Lecture Two: Colonial Medicine

The first lecture explores our colonial origins.  How did the American healthcare system and its doctors change from their European mentors?  What about the American landscape fermented something unique in the colonies regarding the practice and study of medicine?

Transcript

SPEAKER_00 0:00

So we're gonna start by talking about how medicine was in the colonial time period. And you know, when you look back in the colonial time period, you're looking back um two thousand years because very little had changed in medical care from the time of Hippocrates. And Hippocrates was a Greek and he came up with a lot of the ideas of medicine we have today. Even his oath is used uh to new medical students. And Galen, who is a Roman physician, um took his ideas and made them more um erudite. He wrote books about medicine, and those books that Galen wrote became the norm of medical care for thousands plus years. And by the time the colonial period started, that's what they were using. This galanic it was called the galanic system of medicine. And and the the basic crux of it sounds really absurd when we look at it today, but I'll explain to you why in some ways it was not that absurd. And when new medicine took over, what we call orthodox medicine, and eradicated Galen's ideas, they also eliminated some of the real good things that came with Galen. Um, that and that humanized medicine. So, what what was this idea that Hippocrates and Galen came up with? And and God knows how they came up with it, you know, how people came up with these ideas because there was no experimentation, it was purely based on reason. So the body, according to these guys, was divided into four humors: blood, phlegm, yellow bile, and black bile. And these humors were floating around our body. And when they were in good proportion, then people had um good health. And not only good health, but good personalities. All these humors can affect someone's personality. For instance, when people had black bile, they were melancholy and sad, and when they had a lot of phlegm, they were more happy and zippy. Um, so when people's personalities got out of whack or when their bodies became sick, the assumption was that the humoral balance was off. The only real tools that these doctors had to study humoral balance, the only testing was in excretion. So looking at phlegm if they're coughing, but mostly looking at bowel movements and urine. God knows how many bowel movements and urines were studied back then. And there's stories, for instance, of the popes. Um, you know, I read a lot about the popes who was around during the Black Death at the beginning. And that guy had bowel movements uh studied four or five times a day. He was eating so many purgatives, stuff that give you bowel movements, and his doctors would study them and try to figure out the humoral balance. But the the study of the bowel movements and bladder took second seat to the study of the patient. And the study of the patient meant talking to the patient and seeing what the patient was feeling. The vector of care in this humoral dimension was from the patient to the doctor. The patient told the doctor what he or she was feeling. The doctor made assumptions about the humor balance, and then the doctor prescribed treatment. Now, this is where everything went bad, right? The treatment was not so good. We could say that the treatment, for instance, killed George Washington. Um, when we look at the average age of the founding fathers, they lived pretty long. They lived in their 80s as an average age, but Washington died very young. And one of the reasons he died is he had a sore throat. The doctors examined him, felt his humors were out of balance, um, and they uh managed to put leeches on him and then extract blood. One of those things that people did was suck out blood from people any way they could, because again, that was one of the humors. We have to reduce the blood, things are better. And George Washington died from a sore throat, not from the throat itself, but from the doctor. And there's a lot of discussion in the literature uh during this time period how many deaths actually doctors cause versus diseases. But the good part of this was a lot of the treatment was different. It was herbal treatments that have been studied in a sense empirically. And it's important to understand what that word empiric means, because empiricism as a form of healthcare was so vehemently rejected by the American healthcare system as it evolved that we have to know what that means. Empiricism, and as a doctor myself, I practice empirically very often, means just trial and error. Trial and error, seeing what worked, seeing not only what worked for me as a doctor, but historically what has worked. Well, these herbs, when we pick them, seem to help this condition or that condition. And it's assumption that certain herbs restored the humor or balance. So herbs were really important. Diet especially was important. People were told to go on certain diets, eat certain plants, um, not eat meat, eat more meat, that kind of thing. Of course, back then they were drinking a lot of beer, so that also played into it. Why? Because water was dangerous to drink, beer was less so because it, through the alcohol, it killed a lot of the bacteria. Also, exercise. Certain exercises were felt to improve the humoral balance. So the the prescriptions, other than the crazy stuff like bleeding and leeches, was herbal treatments, um, often in the form of powders or pills, um, dietary changes, and exercise. Real good stuff if we look at it today. Um, and and and also solutions that were rejected as orthodox medicine became more prominent. That's the humeral system. Colonial medicine relied heavily on this. And if if a doctor went to a European medical school, this is what he or she would learn. And they would go out and start doing their thing with herbs. Herbs, again, I can't emphasize how important they are, but they become even more important in the colonial period. Why? Because the Native Americans were using herbal treatments. They didn't believe in humors. There was no evidence of that, but they believed in humoral treatments. I mean, in herbal treatments that were time-tested. So the Native Americans were using a lot of herbs to treat things, and the colonial um settlers and then the doctors who came down there understood that these were successful and adopted a lot of them and learned about the plants and created, in some ways, a very unique system of health care in America based on the fact that they co-opted Native American beliefs while at the same time calling those beliefs superstitious and backwards. That's going to be a theme throughout this course. The idea of stealing stuff from other people who they then denigrate. That is crucial to the development of American medicine. A lot of doctors back then in the colonial