Seeking the Cure

A History of Medicine in America

Ira Rutkow

• Publisher: Scribner
• Year: 2010
• Print ISBN: 9781416538417
• eBook ISBN: 9781439171738
• Topic: Medicine
• Subtopic: North American History

A timely, authoritative, and entertaining history of medicine in America by an eminent physician

Despite all that has been written and said about American medicine, narrative accounts of its history are uncommon. Until Ira Rutkow’s Seeking the Cure, there have been no modern works, either for the lay reader or the physician, that convey the extraordinary story of medicine in the United States. Yet for more than three centuries, the flowering of medicine—its triumphal progress from ignorance to science—has proven crucial to Americans’ under-standing of their country and themselves.

Seeking the Cure tells the tale of American medicine with a series of little-known anecdotes that bring to life the grand and unceasing struggle by physicians to shed unsound, if venerated, beliefs and practices and adopt new medicines and treatments, often in the face of controversy and scorn. Rutkow expertly weaves the stories of individual doctors—what they believed and how they practiced—with the economic, political, and social issues facing the nation. Among the book’s many historical personages are Cotton Mather, Benjamin Franklin, George Washington (whose timely adoption of a controversial medical practice probably saved the Continental Army), Benjamin Rush, James Garfield (who was killed by his doctors, not by an assassin’s bullet), and Joseph Lister. The book touches such diverse topics as smallpox and the Revolutionary War, the establishment of the first medical schools, medicine during the Civil War, railroad medicine and the beginnings of specialization, the rise of the medical-industrial complex, and the thrilling yet costly advent of modern disease-curing technologies utterly unimaginable a generation ago, such as gene therapies, body scanners, and robotic surgeries.

In our time of spirited national debate over the future of American health care amid a seemingly infinite flow of new medical discoveries and pharmaceutical products, Rutkow’s account provides readers with an essential historic, social, and even philosophical context. Working in the grand American literary tradition established by such eminent writer-doctors as Oliver Wendell Holmes, William Carlos Williams, Sherwin Nuland, and Oliver Sacks, he combines the historian’s perspective with the physician’s seasoned expertise.

Capacious, learned, and gracefully told, Seeking the Cure will satisfy armchair historians and doctors alike, for, as Rutkow shows, the history of American medicine is a portrait of America itself.

Part I

RISE OF AN INDEPENDENT PROFESSION

One

COLONIAL MEDICINE

Inoculation at Any Cost

ZABDIEL BOYLSTON, ONE of Boston’s most distinguished physicians, cowered in a hidden passageway inside his home. Outside, a rabble of angry townspeople demanded that he be lynched. They had gathered there after searching for the doctor throughout the city for several days and nights while flaunting a hangman’s noose as their flag. It was midsummer 1721 and Boston, a city of almost twelve thousand people, was suffering a devastating smallpox epidemic. Nearly half of the city’s inhabitants would contract the illness and one in fourteen would die.

The mob had targeted Boylston for attempting the medical unknown. He had taken pus and scabs from the pocks of a patient with active smallpox and placed the putrid material beneath a small cut in the skin of healthy individuals, including several family slaves and his six-year-old son. Boylston intended to induce a mild form of smallpox in these patients, who would, he hoped, recover and be protected against the more severe attacks and possible death that resulted from contracting the illness naturally. “I resolv’d to carry it on for the saving of Lives,” he would later write, “not regarding any, or all the Menaces and Opposition that were made against it.”¹ This rudimentary inoculation was untried and risky, even without the mob’s threats.

The physician and his family feared for their lives with good reason. Boylston’s neighbors believed that he was a killer who would expand the disease’s toll. “To spread a mortal Contagion, What is it but to cast abroad Arrows and Death?” stated one outraged citizen. “If a man should willfully bring infection from a person sick of a deadly and contagious Disease, into a place of Health; is not the mischief as great?”² Secreted for fourteen days, the doctor and his kin survived not only the mob’s intimidations but a dud hand grenade thrown into the house’s parlor. So terrified was Boylston that for several weeks after the mob attack subsided he visited his patients only at night and in wigged disguise.

