PIONEER MEDICINE IN VIRGINIA By BLANTON P. SEWARD, A.B., M.D. ROANOKE, VIRGINIA

Now the true and lawful goal of the modern physiology when he published sciences is none other than this: that his book, “De Motu Cordis,” in 1628. human life be endowed with new discov­ Thus the foundations for two of the eries and powers. fundamental branches of medicine were Francis Bacon, Novum Organum. laid only a short time before and after ARELY sixty-five years before the colonization of America. For a long the first permanent colony was time before the laying of the first established at Jamestown, An­ foundations of scientific medicine, a dis­ dreas Vesalius completed his tinction was made between physicians exhaustive treatise on anatomy, “De and surgeons. This distinction, though Humani Corporis Fabrica,’’ a wTork not a wholesome one, was continued, which, according to Osler, represents and it is the reason why the word, the full flower of .the Renaissance. “chirurgeon” or surgeon was placed Vesalius’ successor, Heironymus Fabri- after the names of some of the early cius, added to these discoveries, and colonial medical men, and the word, Harvey, a pupil of the latter, acknowl­ physician, after the names of others. edged that it was the position of the The first physicians who practiced in valves of the veins which Fabricius had Virginia were selected by the London pointed out, that induced him to think Company, a private enterprise which of the circulation of the blood. Twenty- sponsored the colony and managed its five years before Harvey was born, affairs until James I assumed control in Michael Servetus, a fellow-student of 1624. R showed a high conception of Vesalius, wrote his book, “Christian- the type of physician that should be sent isimi Restutitio,” in which he described to the colony in selecting men of good the pulmonary circulation. In the same training and whose talents equalled year that Servetus made known his dis­ those of their British contemporaries. covery, John Calvin and his fanatic The most outstanding of these physi­ Protestants burned him at the stake be­ cians were Walter Russell and Law­ cause the ideas expressed in it were con­ rence Bohun. sidered to be at variance with Christian Russell came with the first reinforce­ teachings. Had not such a fate befallen ment of colonists in January, 1608. He Servetus, “the martyr for the crime of was one of fourteen men who set out honest thought,” he, instead of Harvey, with Captain John Smith in the follow­ might have been the discoverer of the ing June to explore the Chesapeake general circulation. Bay. On this trip Russell rendered serv­ William Harvey, whom Cohn1 char­ ice to Captain Smith, who acterized as a “man unusually favored . . . taking a fish from his sword (not by fortune, one who utilized with great knowing her condition), being much of intelligence the rare opportunities the fashion of a Thornebacke with a which the contemporary world af­ longer taile. Whereon is a most poysoned forded,” helped to lay the foundation of sting of 2. or 3. inches long, which she strooke an inch and (a) halfe into the Indies, and there he wrote later: “I wrist of his arme. The which, in 4. houres found help for my health, and my sick- had so extremely swolne his hand, arme, nesse assuaged, by means of fresh dyet, shoulder, and part of his body, as we al, and especially Oranges and Lemonds, with much sorrow concluded (antici­ an undoubted remedy and medicine for pated) his funerall, and prepared his grave in an He hard by (as himself ap­ that disease, . . .”6 Scurvy had long pointed) ; which then we called Stingeray been known to affect mariners; it was lie, after the name of the fish. Yet by the also known that lemon and orange helpe of a precious oile Doctour Russel juice would either cure or bring about applyed, ere night his tormenting pain an improvement in the disease. One was so wel asswaged that he eate the fish hundred and forty years after Bohun to his supper: which gave no lesse joy and advised Lord Delaware to go to the content to us, than ease to himselfe. Hav­ West Indies where he could easily ob­ ing neither Surgeon nor surgerie but that tain fruit, James Lind wrote his classic preservative oile, we presently set sail monograph in which he urged the use for James Towne.2 of lemon and orange juice in treating Smith gave Russell and Anas Todkill the disease. credit for this report which represents The majority of physicians who prac­ the first literary effort of a physician in ticed in Virginia during the first two America. decades must either have remained here Lawrence Bohun was said by Brown3 a short time before returning to Eng­ to have been a “long time brought up land, or fallen victims of the epidemic amongst the most learned Surgeons and diseases that decimated the ranks of the Physitians in the Netherlands.” Com­ colonists. As a result of an