period didn't go to medical school at all. They were apprenticed. So they worked with a doctor and then they learned that way. There was no rhyme or reason as to who could call themselves a doctor. There was no medical schools that you had to go to. There were no licensing requirements. There were no requirements at all. You could just call yourself a doctor back then. And often that's what people did. So a big part of colonial care occurred in areas where there were heavy doses of slavery. So when we look at colonial medicine, we're not just looking at the colonies, we're also looking at the islands. And the big British island was Jamaica. Jamaica had some of the biggest colonial doctors around. One of the most well known is Dr. Queer, Q I R, who experimented uh a lot on smallpox and inoculations for smallpox. So that's the other important thing that was changing at this time period, especially in the um 1700s, was this idea of experimentation. That you can't just rely on the dogma of Galen anymore. You had to do some experiments. And experimentation became incredibly um robust in the Americas. Why do you think that is? Why was there more experimentation in the Americas than in fact in Europe? Uh the reason comes down to slavery. And the the idea that to actually get bodies to experiment on were difficult in Europe. A lot of times they used poor people. The deal was a poor person got sick, they went to a sick hospital, then they got experimented on. But here the slaves were fodder for experimentation. And slaves did two things. Um, number one, they gave these early doctors um uh tools to experiment on. But secondly, they also gave them a job because um plantation owners needed to keep their slaves healthy and they they were commodities back then, uh as sad as that is. Um and the the doctors worked for the plantation owners. So another interesting idea in early medicine was that the doctors were not taking care of the patient, the doctor was taking care of the slave owner, and the patient became secondary to that. The goal of success was fewer sick slaves. Um, so this is how doctors actually got much of their business. As Rana Hogwarth, who studies this period, says that early doctors invested blackness with medical meaning to justify their own professional existence. And we'll talk more about that when we talk about the racial script, which developed during this time and became crucial for the development of American medicine. Um also using slave bodies not only when they're alive to experiment on and to develop a practice, but also when they're dead. During this time period, uh, because of the the strong presence of the church, um the uh the idea of using cadavers of of dissecting uh was kind of forbidden. It was it was definitely um felt to be something that you could only do in secret, except if the bodies were black. And this is a crucial distinction. Black bodies were not considered um beyond dissection, because as we'll go into in the next talk, um blackness was invested with an inferiority and thus subhuman. And this was by the doctors. It's really important to know that the medical system created in many ways this this the most deepest forms of bigotry and prejudice that ever occurred. Um, and part of it was because they wanted to use these black bodies and so they had to denigrate them. So um grave robbery was common, north and south, uh, and only grave robbery for in African American grave sites. And that's where a lot of the dissection occurred, a lot of learning occurred too. Um enslaved healers are another crucial part of this equation because when these early doctors were trying to show that they were needed uh to plantation owners and to the larger community, they were up against the slaves themselves. Very interesting concept. We talked about how Native Americans used herbal remedies. Um, well, so so did uh people in Africa. In fact, it's really interesting that um books have been written uh about traders uh who slave slave traders who went to Africa to pick up slaves and brought with them both scientists and doctors. And a lot of the doctors during the time that the slave traders were picking up their slaves were out there talk, speaking with people who lived in Africa, uh studying their plants, studying their medical techniques, and stealing these plants essentially for use of patent medicines. Because at this point in the 1700s, um we were seeing the first use of pills, where these herbs were put into a pill form and sold as a medicine, what we call patent medicines. So this became really important to the development of the medical community worldwide, but you can imagine in America it was even more significant because the the people who were enslaved and brought over here, a lot of them were quite familiar with this technique of using herbs, and they brought their own herbs and they grew their own herbs and often worked with Native Americans in developing herbal techniques that became threatening to these new doctors who were European. And we'll have to introduce a word here called orthodoxy. Orthodox doctors are the ones who followed the standard technique that was promulgated in Europe. The galanic theory combined with experimentation, which is what was occurring in the 1700s. Let me explain what the experimentation was. I'll give you an example using um in Jamaica with Dr. Queer. He um extracted blood from uh many slaves who had smallpox, uh, and then he created what he considered a vaccine. So inoculating other people. So first he tests that on other slaves. And if they worked on the slaves, then he would test it on white people. So when he presented his findings, there's more generalization. Initially, when he and others presented their findings in European uh medical circles, that there was a question well, you're you're testing this on black bodies, how do we know they're gonna work on white bodies? Because at that point, through a lot of the work in the Americas, there was a distinction between black and white. Um, and so it didn't necessarily work. So after they succeeded on black bodies, they would he would then try these inoculations on white bodies. Thomas Jefferson, by the way, did the exact same thing, which we'll get to later. But this is experimentation, trying things out, trying herbs out, seeing how they worked. But through the, again, through the lens of galanic thinking, what does that mean? Galanic thinking, the vector is again from the patient to the doctor. How are we going to know if something have someone's sick, if their humors are out of balance? The patient will tell us. We'll see later. William Osler, who was the one of the greats in American medicine and whose ideas were completely rejected by modern medicine, had a line that was similar to a line that Hippocrates used and later Maimonides, who was a Jewish doctor for the Sultans in the Middle Ages, which was that if you want