Marketplace of the Marvelous (2 page)

The reading was fairly typical, a balanced mix of neutral and positive traits, save for one spot particularly galling to the famed humorist. “He found a cavity, in one place; a cavity where a bump would have been in anyone else's skull,” recalled Twain. “He startled me by saying that that cavity represented the total absence of the sense of humor!”
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Twain's colorful report of his analysis in his
Autobiography
is the only remaining record of his visit; the original chart does not seem to have survived. Although he clearly twisted the results for a good joke, Twain, whose interests ranged “from protoplasm to infinity” according to one biographer, remained both dubious about and fascinated with phrenology, among other irregular healing methods, throughout his life, submitting to at least two other evaluations and writing phrenology into many of his stories and essays.
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Twain wasn't alone. In a world where an invisible electric substance could transmit messages over telegraph wires, and where mechanical looms operated by a single person could do the weaving of forty women in a single day, who could really say that phrenology wasn't at least plausible?

In this fast-changing world, Americans wrestled with hope and doubt in their daily lives, but perhaps nowhere more than in matters of health. Nineteenth-century lives billowed with peculiarly named aches, epidemics, and invalidism: Quinsy. Catarrh. Bilious fever. Ague. King's evil. Flux. Neurasthenia. Nearly everyone, it seemed, suffered. Abraham Lincoln shepherded the country through its great civil cataclysm while battling his own severe depression.
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Louisa May Alcott wrote
Little Women
and
Little Men
while suffering from what she believed to be the terrible effects of the mercury prescribed to treat the typhoid fever she contracted during the Civil War. Harriet Beecher Stowe experienced attacks of hysteria so severe that she remained bedridden for weeks at a time in the years before she wrote
Uncle Tom's Cabin
.
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Charles Darwin wrote
On the Origin of Species
while confined to his home, a vigorous young man done in, according to his doctor, by “intellectual labour and moral anxiety” that turned him into a reclusive invalid by age thirty-three.
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Sickness, both physical and mental, was a major part of being alive. Large segments of the population suffered poor health most of their lives. Filth pervaded daily life. Water was often polluted. Food preparation and storage were unhygienic. Garbage littered streets and yards along with animal droppings and the bodies of animals that had simply dropped dead. Privies and cesspools overflowed. All created breeding grounds for mosquitoes, flies, and other disease-carrying pests. Malnutrition and poor housing, particularly in rapidly growing urban areas, only magnified health problems and spawned epidemics. Infants died of diarrhea and dysentery from contaminated food. Deaths from tuberculosis, scarlet fever, diphtheria, smallpox, and cholera occurred so regularly that they were considered a matter of
course. Not every disease killed, though. Others simply made life exceedingly unpleasant and painful.
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But even when a sick American visited a regular doctor, he rarely received an effective treatment. Scientifically valid medical knowledge was limited, and modern methods to sort out effective from ineffective and even dangerous treatments did not yet exist. Doctors did not understand the role of viruses and bacteria in causing disease, how most organs functioned, or the significance of personal contact and insects in the spread of infectious disease. Most people, including doctors, rarely washed their hands and did not think twice about sharing forks and cups. Medical advances of the period tended to occur in areas of theory, classification, and diagnosis, but not cures. For the average patient, these advances offered little immediate benefit beyond fancier and sometimes more specific names for their malady. Doctors made diagnoses by asking questions, observing the patient's appearance, taking the pulse, and examining, and sometimes even tasting, urine; few performed physical exams. Lacking both the understanding and the correct therapeutic measures, doctors could only respond to symptoms and speculate about the cause of disease.
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Regular doctors practiced a form of medicine known as “heroic,” a name that came not from the efficacy of the treatment or the prowess of the administrator but from the magnitude of the intervention. Doctors bled, blistered, and purged to draw disease from the patient. The most extreme form of bloodletting was venesection, in which a doctor would slit open a vein and catch the pint or two of blood in a bowl. Doctors also applied blood-sucking leeches and employed a spring-loaded device called a scarificator that delivered a series of moderately deep cuts to the skin from rows of sharp steel blades at the flick of a release lever; it was developed in the eighteenth century as a more merciful bleeding tool. Blistering involved placing hot plasters or irritating chemicals onto the skin to raise sores that were then drained. Doctors purged patients with large doses of medicines containing mercury, antimony, and arsenic. The effect was always drastic and noticeable. And it was just what patients wanted. Sick people in every time and place want to feel better and will seek out the treatment or healer that makes that desire a reality. Everyone could agree that heroic treatments did something. Emetics purged, diaphoretics sweated, bleeding bled and changed the pulse. These treatments instilled confidence in the doctor's skills, and confidence could
stimulate remarkable recoveries in patients. Anyone could see that bleeding “worked” because it nearly always produced some change in the condition of the sufferer that could be interpreted as progress, though it might also have been a strong placebo effect or simply a different symptom brought on by difficult-to-control treatments that were prone to infection.
