Romancing History

Tag: 19th century medicine

Take a Peek Inside a 19th Century Physician’s Kit

Are you familiar with the 1960s TV game show, Let’s Make a Deal? The host, Monty Hall, would ask costumed contestants, known as trades, for an item and if they could divulge it, they had they had the  opportunity to trade it for hidden prizes. Requested items could range from a safety pin to a plunger or yardstick. Contestants would bring everything they could think of, including the kitchen sink because they new knew what Monty might ask them to produce.

19th century medical bag, photo courtesy of Melnick Medical Museum

During the 19th century, rural doctors were general practitioners by necessity. They delivered babies, set broken limbs, pulled teeth, and tended to all sorts of wounds and diseases. Except in large metropolitan areas, few doctors had medical specialties. Similar to contestants on Let’s Make a Deal, rural physicians needed a variety of tools to be prepared for any situation.

Doctors traveled long distances on foot, on horseback, in wagons, buggies, ferries, canoes and boats. Traveling to a settlement might be a cross country journey on nothing more than an unmarked trail. The doctor’s bag was designed to carry the tools of the trade and withstand travel in all sorts of weather. Bags of durable oiled canvas or leather stood up to extended travel, whatever the season and terrain.

What might you find in the 19th century doctor’s bag?

Midwifery Kit, United Kingdom, 1866-1900, courtesy of sciencemuseum.org.uk

A variety of tools for everything from pulling teeth to delivering a baby to amputate a limb might be found inside. A basic medical kit would include scalpels, tweezers, razors, and scissors. They would have carried catgut for suturing and gauze bandaging as well. If they were desperate, human or horse hair, or even fiddle strings would suffice when stitching up an injured patient.

Bullet probes and extractors were very important items. They looked like bent tongs or forceps. They came in various lengths to extract a bullet, depending where it was located in the body.

Other items in the bag might include a stethoscope, glass thermometer (3 inch mercury ones started around 1867; up until then they were longer at 6 inches, sometimes 12), splints for broken bones, vaginal specula, forceps for labor and delivery, and bloodletting instruments.

 

A frontier doctor would have also needed tools for general surgical procedures of the time.

19th century general surgical kit

This would include items such as tourniquets, knives and scalpels, and saws for amputation.

The use of antiseptics would not have been on the mind of these pioneer doctors. Although Louis Pasteur’s research provided solid evidence in support of the germ theory of disease, American physician’s clung to the older view that germs were spontaneously generated. The American Medical community also opposed Joseph Lister’s research indicating that the use of carbolic acid to clean medical and surgical instruments significantly decreased the  rate of infection and mortality from surgery. Therefore American doctors took no care to clean their instruments, wear gloves, or fully seal wounds. In fact, drainage of “laudable pus” and inflammation were considered signs that a wound was healing properly.

Because the antiseptic technique was slow to be adopted in American hospitals, medical instruments continued to be manufactured with decorative etching, wooden or grooved handles, and velvet cases, like those pictured above, reflecting that hesitancy.

19th century chloroform inhaler

Doctors would have had a variety of painkillers at their disposal including laudanum, morphine and cocaine. For more on 19th century painkillers, see my post “Got Anything for the Pain, Doc?”

By 1850, most frontier doctors carried some basic anesthetics for use in extreme cases. Nitrous oxide, called Laughing Gas because of its euphoria inducing qualities, was first used as a dental anesthetic in 1844. Ether was used for general anesthesia starting in 1846, and chloroform in 1847. Chloroform anesthesia became very popular after it was administered to Queen Victoria in 1853 for childbirth.

Keeping up with the latest medical procedures would have been a high priority for rural doctors as well. The American Medical Association began in Philadelphia in 1847. Members received a quarterly newsletter announcing new methods of surgery, recent research, advice from prominent physicians on the East Coast or Europe.

Because of their dedication to their patients, frontier doctors were often the most well-known and most valued members of their communities. They likely delivered every child in the community and sat with the dying as they drew their last breath. They saw people into and out of this world, and in the meantime tried to keep them alive and healthy. Their selfless devotion to their patients and and creative ingenuity have left a legacy that continues to capture the imagination of the American people.

 

 

“Got Anything for the Pain, Doc?”

Collection of Vintage Medicine Bottles, Courtesy of Antique Trader

If you’re a fan of old westerns I’m sure you’ve heard that line before, right? This came to mind the other day when I reached for the Costco sized bottle of generic pain relievers I keep in my kitchen cabinet. I’m blessed to not only have my handy-dandy Ibuprofen, but also Acetaminophen and Naproxen as well. Don’t judge me! If you’re over 50, I’m sure  you have your favorite pain med for whatever ails you as well!

All this got me to thinking about how people treated their aches and pains in the past. It’s not uncommon in an old movie or historical novel to see a patient guzzling whiskey before the doctor begins a painful procedure. Doctors didn’t hand over the bottle to numb the pain, but to calm their patient and make them groggy. Since Aspirin wasn’t available in a commercially marketable form until the late 1890s, how did practicing physicians in the western world treat their patients pain in the 1800s?

