Not So Glamorous Years of American Medicine

Orthodox medicine in the late 1700s was an exclusively male, elitist enterprise, taught in universities closed to women. The University of Edinburgh had the leading medical school of the period, and its professor of physic, William Cullen, was the chief theoretician of heroic practice. Cullen believed in a unitary theory of disease. He felt that all symptoms resulted from one underlying cause: bad blood. The remedy was to remove it.

Cullen’s chief disciple in America was Benjamin Rush, a singer of the Declaration of Independence and heroic physician par excellence. Rush carried bleeding to an extreme. He bled one patient eighty-five times in six months, removed eight pints of blood from another over six weeks, and is credited with saying: “I would rather die with my Lancet in my hand than give up while I had Breath to maintain it or a hand to use it.”

Bleeding was supplemented by several other treatments designed to remove impurities and toxins from the body. Intestinal purging was held in high esteem, and the drug most often used to produce it was calomel (mercurous chloride). Heroic doctors gave their parents huge doses of calomel, following the current teaching to administer it until the patient began to salivate freely, a sign that the drug was working. Toxicology tests today list salivation as an early sigh of acute mercury intoxication, one of the most dangerous forms of heavy metal poisoning.

In addition to purging, vomiting was induced by giving violent emetic drugs such as tartar emetic, a poisonous antimony salt. Other drugs, called diaphoretics, were used to cause profuse sweating. Blistering was carried out by rubbing or burning local irritants on the skin, including cantharides (Spanish fly). In “cupping,: a heated glass cup was placed on the skin; as it cooled, a partial vacuum drew blood to the site, which was then lanced as another way of drawing off the bad fluid.

In the light of today’s knowledge, it is certain that heroic medicine sped many patients on their final rest. Here is an account of the death of George Washington:

Even George Washington, who received the best medical care of the day, spent his last hours undergoing heroic treatment. On December 14, 1799, the former President came down with a severe sore throat. It was inflamed and gave him some difficulty in breathing. His overseer removed a pint of blood, but it provided no relief. A physician was called who soon after his arrival applied a blister to the throat and let another pint of blood. At three o’clock in the afternoon, two other doctors came to consult with the first one, and by a vote of two to one, they decided to let more blood, removing a quart at that time. They reported that the blood flowed “slow and thick.” By then the President was dehydrated, and it would seem that the doctors must have had to squeeze out the final drops of blood. Washington died sometime between ten and eleven that same night. In his case heroic treatment consisted of the removal of at least four pints of blood, blistering, and a dose of calomel. Perhaps he would have died in any case, but the treatment certainly provided no relief.

Health and Healing

Andrew Weil. M.D.

Aren’t you glad now that we have antibiotics?