based deliver.This resulted in the formation of the American Medical Association. * The story of anesthesia can be found on pages 44-60.