insufficient ing to Virginia with Lord Delaware in number of physicians, the colonists were 1610, he soon gained the confidence of often in dire straits for medical aid. On the colonists. A few months after his ar­ several occasions the governors and the rival, he was commended by the Gov­ council wrote letters to the London ernor and the Council for his “care and Company requesting it to send more industrie for the preservation of our physicians and apothecaries.7,81 9 men’s lives (assaulted with strange The Company early gave the specific fluxes and agues), . . .”4 According to instruction: “Neither must you plant Strachey,5 Bohun investigated the me­ in a low or moist place because it will dicinal properties of several plants, par­ prove unhealthful.”10 That this instruc­ ticularly sassafras and galbanum mecho- tion was disregarded was neither the acon, or rhubarb, which he used “in fault of the colonists, nor of their physi­ cold and moist bodies for the purginge cians; the lowlands along the coast were of fleame and superfluous matter.” As infested with malaria but offered them far as we know, Bohun was the first phy­ escape by sea in case of overwhelming sician to investigate the medicinal prop­ attacks by the Indians, while certain erties of plants in this country. death awaited them in the interior at His investigations were terminated the hands of the savages. after about a year, when he accom­ It is interesting to note that in the panied Lord Delaware, who was suffer­ early years the colonists began making ing with scurvy, to the West Indies. It plans for a hospital, and in 1612 they was upon Bohun’s suggestion that the actually began constructing “a retreat Governor sought a cure in the West or guest house for sicke people”11 at Henricropolis on the James River a few cians who practiced in Virginia during miles from Richmond. The building the remainder of the seventeenth cen­ “with four-score lodgings (and beds al- tury excelled either in education or in readie sent to furnish them) for the talent those sent here by the London sicke and lame, with keepers to attend Company. Some who practiced here in them for their comfort and recoverie,”12 the latter part of the century probably was ready for use in 1618. As nothing were native Virginians who received further was said about the hospital, it their training by serving as apprentices was probably destroyed in the confla­ to local physicians. A few of the well- gration following the massacre in 1622. to-do planters sent their sons abroad to It is interesting to note also that the be educated. Bruce15 was inclined to London Company in 1620 issued orders think a large number of young Virgin­ for the building of hospitals in the col­ ians went to England to receive instruc­ ony. According to the orders, “. . . in tion in the foremost schools and col­ each of the four ancient Boroughs . . . , leges, although he mentioned only one, as also in each of the Plantations, a John Lee, who entered Queen’s Col­ Guest-house (hospital) shall be built, lege, Oxford, in 1658, received the for the lodging and entertaining of fifty Bachelor of Arts degree in 1662, and persons in each, . . .” in order that “later the degree of Doctor of Physic.” “the people now sent, and which here­ One may infer that he obtained his de­ after shall come, may be better provided gree in medicine at Queen’s College. A against sicknesse, (seeing in the health careful review of the records of that pe­ of the People consisteth the very life, riod, however, shows that he did not strength, increase and prosperity of the obtain the degree at that school.16 whole generale Colony), . . .”13 Spe­ Michel,17 in commenting upon educa­ cific directions were given for the size tion in the colony, stated: “. . . it was of the buildings, each one of which was the custom of wealthy parents ... to to have twenty-five double beds for the send their sons to England to study accommodation of fifty patients. When there. But experience showed that not the Government took charge of the col­ many of them came back. Most of them ony three years later, the Privy Council died of small-pox, to which sickness the ordered “Guest-houses to be built for children of the West are subject.” harboring sick men and receiving stran­ Many physicians who emigrated from gers.”14 Thus the institutional care of England to Virginia also did not have the sick was carefully considered, and degrees in medicine; like many Vir­ provisions were made for it, but un­ ginians, they acquired their knowledge fortunately the plans did not materi­ by serving as apprentices to well-known alize. One hundred and forty years after physicians—no mean way of obtaining the construction of a hospital in Vir­ a knowledge of medicine in those days, ginia, the Pennsylvania Hospital was for some of the most illustrious physi­ founded in Philadelphia. This hospital