Boylston could do little to calm the raging fears but wait for the passage of time to prove his medical claims. The city’s selectmen scolded him, his fellow physicians labeled him unscrupulous, and vituperative journalists described him as a mass murderer. A weak-willed man might not have persevered, but the forty-one-year-old Boylston was no ordinary doctor, nor easily bullied. His earliest biographer said he possessed “a strong and reflecting mind, and acute discernment,” leading a life of “unimpeached integrity.”³ Unlike other practitioners who were less educated and poorly trained, the bold and stubborn Boylston never shied away from undertaking difficult medical cases. He had a reputation for performing virtuoso feats of surgery long before the inoculation crisis—in 1707, he had extracted an egg-sized stone from the urinary bladder of a thirteen-year-old boy, and a decade later, in the presence of clergy and other spectators, Boylston had removed a woman’s breast for the “repeated bleeding, growth & stench”⁴ of cancer.

Cotton Mather and Smallpox

Smallpox and other epidemics, such as diphtheria, dysentery, influenza, measles, scarlet fever, and yellow fever, were the colonialists’ persistent nightmare. Medical anthropologists believe that the small pox (or variola)—differentiated from the large pox (or syphilis)—was introduced into Europe around AD 500 by nomadic Saracen tribes from the east. Europeans subsequently brought it to the new world, where it ravaged native populations. Smallpox first reached New England in the early 1600s and continued to plague the colonialists every dozen or so years. The disease easily provoked panic due to its gruesome sequelae: “Purple spots, convulsion fits, bloody urine, violent inflammations in the eyes, throat, and other parts,” according to Boylston. “In some, the pock runs into blisters, and the skin stripping off, leaves the flesh raw, like creatures flea’d [flayed]. Some have a burning, others a smarting pain, as if in the fire, or scalded with boiling water.”⁵

With no knowledge of virology or pharmacology (smallpox is caused by the double-stranded, DNA-rich variola virus), the colonials could only curb smallpox’s spread with strict isolation procedures. A Massachusetts statute even stipulated that all smallpox sufferers should be separated from the healthy population in designated “pox” houses.

As the 1721 smallpox epidemic wore on, news of Boylston’s radical smallpox experiments panicked Bostonians, convinced that isolation was the only solution and that other approaches, especially inoculation, would worsen the plague. Then, the city’s renowned firebrand preacher, Cotton Mather, publicly declared his support of Boylston’s efforts, something few had anticipated.

The fifty-eight-year-old, Harvard-educated Mather, the controversial pastor of the city’s original Congregationalist North Church, was a prominent public figure and Boston’s “keeper of the Puritan conscience.”⁶ Mather influenced both spiritual and secular matters, from his youthful persecution of witches to a middle-aged enthusiasm for medical and public health improvements. He advocated Bible societies, the education of slaves, religious missionary work, and temperance. He also helped organize a college in New Haven, Connecticut, and suggested that it be named after the major benefactor, Elihu Yale. In addition to all of this, Mather was, according to one historian, “the most original medical thinker in the colonial period.”⁷ He was, among other things, one of the first to realize the cyclical nature of smallpox epidemics.

While Mather’s curiosity and intellect were rare, his interest in medicine was fairly common for a clergyman in the colonies. Minister-physicians, as they were known, continued a clerical tradition common to England and compounded by a paucity of decent healers in the new world. America’s preachers, the colonies’ best-educated and most well-read individuals, found that their book knowledge of medicine provided an effective way to establish rapport with congregants and the general public. Since religion and medicine had been interwoven for centuries, especially through the view that illness was the work of the devil and punishment for religious transgressions, it was de rigueur for colonial clergymen to attend to their flocks’ medical needs as part of pastoral care.

During the early 1720s, Mather had read a series of articles in the Royal Society of London’s Philosophical Transactions detailing a little-known Asian and Middle Eastern folk medicine practice of inoculation for smallpox. It appeared from eyewitness accounts that when a person acquired smallpox through inoculation, the resulting illness was less deadly than a natural case. In fact, inoculation, the eighteenth-century version of modern vaccination (there was no word for immunization or immunity in that era’s scientific lexicon), caused a case of genuine smallpox, but one considerably milder than smallpox contracted at random. Those who received inoculation were as resistant to subsequent smallpox outbreaks as those who had acquired it naturally, despite the attenuated nature of the induced illness.

