THE DOCTOR'S BAG
BY
KEITH SOUTER aka CLAY MORE
You may think that doctors in the Old West had relatively few drugs at their disposal. In fact, the town doctor who had the time and inclination could compound hundreds of medicines and remedies using the US Pharmacopeia, which was first published in the 1820s. This was a tome containing all of the recognised formulae for compounding the medicines of the day. The year 1875 represented its fifth edition.
Most of the remedies used were botanicals, although many mineral based remedies were also used. And of course, there were many formulae which combined the two.
Heroic medicine
Medicine in the early19th century was only starting to become scientific. Many doctors practiced heroic medicine, involving bleeding and purgation. This had been a practice extending back to the days of antiquity. It was based on the Doctrine of Humors, the belief that there were four fundamental humours or vital fluids that determined the state of health or illness of a person. These were blood, phlegm, black bile and yellow bile. Diagnosis of the imbalance led the doctor to the treatment, which could be to blister, bleed, purge or give an enema.
Dr Benjamin Rush
Then name of Dr Benjamin Rush (1746-1813) is stamped on the early history of the USA. He was one of the founding fathers of the United States. He was a signatory of the Declaration of Independence and was a physician, politician and social reformer. He was a personal friend of Thomas Jefferson and had been the Surgeon General of the Colonial Army. He is considered to be the father of American psychiatry.
Dr Benjamin Rush (1746-1813)
Without doubt he was the most famous physician of his day. His medical influence was extensive and it is not surprising that Thomas Jefferson asked him to advise Meriweather Lewis and William Clark about medical practice and the medication that they should take with them on their expedition to explore the Great Plains following the Louisiana Purchase.
Dr Rush was an advocate of heroic medicine, involving bleeding and purgation. Accordingly, he advised them to take copious quantities of calomel in tablets of his own manufacture.
Dr Rush's Bilious Pills
Calomel was one of the most powerful drugs known in the 19th century. It is actually mercurous chloride. It was effective against syphilis and was a powerful 'alterative.' This meant that it affected the patient's constitution. In large doses it was an extremely efficient purgative (laxative). Unfortunately, it was often prescribed in small doses for long periods, when it would induce what we now know to be mercury poisoning. A consequence of this was that the teeth fell out. Almost certainly George Washington lost his test because of this, as well as his life after heroic medicine physicians treated him for a throat infection by bleeding him and giving him large doses of calomel.
Lewis and Clark
The Lewis and Clark expedition set off from St Louis in 1804 and lasted 2 years, during which they travelled 4,000 miles across the land, during which time they lost only one man, due to appendicitis. It is said that they were both adept wilderness doctors, who treated their men with Dr Rush's Bilious Pills.
Lewis and Clark's expedition 1804-1806
Dr Rush advised that at the first sign of illness they should give one or two of his pills. This meant effectively, at the signs of constipation and abdominal pain, they were to give his calomel-containing laxatives. So effective were they, that they were known as Rush's Thunderbolts!
These pills, which Rush made himself for them contained large amounts of calomel. They purged quickly and furiously, producing a perspiration and an intense salivation reaction that was concluded to be a sure sign that a toxin was being removed from the body.
The Civil War and the Calomel Rebellion
By the time of the Civil War calomel was immensely popular with doctors. It was not so popular with Dr William Hammond, however. He was a neurologist who was appointed Surgeon General of the Union Army at the age of 34 years, by Abraham Lincoln. He was concerned about the use of calomel and also of 'tarter emetic' (a preparation of antimony and potassium tartrate, which also produced vomiting and a perspiration reaction) and removed them from the Army supplies. He was concerned about the side effects from overuse, including salivation, gum disease, tooth loss and mercurial gangrene.
Circular Number 6 from him stated that calomel use....'has so frequently been pushed to excess by military surgeons that the only way to deal with it is to banish the drug.'
He went on to say: 'No doubt can exist that more harm has resulted from the misuse of both these agents, in the treatment of disease, than benefit from their administration.' It was his firm belief that they caused more deaths than they apparently saved.
The medical profession was outraged and led to what has been termed the Calomel Rebellion. To understand this you have to appreciate that there were numerous schools of thought in medicine: Thomsonians, who were against all mineral remedies, hydropaths, who advocated therapeutic bathing, homoeopaths, who used minimum doses of like to deal with like, and Botanics, who prescribed plant remedies. All of these were considered 'faddists,' or quacks by the main medical profession. By removing Calomel and Tarter emetic he was seen as siding with the faddists. He was lampooned as the king of the quacks.
General William Hammond (1828-1900)
The upshot was that Hammond was effectively framed and had trumped up charges brought against him by a rival. He was court marshalled in 1864.
A watering down
So, calomel and tarter emetic were both reinstated into the Army supplies and continued to be used by both the North and South throughout the war. A sort of concession was made, however, with a reduction in the amount of mercurous chloride used.