Doctors used the same major painkiller that is still one of the most commonly prescribed painkillers in hospitals today–morphine.

Antique Morphine Bottle

Are you surprised? I was. Today we think of this as an extremely potent drug reserved for the severest of pain. It has ten times the potency of Demerol, a synthetic painkiller invented in the 1930s. I recall my husband suffering from back pain, immobile on the hallway floor waiting for the paramedics to come because at 6’2″ and 230 pounds, I was unable to help him into the car to drive him to the emergency room. When the ambulance arrived, morphine was administered and although it didn’t immediately eliminate all of his pain, it would take lumbar surgery to correct that, it did bring him substantial relief.

Named after Morpheus, the Greek God of Dreams, the narcotic was discovered in 1803. Morphine is  part of a larger family of drugs known as Opiates that are all derived from opium, found in the poppy plant. Extracts from poppy plants have been used for medicinal purposes since 4,000 B.C.

After its discovery, morphine was administered orally but the invention of hypodermic needles in 1853 led to intravenously injecting the medication for faster pain relief. Many people are familiar with the use of morphine for treating injured soldiers during the Civil War, but did you know it was also prescribed during childbirth and as a cough suppressant? The medication’s side effects include drowsiness, nausea, vomiting and constipation. The latter making it an effective 19th century remedy for diarrhea and dysentery.

Other opiates became widely available in corner drugstores in cities and towns across America.

Cocaine  Although today it is considered one of the most potent and most dangerous natural stimulants, Spanish missionaries first encountered the use of the drug during religious ceremonies in the Peruvian Andes. The locals were known to chew the leaves of the coca plant to give them “energy and strength.” Native medicine men used its leaves to wrap broken bones, reduce swelling and treat festering wounds. Unable to cultivate the plant in Europe and North America, efforts to import the plant failed too as the leaves spoiled easily during transport. In 1859 German chemist, Albert Niemann, extracted cocaine from the coca leaf but it wasn’t until the 1880s that it started to be popularized in the medical community.

Austrian psychoanalyst Sigmund Freud, who used the drug himself, was the first to broadly promote cocaine as a tonic to cure depression and sexual impotence. In 1884, he published an article entitled “Über Coca,” About Coke, which promoted the “benefits” of cocaine, calling it a “magical” substance.

From the 1850s to the early 1900s, cocaine and opium-laced elixirs, tonics and wines were broadly used by people of all social classes. By 1885, cocaine was sold in corner stores in America in various forms–cigarettes, powder, even injection by needle (heroin was also widely available). In medicine, cocaine was commonly used as a local anesthetic. In 1886, the popularity of the drug got a further boost when John Pemberton included coca leaves as an ingredient in his new soft drink, Coca-Cola. The euphoric and energizing effects on the consumer helped to skyrocket the popularity of Coca-Cola by the turn of the century.

As cocaine use in society increased, its addictive nature became more evident. Public pressure forced the Coca-Cola company to remove the cocaine from the soft drink in 1903 and by 1922, the drug was officially banned.

Laudanum Known as the “Victorian’s favorite drug,” laudanum was sold as Tincture of Opium and used as a common painkiller. The drug was often cheaper than alcohol, making it affordable to all levels of society. Laudanum was a 10 percent solution of opium powder in alcohol, widely used to treat headaches, persistent cough, gout, rheumatism, diarrhea, melancholy and “women’s troubles.” It was even used to quiet crying babies. By the 1800s laudanum was widely available—it could be easily purchased from pubs, grocers, barber shops, tobacconists, pharmacies, and even confectioners.

Many Victorian writers and poets were known to use the drug—Charles Dickens, Lord Byron, Mary Shelley, Lewis Carroll, and Bram Stoker just to name a few. Most famously, the English writer Thomas De Quincey wrote a whole book, Confessions of an English Opium-Eater, on his use of opium and related drugs. The book proposed that, unlike alcohol, opium improved the creative powers, an opinion that only served to make the drug more appealing to those searching for artistic and literary inspiration. A number of other writers also played on the perceived glamor of the drug, praising its ability to enhance the imagination.

Laudanum advertisement, Sears catalog circa late 19th century

As more widespread use of the laudanum was observed, it became obvious that the euphoria inducing drug was highly addictive and had some serious side effects including crashing lows, restlessness, lethargy, and sweats. It became clear that the drug needed to be better regulated.

By 1868, the first known restrictions were placed on the narcotic. Now, laudanum could only be sold by registered chemists in England and must be clearly labeled as poison. It wasn’t until 1906 that the U.S. government passed the Pure Food and Drug Act requiring that certain specified drugs–alcohol, cocaine, heroin, morphine, and cannabis be accurately labeled with contents and dosage. Previously, many drugs had been sold as patent medicines with secret ingredients or misleading labels. Authorities estimate that sales decreased by one third after labeling was required.

Its hard to imagine sending your child to the drugstore to buy a penny’s worth of candy and some laudanum.

Were you as surprised as I was to learn how readily available narcotics were in the 19th century?

 

 

 

 

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