The commonsense medical approach of this technique intrigued Mather, who, realizing the severity of the current smallpox epidemic, decided to recommend the immediate use of inoculation to Boston’s physicians. “The practice of conveying and suffering the Small-pox by Inoculation, has never been used in America, nor indeed in our nation,” Mather wrote in his diary. “But how many Lives might be saved by it, if it were practised?”⁸

The reaction of Boston’s approximately dozen physicians was contemptuous at best. Two of them united in violent opposition to the proposal, denouncing it as similar to introducing the plague in Europe. They declared that any attempt to put inoculation into effect would be “no less criminal than murder.”⁹ Dozens of pamphlets and broadsides were published in a back-and-forth war of words. The dispute became a cause célébre as the newspapers of the day teemed with accusations and character attacks.

Mather made a personal plea to Boylston, the one physician who he believed would support his radical idea. “You are many ways endeared to me,” wrote the preacher, “but by nothing more than the very much good which a gracious God employs you and honors you to do to a miserable world.”¹⁰ Mather argued that, with an ongoing epidemic, inoculation should start as soon as possible. An unhesitant Boylston, whose face bore the undulating scars of a childhood case of smallpox, agreed. Two days later, inoculation, and threats to Boylston’s life, commenced.

The Great Inoculator

By mid-July, Boylston had successfully treated ten individuals and announced his results in the Boston Gazette (colonial newspapers functioned as modern medical journals and were filled with the latest clinical reports as well as advertisements for physicians’ services, textbooks, and drugs). He cautioned his critics that he was not afraid of their rage. “I have patiently born with abundance of Clamour and Ralary [raillery], for beginning a new Practice here (for the Good of the Publick), which comes well Recommended, from Gentlemen of Figure & Learning, and which well agrees to Reason,”¹¹ insisted a determined Boylston. He was so intent that he inoculated an additional seventeen people in August, thirty-one in September, eighteen in October, and in November, at the height of the epidemic, one hundred and three. Shuttling between Boston, Cambridge, and Roxbury, performing up to a dozen inoculations a day, Boylston found that the better-educated townspeople sought his help while the uninformed masses, as well as most of the city’s physicians, feared it.

Boylston pleaded with the other doctors to visit his patients and judge his results. Rather than accepting this offer, Boylston’s critics only intensified their scolding, accusing him of malpractice and murder. The incensed physicians spread their invective in the New England Courant, a newspaper published by James Franklin and his teenaged apprentice, his brother Benjamin. They argued that Boylston’s action was imprudent. It would widen the spread of smallpox and worsen the social upheavals brought about by the current epidemic. Commerce and daily business would be halted, and Boston would be an unlivable city under medical siege with no food or other necessities brought in.

The hullabaloo intensified, and as physicians realized the resolve of Mather and Boylston, they appealed directly to the town authorities to stop the inoculation madness. These local selectmen reprimanded and legally threatened Boylston, who was repeatedly summoned before their public tribunals. Out of blind fear, they attacked and abused Mather as well. “They rave, they rail, they blaspheme; they talk not only like Idiots but also like Franticks,” observed Mather. “I am an object of their Fury; their furious Obloquies and Invectives.”¹²

In November, popular resentment, simmering since the attempted lynching of Boylston in the summer, came to a head again when someone tried to assassinate Mather. The attacker threw a bomb through Mather’s window, but it failed to explode. The assailant had tied a chilling message around the device: “COTTON MATHER, You Dog, Dam you: I’ll inoculate you with this, with a Pox to you.”¹³ The attempted murder became the talk of the town and the courts offered a large monetary reward to find the perpetrator, but the case was never solved.

By winter 1721–22, the smallpox scourge had ended and confirmed the assumptions of Boylston and Mather. Of the approximately 5,800 Bostonians who contracted the disease naturally, about 850 died, a death rate of almost 15 percent. The remainder of the city’s 6,200 citizens had been presumably exposed to smallpox in prior outbreaks and survived unscathed. Of the 247 people that Boylston inoculated, only six died, a death rate of less than 3 percent. Not only were deaths reduced, but the artificial smallpox attack was mild in character. “They found ease and sweetness, and lay praising God on their beds, or rather sat up in their chairs to do so,” said one contemporary observer about Boylston’s patients. “Their tongues were filled with laughter, and ours with thanksgiving on their account when we went to see ’em. We saw them recover fast.”¹⁴ To deliberately permit oneself to be infected with smallpox, however, was a terrifying decision plagued by the possibility of death or disfigurement. And in the eighteenth century, there was no obvious reason (nor has one been found in the twenty-first century) as to why smallpox acquired through inoculation should somehow be different from the disease that was contracted by chance. Yet the inexplicable worked!