cians of the seventeenth and eighteenth is usually regarded as the first one centuries, as Jenner, did not hold a de­ founded in the United States. gree. That the medical training of many As the colony increased in population of the early colonial physicians was con­ and in wealth, the field was opened for sidered inadequate by contemporary a larger number of physicians. It is laymen is revealed in a letter written doubtful, however, if any of the physi­ in 1683 by Acting-Governor Nicholas Spenser18 to his brother. Suffering cine in Europe were closely followed by either with gall-bladder disease or ne­ the colonial physicians; their libraries phritis, Spenser plainly indicated his contained books and articles written by preference for long distance treatment the men who made medicine in Europe from England to treatment by local phy­ in this century, and physicians born and sicians, for after describing his symp­ educated in Great Britain dominated toms, he requested his brother “to ad­ the profession here. Towards the end vize with some able Physitian for me.” of the century increasing numbers of Early in the following century William young men sought their education Byrd II19 wrote to Sir Hans Sloane be­ abroad. The physicians of the eight­ moaning the lack of an education eenth century were better educated among the physicians in the colony, at than their predecessors of the seven­ the same time describing some of them teenth century, and they had a better as “discarded Surgeons of Ships, that clientele. On the other hand, the av­ know nothing above very common erage Virginia doctor, like the majority Remedys.” of his contemporaries, was greatly han­ Notwithstanding those disparaging dicapped by his devotion to theory; his remarks, the physicians made some ef­ ideas of the causes and treatment of fort to keep abreast of the times. Their diseases were the same as those of his libraries contained the “Works of that predecessors. While the number of famous Chirurgeon, Ambrose Pare,” physicians in Virginia increased, quacks Harvey’s “De Motu Cordis” and “De also became more numerous. During Generatione Animalium,” Bidloo’s this century noteworthy botanical ob­ “Anatomia,” Cowper’s “Anatomy of servations were made by physicians in Human Bodies,” Thomas Willis’ “Prac­ Virginia, and towards the end of the tice of Physic,” Platter’s “Praxis Medi- century several of them made notable cae,” Solomon’s “London Dispensa­ contributions to medicine. tory,” Sydenham’s “Opera Universa” One of the most cultured and distin­ and other books published in those guished physicians of the Colonial Pe­ years. riod was John Mitchell, who emigrated The eighteenth century, a colorful from England to Virginia about 1700. period in the history of Virginia, was He was a man of genius and originality; characterized by a rapid growth in pop­ his powers of observation were keen, ulation, the expansion of commercial and his skill in collecting and describ­ activities, the accumulation of wealth, ing plants was unexcelled. His contribu­ the acquisition of large landed estates, tions covered a wide range of subjects: the development of means of intercom­ botany, medicine, chemistry, physics, munication, the production of states­ history, cartography and agriculture. men of the highest rank, the develop­ His first contribution, “Dissertatio ment in common with the other brevis de principiis Botanicorum et colonies of a political philosophy which Zoologicum,” published in 1738, was led to independence, the development dedicated to Sir Hans Sloane. Three of educational facilities, and the cultiva­ years later he wrote another paper, tion of the arts. During this period med­ “Nova Plantarum Genera,” dedicating icine in Virginia, as in the other col­ it to Peter Collinson of England. In this onies, was greatly influenced by British paper he described thirty genera, nine thought. The developments in medi­ of which were original and subse­ quently confirmed, although only two observations, the bane of physic and re­ of the names, Acnida and Pentstemon proach of human reason.” which he proposed, have been re­ As far as we know Mitchell was the tained.20 Both of these papers were pub­ first physician in America to write on lished in one volume in Nuremberg in yellow fever, although his article was 1769. A copy of this volume is in the not the first one by an American physi­ library of Harvard University. Lin­ cian to be published. Mitchell sent his naeus, the leading botanist of that time, article to Benjamin Franklin for pres­ gave in 1753 the name, “Mitchellia entation to the Society for the Promo­ Repens,” to the familiar partridge­ tion of Useful Knowledge. Through berry, first described by Mitchell. Ac­ him it fell into the hands of Benjamin cording to Braasch,21 Mitchell’s success Rush, who acknowledged his indebted­ as a botanist may be accounted