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Bleeding and purging could cause a patient's blood pressure to drop by decreasing blood volume and oxygen delivery to tissues. Too much, though, could cause organ failure and eventually death. Blistering opened wounds on the skin that could become infected, particularly in these unsanitary times, and spread to the bloodstream, which could also cause organ shutdown and death. Leeches, on the other hand, are still used in medicine to remove excess blood, helping doctors do everything from preventing clotting to reattaching severed fingers.
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Heroic approaches to healing reflected contemporary thinking on how disease worked but also an ancient cosmology. Medical theory of the time held that external symptoms revealed the disease, so anything that changed symptoms was viewed as potentially useful. These ideas went back thousands of years to the Greek physician Hippocrates and the Roman physician Galen, who proposed that the body consisted of four humors (black bile, yellow bile, blood, and phlegm) that needed to be kept in balance to be healthy. Every person had his or her own temperament or mixture of humors that could be thrown off balance by a variety of factors, including diet, lifestyle, or environment. The symptoms that people complained of and associated with sickness were not the actual disease but a sign of an internal imbalance that needed adjustment. Fever, for instance, was believed to result from too much blood, so anything that could reduce or eliminate it, usually bloodletting, was viewed favorably.
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Most of the medicines in active use were also known for their harsh effects. Some we would now think of primarily as poisons, such as the derivations of mercury used to purge and sweat patients. Leading emetics to produce vomiting included ipecac, tartar emetic, and sulfate of zinc. Powerful laxatives to clear the bowels included calomel and the root of the jalap plant. Of these, calomel, or mercurous chloride, was among the most dreaded of drugs. Doctors believed that this powerful cathartic flushed disease from the body and stimulated the cleansing power of the liver. But as a compound of mercury, calomel was also toxic. Patients given doses over a period
of several weeks developed swollen mouths, ulcerated gums, and uncontrolled drooling. A 1720 prescription for a patient suffering from swollen joints called for two doses of calomel, followed by bleeding twelve to fourteen ounces of blood. After a day of rest, the patient received two more shots of calomel, more than enough to cause acute mercury poisoning. Doctors considered the visible oral damage and extreme salivation proof that the calomel had worked by producing a physical response that differed from that of the disease. Horrible side effects were considered necessary evils on the path to health.
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With these treatments, the real wonder is that most people survived. But many people did improve, enduring both their sickness and its treatment. Doctors viewed recovery as confirmation of the effectiveness of their therapies and as proof that their underlying theories were valid. In truth, many illnesses, particularly most infections, simply went away on their own. Thousands of years earlier, Hippocrates identified the body's innate ability to respond to illness and even restore itself to health in some cases. This capacity was given the Latin name
vis medicatrix naturae
, “the healing power of nature.” Mainstream doctors from antiquity onward held nature in high regard but by the late eighteenth century, that esteem had become little more than lip service. Most doctors enthusiastically pursued heroic interventions when they could. They did not necessarily deny nature's power, but few believed that she alone could cure.
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To claim otherwise, though, would have been career suicide for doctors, an admission that medicine was redundant or worse, helpless in the face of nature's supremacy. Well-known colonial American physician Benjamin Rush advised medical students at the University of Pennsylvania to “always treat nature in a sick room as you would a noisy dog or cat” by “driv[ing] her out at the door and lock[ing] it upon her.”
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Nature often had no answer for chronic illnesses, however. Even after surviving a disease, many people lived with compromised health for the remainder of their lives, as did Louisa May Alcott after surviving typhoid fever and its brutal, if well-intended, medical treatment. Disease became a part of life, and many people treated themselves for the aches and pains of everyday living. Do-it-yourself medical books, medical almanacs, and family recipe books abounded with recipes for healing salves, prophylactics, and popular herbal remedies. Many American colonists had brought their favorite manuals along with them, like Nicholas Culpepper's
The Complete Herbal
or E. Smith's
The Compleat Housewife; Or, Accomplish'd Gentlewoman's Companion
. Treating yourself was more convenient and cost less than a visit with a doctor, if one could even be found within a day's journey from home. For some, home care was a powerful way to democratize medicine and spread knowledge. John Wesley, better known as the founder of Methodism, was among domestic medicine's biggest proponents. In 1747 he published
Primitive Physick: Or, An Easy and Natural Method of Curing Most Diseases
, his own low-cost and nontechnical medical manual that instructed users on how to turn kitchen staples into medicine. Onions, honey, and licorice could treat coughs; apple water, asthma; whey and raisins, nosebleeds. He also recommended the unusual application of toasted cheese as a bandage to staunch bleeding.
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For millions of Americans, these domestic guides functioned as primary care doctors.