Unique circumstances and a fair bit of luck—if such a thing can be found during a smallpox epidemic—facilitated Boylston’s success. There is little doubt that inoculation, contrasted with present-day vaccinations, could have further spread an epidemic. His critics were correct when they demanded that inoculated patients, despite having only the mild form of smallpox, be isolated. Boylston’s good fortune was that the epidemic of 1721 was so severe and spread so quickly that the overwhelming number of individuals who naturally contracted the disease left few for the inoculated to cross-infect. Boylston again aroused public apprehension when, in the absence of an ongoing epidemic, he resumed his experiments in spring 1722. Once more, Boston authorities demanded that the newly inoculated be secluded from other citizens or Boylston’s experiments would be stopped.

In view of the continuing controversies, it almost seemed expected and welcomed when a year later, in mid-1723, Boylston suddenly uprooted his family and left for London. Members of the Royal Society of London had invited him to present his experience with inoculation. London’s physicians were eager to hear about his therapeutic encounters, as he was billed as the inoculator with the largest individual know-how in the Western world. He received numerous honors, including a lectureship before the Royal College of Physicians and membership in the Royal Society. But there was a more intriguing reason behind his visit. Boylston family lore suggested that England’s King George I ordered the invitation with the intent that the colonial physician inoculate the royals. Boylston quickly became a medical celebrity in London who, according to a contemporary account, “received the most flattering attentions and friendship of some of the most distinguished characters of the nation.”¹⁵

While abroad, Boylston also authored a small volume that became the chief American contribution to the world of medicine prior to the mid-nineteenth century, An Historical Account of the Small-Pox Inoculated in New England, Upon All Sorts of Persons, Whites, Blacks, and of All Ages and Constitutions. The book, an explication of Boylston’s inoculation technique and clinical records, meticulously described patients and offered technical explanations and detailed statistical tables. He dedicated it to George I’s daughter-in-law, Caroline, the Princess of Wales and wife of the soon-to-be George II: “The countenance which your royal highness hath given to the practice of inoculation, is a noble instance of your royal highness’s superior judgment and parental tenderness; and the success with which it hath been attended in your royal family, is alone sufficient to recommend it to the world.”¹⁶

With his business completed, Boylston departed London a wealthy man, supposedly remunerated one thousand gold guineas by the king. Boylston’s biographer was careful to note that “he returned home with ample funds to enable him to retire from professional business.”¹⁷ Accorded acclaim upon his arrival back in Boston, Boylston was given the epithet “The Great Inoculator.” He enjoyed the role of a well-to-do colonial physician and gentleman farmer for the remaining forty years of his life, celebrated by English followers and grudgingly admired by American adversaries. Although it took time for Boylston to earn his peers’ admiration, his career and accomplishments were defined by a willingness to challenge conventional wisdom, a go-it-alone mind-set that appears repeatedly in moments of discovery and innovation throughout the history of American medicine.

“Doctor” Benjamin Franklin

Despite lower death rates for the inoculated versus the naturally infected, the practice of inoculation remained restricted and unpopular in the colonies. It would take several decades to spread from New England to New York, Philadelphia, Baltimore, and Charleston. The idea of inoculation was vigorously debated during these years, with one unexpected advocate taking a central role in the discussions, the up-and-coming Benjamin Franklin.

To the well-known image of Franklin as philanthropist, politician, scientist, statesman, writer, and womanizer should be added the honorary title of physician. He invented spectacle...

Table of contents

• Cover Page
• Dedication
• Introduction
• Part One: Rise of an Independent Profession
• Part Two: Coming of Age
• Part Three: Triumphs and Trials
• Epilogue
• Acknowledgments
• ‘Empire of the Scalpel’ Teaser
• About the Author
• Notes
• Selected Bibliography
• Index
• Copyright Page