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Doctors and Diseases on the Oregon Trail
A Matter of Theory
The reason mainstream medicine was so ineffective in the 1800s was that it was all based on an idea that was over a thousand years old. The basic concept was first described in the Second Century and had been updated only slightly in the Sixteenth and Seventeenth Centuries to take into account improved knowledge of human anatomy, the discovery that blood circulates continuously through the body, and primitive theories to explain why we breathe.
The theory of the Four Humors was part of the ancient belief that the world was made of four elements: air, earth, fire, and water. Each element was represented by one of the Four Humors: choler, black bile, blood, and phlegm. Good health was the result of the elements being in balance within the body; illness, as well as insanity and failings of one's moral character, was believed to result from the Four Humors being out of balance. It's important to recognize that the theory of the Four Humors was not merely a tool to diagnose sick people -- it was an effort to explain all the illness, madness, and evil in the world.
Under this way of thinking, doctors did not really see separate, distinct diseases the way they do today. There was just one malady: the Humors being out of balance. The patient's symptoms indicated the nature of that imbalance, suggesting which Humor(s) the patient had too much or too little of. For example, blood was associated with fire and was believed to be the source of the body's heat. Thus, it was common to bleed patients who were running a high fever, as described in The State of the Art.
In addition to bleeding, doctors would try to bring a patient's Humors into balance by giving a laxative to cause diarrhea or an emetic to induce vomiting. Doctors also attempted to draw off excess Humors by raising blisters on the skin with poultices of ground chili peppers or cayenne pepper. Another technique, called "cupping," involved placing heated glass cups upside-down on the patient's skin. As the cups cooled, the air pressure inside them dropped, and the partial vacuum raised large, red welts which were thought to concentrate and draw off toxins in the body. Cupping was also sometimes used in combination with bleeding: after one or two aggressive bleeding treatments, a patient's blood pressure would drop to the point where blood would no longer spurt out, so heated cups were placed over incisions to help draw more blood.
Most responsible doctors -- as opposed to the many quacks plaguing the profession -- learned how to ply their trade either by attending medical school for a few months or by serving as an apprentice to a practicing physician for perhaps two or three years. Different teachers often passed on very different lessons about how to treat disease, however, as they could do no more than teach their students what they believed had worked for them in the past.
Medicine was slow to accept the basic scientific method of advancing knowledge by observing and experimenting, and as a result there were no verified, accepted, concrete facts to compare when two doctors disagreed about something in the mid-1800s. Many doctors taught that mercury was a useful laxative that had been used successfully for centuries, for example, while others believed it was poisonous and advised their students to prescribe lobelia or aloe, instead.
It was perhaps a blessing in disguise that doctors were few and far between on the frontier. Most folks only called on a doctor in an emergency, such as to treat a gunshot wound or set a broken bone. Inste ad, settlers relied on "granny medicine" -- home remedies passed from mother to daughter over the years -- though some families also put their faith in books such as The Family Nurse and Gunn's Domestic Medicine, or the Poor Man's Friend.
Granny medicine was no more effective than mainstream, or "heroic" medicine, but it is at least easier for us to understand today. There was a certain amount of common sense in granny medicine. For example, one basic rule was that anything that had some sort of noticable effect on the body must have medicinal value: peppermint oil was used to treat all manner of aches and pains because it causes a sensation of warmth when applied to the skin, and asparagus was widely thought to be good for the kidneys because it makes urine smell odd. Granny medicine also followed what modern anthropologists call the "Rule of Similars" -- for example, snakebites were often treated with extracts made from plants with long, stringy roots that looked sort of snake-like.
But the grannies and the doctors were on the same page when it came to the Four Humors. Granny medicine and heroic medicine even used many of the same medicinal plants to prepare "purgatives" to drain excess humors from their patients. As strange as the Four Humors seem to us today, they were entirely real to our ancestors. They worried just as much about acrimonious humors and disorderly movement of the blood as we worry about the ebola virus and antibiotic-resistant bacteria.
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