Medicine in the 18th Century

By Jonathan Klemens, FSA-Scot

Author and Historian

Surviving the 18th Century was a very perilous challenge. If war or Indian raids did not maim or kill you, you could always succumb to a plethora of lethal or debilitating diseases. Mortality was high for infants and small children, notably from diphtheria, smallpox, yellow fever, and malaria. If you survived childhood, or didn’t die during childbirth, you might just might live a long productive life. Life span varied depending on social status, disease avoidance, surviving violent confrontations, and having a good gene pool. Disease was the daily norm.

Humourism

There was  no understanding of disease causation, disease contraction, or transmission. Disease and treatment was based on the 4th century BC holistic theory of Humourism advanced by Hippocrates and accepted throughout the world. Disease was assumed to be the result of noxious vapors called miasmas causing the humours to not be in balance. Treatment was based on balancing the four humours: black bile, yellow bile, blood, and phlegm.

There was also no understanding of good nutrition, public health, or sanitation, and generally no handwashing. Food had to be properly preserved and prepared to avert food poisoning and destroy any parasites such as tapeworms. Drinking water was often contaminated, encouraging consumption of alcoholic libations. Americans in 1790 consumed an avg. of 5.8 gallons of pure alcohol a year.

Basic Medical Treatment

Basic Medical Treatment to Balance the Humours:
country air, mineral baths (thermal springs)
special diets, diaphoresis,
herbal therapies,
apothecary medicine

Aggressive Treatment:
profuse bleeding, blistering
purging (mercury tablets)
general surgery

Herbal therapy and folk and Indian healing arts were the foundation of medicine in the Depreciation Lands, Donation Lands, and other frontier regions. The closest “doctors” were in larger towns however, few could afford them. Many log houses or cabins cultivated a small garden of cooking, dyeing, and medicinal herbs.

Bad tasting and odiferous apothecary medicines, plus the relatively high physician costs, made it a most opportune time for the development of patent (nostrum) medicines, usually high in sugar or alcohol. Most, if not all, of these medicines made extraordinary health claims without proof of efficacy. Quackery was commonplace.

Bleeding

Bleeding was a major treatment to balance the humours. Over 700 species of leeches exist; 75% are parasitic and secrete an anesthetic and anti-blood clotting substance. A leech can ingest about 5 to 10 ml of blood, almost 10 times its own weight.

George Washington suffered and survived seven common, but serious, diseases or conditions: Malignant Croup (Diphtheria), Malaria, Tuberculosis, Smallpox, Dysentery, Quincy, Pneumonia, and very poor dental health. He finally succumbed to Epiglottitis and hypovolemic shock (bled 4 times losing 40% blood volume over 12 hours).

With the aid of microscopes, the germ theory of disease gradually replaced the miasma theory in the second half of the 1800s.

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