Calomel continued to be used extensively by doctors up until the 1940s, when superior and safer laxative drugs were introduced.
On the latrine trail of Lewis and Clark
As we know, Lewis and Clark made their way across America from St Louis to Fort Clatsop in Oregon. Interestingly, archaeologists have been able to follow the trail (and their movements) by finding the sites of their latrines, where the heavy metal mercy salts have been detectable in the ground, thanks to the purgative effects of Dr Rush's Bilious Pills.
The formula for watered down Dr Rush Bilious Pills in 1946
******
Keith's latest health book is available in March 2015 from Summersdale
Clay More's novel about Dr George Goodfellow is published in the West of the Big River series by Western Fictioneers.
Available at Amazon.com:
THE DOCTOR by CLAY MORE
And his collection of short stories about Doc Marcus Quigley is published by High Noon Press
Available at Amazon.com:
And his latest western novel Dry Gulch Revenge was published by Hale on 29th August.
I'd heard of calomel before but did not really understand it. Thanks for the explanation. You always give us interesting stuff, Keith. Thanks.
ReplyDeleteThank you, Frank. Dr Rush's reputation suffered after his heroic treatments during a yellow fever epidemic resulted in a disproportionate number of deaths.
DeleteDr. Keith,
ReplyDeleteGeez! How's that for a scientific term? My favorite phrase and I use it to express a multitude of emotions. Glad I wasn't treated by a doctor back then. Even today doctor's have questionable practices. They shortened the life of my mother by giving her too many IV fluids which filled her lungs. Even though she only weighed 98 pounds, she gained seventeen pounds in two days. Her lungs filled, she couldn't breathe and she died.
I know that modern medicine saves lives and medicines do as well, but still...there seem to be problems.
Again, this is another marvelous post by the good doctor.
Charlie
So sorry to hear about your mother's treatment, Charlie.
DeleteNapoleon did not have a great opinion about doctors:
'Doctors will have more lives to answer for in the next world than even we generals.'
Tracking their "MOVEMENTS" - HAHAHAHAHA!!! oh, my goodness. I also wonder at the "colon cleansing" practices of today... Yeee-ikes.
ReplyDeleteIndeed, Meg!
DeleteActually, archaeologists can discover a lot from examining latrine sites and examining the movements of those who had once used them! A comparison of the latrines at Versailles (home of King Louis XIV, the Sun King) with those of poor Parisians of the same time showed that the poor may well have been healthier than the rich. The latrines at Versailles contained more fossilised parasites than those from the poor districts of Paris. The rich ate meat, which often may have been rancid and contained parasites. On the other hand the poor had less meat, more vegetables and seemed to have less parasite infestations!
I find it interesting that many cures are almost worse than the disease. It is also interesting the most of the women doctors in the late 1800's were homeopaths, with a few allopaths.
ReplyDeleteAs usual, your post is fasciniating and useful. It helps me a great deal in my own research. Your new book also sounds like a winner. Doris McCraw/Angela Raines
Thank you, Doris. That is interesting about women doctors and homeopathy. I see that The Female Medical College of Philadelphia (the first medical school in the world exclusively for women) was founded in 1850 and became the Women's Medical College of Philadelphia in 1867. It only admitted men in 1970 and then became the Medical College of Philadelphia. It was amalgamated with Hahnemann Medical College, the USA's first homeopathic college (founded around the same time as the WMCof P), to become Drexel University College of Medicine in 2002.
DeleteI concur with Doris in that these posts you share on the old timey medical topics are fascinating. I look forward to reading them.
ReplyDeleteIf my American history memory serves me, I believe George Washington underwent a bloodletting procedure that hastened his death.
Back then, it was certainly scary to be ill... heck, it still is. :-)
Thank you, Kaye.
ReplyDeleteYes, George Washington was given the heroic medical approach. The methods of Dr Benjamin Rush were very influential on the doctors of the day. When the president fell ill he was attended by three doctors; his own family physician, Dr James Craig, Dr Gustavus Brown, a physician with a good diagnostic reputation, and Dr Elisha Dick. He was treated by blistering, enema and four blood-lettings. Dr Dick was against the excessive blood-letting and advised performing a tracheotomy (an operation to make an opening in the throat to by-pass the obstruction to his breathing), but the other two over-ruled him. He was given further poultices and purged with CALOMEL!
Realising he was going to die, George Washington thanked all three doctors.
Yes, it was brutal and it seems totally barbaric, yet the doctors were doing their very best, applying the accepted treatments of the day.
Incidentally, George Washington seems to have had calomel at various times in his life and it is thought that this may have contributed to been responsible for the loss of his teeth. His famous false teeth, once thought to have been made of wood, but now known to be carved from hippopotamus ivory, were stained and discoloured from his tea and wine drinking tastes. The dentures are on display at the National Museum of Dentistry in Baltimore.