for by ness to Mitchell’s ideas concerning the his early recognition of the merits of treatment which he employed during Linnaeus’ system of classification of the epidemic of that disease in Phila­ plants, and his mastery of its technical delphia in 1793. Upon Rush’s sugges­ details. tion the paper was published in the Mitchell wrote in 1774, “An Account Philadelphia Museum in 1805, long of the Yellow Fever which Prevailed in after Mitchell’s death. It was reprinted Virginia in 1737, 1741, and 1742.”22 in 1814 in the American Medical and The descriptions of his clinical observa­ Philosophical Register. The editors of tions in a large number of patients suf­ this journal, in commenting upon Mit­ fering with the disease, and of his chell’s work, said: “With Chalmers findings in five autopsies which he per­ and Lining of South Carolina, and formed, are remarkably accurate. He Alexander and Colden of New York, he noted the jaundiced mucous mem­ has done much for the advancement of branes and serous coats, the dark con­ medical and physical science on this side tents of the stomach, the color and con­ of the Atlantic.” sistency of the bile, the distended lungs Of the many articles Mitchell wrote with hemorrhagic areas, and the rela­ on other subjects, those on the early his­ tively normal appearance of the other tory of America, written after he had organs. The treatment he recom­ gone back to England to live, should be mended, bleeding in small quantities of interest to every American. His arti­ only in the earliest stages of the dis­ cles, “An Account of the Discoveries ease, early evacuation of the bowels with and Settlements made by the Eng­ calomel but no purgation thereafter, lish in Various Parts of America,”23 and the administration of large quanti­ and “The Contest in America be­ ties of fluids, was in advance of his day. tween Great Britain and France, by He also discussed the use of the “bark” an Impartial Hand,”24 were published (Peruvian) frequently prescribed by in 1748 and 1757. The latter was European physicians for fevers, but ac­ accompanied by the map which the knowledged that his experience with it British Government had asked him was too limited to warrant drawing con­ to prepare at the beginning of the clusions as to its value. He concluded his hostilities preceding the French and article with a warning to physicians Indian Wars. Carrier20 stated that this against the “dangerous consequences of map, first published in 1755, went drawing general rules from particular through several editions in the English and French languages. It is of interest these articles, that as far as he could to us because it was used at the peace determine, John Clayton, of Virginia, council at the close of the Revolution­ never contributed a paper to the Trans­ ary War, and it was often referred to in actions. The papers that have been the dispute over boundaries which fol­ attributed to him were written by a cler­ lowed that war. Benjamin Franklin gyman, John Clayton, Rector of Crof­ wrote, during his last illness, to Thomas ton in Yorkshire, and afterwards Dean Jefferson in answer to an inquiry in re­ of Kildare, Ireland. This person appears gard to the use of the map: “I remem­ to have made a voyage to Virginia, and ber distinctly the map we used in trac­ upon returning to England, he sent an ing the boundary was brought to the account of what he saw to the Royal treaty by the Commissioners from Eng­ Society. Moreover, the articles in vol­ land, and that it was the same that was umes 17 and 18 of the Transactions published by Mitchell above twenty were written when Clayton, the botan­ years ago.”20 ist, was an infant.26 John Clayton, one of the greatest John Tennent was the first physician botanists of America, came from Eng­ to write on the therapeutic value of land to Virginia in 1705. Although he Polygala Senega. Coming from Eng­ was said by some of his biographers to land about 1725, he located in Virginia have been a physician, it is not defi­ where he lived quietly, practicing medi­ nitely known whether he studied medi­ cine for ten years. During that time he cine. Benjamin S. Barton,25 writing in sought a cure for the annually recur­ 1805, stated that “he was not brought ring respiratory diseases. He learned up to the profession of physic, much less from “a Nation of Indians, called Senek- had he received the degree of Doctor of kas,” that the root of a certain plant, Medicine, as we are led to suppose from later called senega or snake-root, when the title-page, and from the dedication chewed immediately following the bite of the last edition of the Flora Virgin- of a rattlesnake, would prevent death. ica.” Judging from this statement and Thinking the same root might be of from other facts concerning Clayton, value in the treatment of pneumonia we are of the opinion that he did not and pleurisy, he began using