to know what's wrong with the patient, ask the patient. The vector is the patient. You ask the patient. The patient will tell you if they're sick. Oh, they're sick, their humors are out of balance. What do we do? We're gonna try some things out. We have some empiric techniques that the doctor down the street used, and we'll try that. Or we'll experiment and try something new. We'll try these new herbs, we'll see if that works. How do we know if they work? We don't have tests, right? Um, studying the bowel movements only goes so far. How do we know they work? The answer is the patient will tell us. The patient will get better, they worked. So again, that vector being the patient-centric system, where the patient is the one who tells you when things are out of balance and when things are restored, is crucial because that becomes, we will see, not the focus of later medical care. Patient becomes marginalized, as is the case today when we talk about American health care. So it's important to know that these doctors who were establishing practices often through plantations or through slave work, that's how they got most of their money, because most people could not pay them, were in direct competition with the slaves themselves, who often had better outcomes. And that that was troubling because especially a plantation owner who wanted to keep their slaves alive and healthy, when they see that the slaves were creating better outcomes, and these doctors who they had to pay were causing more death, that was problematic. Um enslaved healers and and also the midwives posed a serious threat to Orthodox doctors. They performed their services locally, they cost the slave owner nothing. And their methods were accepted by the slaves, which was most important because slaves didn't want to be bled and put had leeches put on them. They pushed back. Historian Sarah Fett notes that doctors benefited by scripting an oppositional dichotomy between slave medicine and emerging European-derived orthodox medicine, which was the experimental humoral medicine. And they portrayed slave healers as backwards and their own orthodox techniques as valid. She writes overwhelmingly white and male in profile, orthodox medical practitioners sought to carve out a more secure foundation of professional identity by establishing exclusive medical legitimacy against these slave healers. Todd Savitt, who writes a lot about uh medicine on the plantation during this period, writes that poor health led to medical intervention that often became a contest between white medicine and the medical beliefs and practices of the slave community. So, how did doctors push back against this? Um, this is really important because if plantation owners did what was most logical, which was simply to allow slave healers to take care of the slaves and have better outcomes, um then orthodox doctors would really have very little place to practice, experiment, steal bodies, all the things they like doing. Um biggest thing they did was try to prove that slave medicine empowered slave revolts. So this became a theme uh in the 1700s. If you um allow these slaves to take care of people, they're they're going to A create conditions where slaves will pretend they're sick and get out of work, and B, empower them to fight against the white system. And and this became so compelling to um to owners that who were scared to death of slave revolts, that they accepted the logic of this. And the South passed a lot of laws to bar slave medicine and to prevent any African Americans from practicing medicine. They could not, and we'll see this, that they were not allowed to be doctors, and white doctors were not allowed to work with African-American healers. So these became laws. The other thing that these new um Orthodox doctors did, as they had done in Africa and as they had done with Native Americans early on, is simply to commandeer the slave treatments, to take the slave treatments, to use their herbal knowledge and other more spiritual things that slave medicine encompassed. Very, it was very spiritual. Native American and slave medicine believed that the mind-body was connected, something that Orthodox doctors were not necessarily in tune with. Um, they commandeered it. Sometimes they took the herbs and they made them into medicines. This is part of their experimentation. And then they said that this was orthodox medicine. So they basically took what was best from slave medicine for themselves and claimed it was through experimentation and numeral theory, it was orthodox medicine. You don't need these slaves doing this. And uh in this way, they basically marginalized slave medicine, which which is crucial to the establishment of colonial medicine. So we we have a few themes and and the readings that that you'll see here go through some of this. Um the optional reading I have is real, it's if you get a chance to read it, it's really interesting uh from a book called The Secret Cures of Slaves. But it it talks about how this commandeering process worked and how slave um slaves represented the vector of uh success for colonial American doctors at the time. But by the time the revolution the revolution occurred in 1776, and there was a more established American Orthodox medicine, by that time the roots of American medicine had been established. There was um a strong um racial script that we'll talk about in the next talk that was built that essentially marginalized African-American providers while at the same time demonizing any healthcare, any medicines that were um that were black related, African-related, native related, um, partially by stealing those healthcare um ideas. And also the idea that the humoral theory um was being modified to some extent by experimentation. Experimentation on African American bodies almost exclusively. There was some experimentation on poor people up in the north, especially Irish, uh, much less so than Africans, even up north. So, also the idea that the learning process would include dissection, which occurred on African American bodies, and by studying. Experimenting on and studying African American bodies while they're alive and coming up with theories of healthcare while at the same time creating a cohesive white male medical base in opposition to anything native and utilizing the term orthodox to establish some type of scientific legitimacy, which is what they were trying to do. So this is the origin of our healthcare system in a nutshell. Some of the readings will elucidate this a little further. And the next talk we will talk about this medical racial script because even though it sounds kind of marginal, it actually was foundational to the development of the American Medical Association and Orthodox Medicine and ultimately modern medicine as we know today. And it's a theme that will run through this entire course. So I wanted to spend one talk just talking about that.