Armed with these guides, women served as “Dr. Mom” long before marketers invented the term. Since the earliest colonial days, women acted as their family's doctor, nurse, and pharmacist, providing most home medical care and nearly all birthing assistance. Many women had an impressive knowledge of herbal remedies, traditional rituals, and preventative measures passed down through families, found in books, and gained through firsthand experience. The technical simplicity of contemporary medicine made it possible for women, and others who were at the time denied any formal education, to offer many of the same services as a doctor.

Although these alternate healers, and alternate forms of health care, had long existed alongside doctors, many more Americans began to turn away from regular medicine in the nineteenth century. It was not so much that medicine had changed as that American culture had changed after independence from Britain.

Early Americans demonstrated a stubborn attachment to the idea that every person possessed the common sense to take care of him- or herself. The conditions of life on a new continent had forced colonists to improvise and make their own way in a rough and challenging new environment. As a result, Americans became proudly self-directed, self-reliant, and confident in their own judgment. This did not mean that no one ever sought the advice or counsel of others but it did foster an environment that prized individual good sense. Breaking away from British control only bolstered American confidence in the power of personal freedom and a concomitant distrust of authority, elitism, and control.

The rise of Andrew Jackson, a poorly educated man from the backwoods of the Carolinas, to the presidency in 1828, seemed, to many Americans, to herald the triumph of the common man, equality, and democracy in the new country. The Jacksonians denounced the moneyed aristocracy and espoused a democratic ideology predicated on equality, although this equality remained restricted to white males. Under Jackson, free white men finally earned the right to vote as rules requiring property ownership fell. Celebrations of democracy and the right of the people to have a say in all aspects of life shot through popular culture even as the Jacksonian policies simultaneously supported sexual, racial, and ethnic subordination and exclusion. Slogans such as “knowledge is power” and “knowledge, like money, depends on circulation” became the catchphrases of the day. New technology made print cheaper, so books and newspapers proliferated. Public libraries, political parties, and associations devoted to literature, science, and philosophy encouraged the spread of ideas. This democracy of knowledge covered a wide range of topics, including health and science. These events and institutions spurred an egalitarian ethos among many Americans that clashed with the exclusivity of medical knowledge and skill claimed by regular medicine.
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