it. In his practice medicine, if indeed he ever “Essay on the Pleurisy,”27 published in studied medicine. Williamsburg in 1736, and which is John Clayton, the botanist, has been thought to have been the first work confused with a clergyman by the same strictly on medicine published in Vir­ name. All of the former’s biographers ginia,28 he claimed senega would cure stated that he wrote articles on “Some pleurisy. Experiments Concerning the Spirit of The publication of this essay marked Coals,” on the medicinal properties of the beginning of a controversy over the plants he discovered, on the species of efficacy of senega that caused Tennent tobacco and their cultivation, and on much unhappiness. From that time un­ other botanical observations that were til his death he was constantly urging published in volumes 17, 18, and 41 of physicians both in the colonies and in the Philosophical Transactions of the England to use the drug in treating Royal Society. Mr. H. E. Powell, for­ other diseases as well as pneumonia. Be­ mer librarian of the Royal Society of ing disgruntled because he had lost the Medicine, London, stated, after tracing respect of the physicians in the colony, and also because the House of Burgesses University of Edinburgh in 1770, he granted him £100 instead of £1000 in spent two years studying in Paris and recognition of the service he claimed in London. While in London in 1772 to have rendered humanity in discov­ he wrote an essay, “Experiments Upon ering senega,29 he went to England to the Human Bile and Reflections on the live. There Parliament refused his re­ Biliary Secretion, with an Introductory quest for a grant. He spent much time Essay.”30 in writing pamphlets in an attempt to In the introduction he argued for the justify his unethical course. His criti­ necessity for reasoning in medicine cisms of physicians who did not agree rather than blindly accepting the teach­ with him, of the College of Physicians, ings of the leaders. “Our science is pro­ and of the methods of treating diseases gressive and subject to perpetual increased the unfriendly feeling towards change,” said he, but instead of devel­ him. oping his thesis along practical lines, he It is difficult to explain Tennent’s confined his remarks chiefly to the de­ conduct after the discovery of senega. fense of the theories that dominated Was it due to his unbounded enthusi­ medicine. In the second part of the es­ asm for the drug, or did he sulk upon say he reported the results of his experi­ finding that other physicians would not ments in which he noted the effects of uphold him in his claims for it? Did he heat and cold upon bile, and the action have a disease of the central nervous of bile upon muscle tissue and upon fat. system? Certain traits of character, as He also noted the sweet taste of bile, regarding himself a benefactor of hu­ due he thought, to a sugar analogous to manity, his fixed idea concerning the ef­ milk sugar. He concluded that bile is ficacy of senega, and his opinion of his formed from blood in the liver, and that own ability to prepare regulations for its functions were to prevent fermenta­ the practice of medicine that were supe­ tion and putrefaction. From this point rior to those of the College of Physicians he ignored facts, and evolved a theory would seem to indicate a delusional of his own concerning bile and the treat­ trend of mind, probably due to para­ ment of patients suffering with diseases noia. On the other hand, his enemies of the liver. Written in fine English, considered him an outright charlatan. and containing many classical quota­ Perhaps the kindest explanation is that tions, the essay attracted much atten­ he was one of those people who are tion. It immediately gave him prestige guided by their enthusiasm rather than both in Europe and in America. While their better judgment, thereby laying we may commend him for his desire to themselves open to ridicule and disap­ advance the knowledge of medicine, yet pointment. we regret that he did not prove facts by In the latter part of the eighteenth the experimental method as he set out to century, three Virginians, Jarnes Mc­ do. Clurg, William Brown, and John McClurg returned in 1773, to Wil­ Leigh achieved distinction through liamsburg, where he soon became a their literary productions, by which prominent physician. He was appointed they are chiefly remembered. Professor of Medicine in William and James McClurg appears to have been Mary College when that school was re­ the first American who experimented organized by Thomas Jefferson. This with bile. After graduating from the was the first Chair of Medicine created in the South. The Chair of Medicine in quently called him into consultation. It the Medical School of the College of is said that he neither dispensed drugs Philadelphia, now the University of nor performed any surgical operations.

Pennsylvania, had been created in 1765. He seems to have been the first inter­ McClurg was the first person in the nist in Virginia. South to receive the title of Professor of William Brown prepared the first Medicine. It is not definitely known pharmacopeia published in America, whether he actually taught in the “Pharmacopoeia Simpliciorum et Effi- school, as the faculty records for that caciorum in usum Nosocomii Militaris period are informal.31 While still a ad exercitum Foederatorum Americae young man, McClurg moved to the new Civitatum,” a pamphlet of thirty-two capitol of Virginia, Richmond, where pages. Brown was appointed Surgeon- he became a leader in the profession General of the Hospital in the Middle and in civic affairs. His opinion was Department of the American Army in sought by other physicians who fre- 1777, and in the following year he was promoted to the position of Physician- ing Avith Avater and alcohol, and by General of the same department to suc­ filtering and weighing. He found that a ceed Benjamin Rush. While in charge large part of each preparation consisted of the hospital in Lititz, Pennsylvania, in 1778, he found time to compose his pharmacopeia. It contained sixteen sur­ gical and eighty-three medical prescrip­ tions of the more simple and efficacious drugs, as indicated by the title-page, rhe Avar had made it necessary for all physicians in the colonies to rely almost entirely upon drugs that cotdd be grown and prepared in this country. For this reason Brown prepared the pharma­ copeia, which he intended to be used chiefly by the military physicians. When Brown resigned from the army three years later in order to return to private practice, Congress passed the following resolution: “Resolved, that Congress entertains a high opinion of the ability, integrity and past services of Dr. William Brown, Physician- General; but as circumstances will no longer permit his continuance in the service, his resignation is accepted.”32 Seven years after the publication of Brown’s Pharmacopeia, John Leigh Avon the Harveian prize for his essay, “An Experimental Inquiry into the Properties of Opium and its Effects on Living Subjects: With Observations on its History, Preparations, and Uses.”33 While a student or soon after com­ of inert material. Furthermore he found pleting the medical course in one of the medical schools in Europe, Leigh be­ that the methods recommended by the came impressed with the large number pharmacopeias for purifying opium of preparations of opium listed in both Avere inefficient. He mentioned his oavu the Edinburgh Pharmacopeia and the method for purifying the drug, stating London Dispensatory. Being impressed that “while we have opium in this pure further with the uncertain action of state the physician Avho is acquainted many of these preparations, he decided Avith its operation Avill be enabled to to conduct a series of experiments for form, as to its effects, a true opinion, the purpose of obtaining information and Avill also have some prospect of cer­ on the properties and action of opium. tainty in the dose which he may ad­ In the first group of thirty-five experi­ minister.” Finding eleven of the four­ ments, he analyzed the constituent ele­ teen preparations, including philonium, ments of many preparations by extract­ mithridatum, and theriaca Avorthless, he recommended that they be discarded, tween go and 100 drops of the same at the same time recommending changes Theb. Tinct. which soon roused me in the other three preparations that from my drowsiness and invited me would make them less bulky, more pal­ once more to engage in my business; I atable and efficient. soon found myself so exhilarated as to Leigh then described in detail thirty- grow careless of my occupation, and four experiments with the simplest and rather inclined to indulge in an excess best preparations of opium which he of gaiety. . . Alarming symptoms as performed in order to determine its ac­ palpitation, vertigo, unsteady gait, and tion on animals and human beings. He nausea followed. Finding it difficult to displayed boldness and ingenuity in ad­ attend to his work the next day, he ministering varying doses, and in mak­ called in a physician who restored him ing topical applications to the skin, the by resorting to such simple measures as mucous membranes of the eyes, the in­ “warm applications to my extremities testine, the urethra and the rectum, to and a dose of musk.” Leigh concluded exposed muscles, to the heart, the his essay with an enumeration of dis­ blood-vessels and the nerves. The inves­ tigator carefully observed the time of eases in which reliable preparations of absorption of the drug, its maximum opium may be given with benefit. effect, and duration, changes in the This essay shows that Leigh possessed pulse rate, and also any undesirable an analytical mind much in advance of symptoms as nausea, dreams, hallucina­ his day. If he were living today, he tions, local heat, and pain. would, as Miller34 stated, rank high in With Leigh in Edinburgh there was research work. His experiments, con­ a fellow Virginian, James Ramsay, who, sisting first, of a chemical analysis of the being anxious to know the effect of different preparations, and second, an opium, took repeated doses of the tinc­ investigation of their action on living ture of thebain. It produced, he said, subjects, were conducted in a modern “such enlivening effects as to enable me manner. While he did not discover any to prosecute the study in which I was essentially new facts, and his work had then engaged. In this cheerful situation no immediate effect, yet he followed I remained until one o’clock in the with scientific accuracy a method that morning, when I found a violent drow­ yielded a vast amount of information in siness coming on. ... I then took be­ the following century.

[To Be Concluded]