What It Was Like To Be Sick In 1884

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For the doctor, the challenge lay in predicting an ailment’s course and suggesting appropriate treatment. The ophthalmoscope and laryngoscope could be of great value in diagnosing ills of the eye and throat; but although they had been known since the 185Os, their use was limited largely to a minority of big-city practitioners. They were still the specialist’s tools, and the regular medical curriculum offered no training in their use. More ambitious physicians also had at their disposal a whole battery of urine tests. (A urinalysis manual of over five hundred pages had, in fact, been translated from the German a few years earlier.) Blood-cell counting was still an academic exercise, but many physicians tested routinely for albumin and sugar in the urine of patients suspected of having kidney ailments or diabetes. In the latter case, availability of a simple chemical test for sugar marked an aesthetic if not intellectual advance over the earlier practice of tasting the urine in question. But the availability of this handful of instruments and laboratory tests had not fundamentally altered traditional medical practice. The era of high-technology diagnosis still lay far in the future.

Most diagnoses depended on sight and touch. Did the patient appear flushed? Was the tongue coated? Eyes cloudy? Even more important was the patient’s account of his or her symptoms.

The physician brought three basic resources to the sickroom. First, of course, was the doctor’s individual presence. In an era when patients with severe, and possibly fatal, infectious diseases were treated under the evaluating eyes of family, friends, and servants, nothing was more important than a physician’s ability to inspire confidence. And contemporary medical doctrine specifically recognized that patient confidence was a key ingredient in the physician’s ability to cure—even in surgery. The second resource available to the practitioner was the contents of the medical bag, the drugs and instruments of the physician’s trade. The final resource lay in the doctor’s mind: the assumptions about disease that explained and justified its treatment.

The doctor’s bag was filled largely with drugs: pills, salves, and powders. Medical therapy revolved around their judicious use; in fact, physicians used the term prescribe for synonymously with treat . Doctors often complained that patients demanded prescriptions as proof that the physician had indeed done something tangible for them. And in most cases patients and their families could see and feel the effects: most drugs produced a tangible physiological effect. Some induced copious urination, while others caused sweating, vomiting, or—most commonly—purging. In addition, the majority of physicians carried sugar pills, placebos to reassure the anxious or demanding patient that something was being done.

PHYSICIANS WERE WELL AWARE that, in part at least, the efficacy of any drug lay in the realm of psychology and not of physiology. The danger, as one warned, was that practitioners might become so conscious of such effects that they would lose sight of the utility of genuinely active drugs. Another practitioner noted that he did not use sugar pills in treating patients in whom he had “confidence”—presumably those better educated and more congenial to him.

In the half-century before 1884, physicians had become increasingly skeptical of the staggering dosage level of drugs routinely employed in the first quarter of the century. Few drugs had actually become obsolete, but mild doses and a parallel emphasis on tonics, wines, and a nourishing diet had come to be considered good practice. Bleeding, too, had dropped out of fashion, though it was still regularly employed in a number of conditions—the beginning of a fever, for example, or with unconscious victims of severe head injuries.

None of this is meant to give the impression that remedies used in 1884 exerted only psychological effects. Even from the perspective of 1984, medicine a century ago had a number of effective tools at its command. Opium soothed pain and allayed diarrhea, digitalis was useful in certain heart conditions, quinine exerted a specific effect on malaria, and fresh fruits relieved scurvy. Vaccination had made major inroads against smallpox (even though technical problems and lax enforcement had made it less than 100 percent effective). Aspirin (although not under that name) had just come into widespread use in the treatment of fevers and rheumatism; it was, in fact, so fashionable that cautious physicians began to warn of its possibly toxic effects. Mercury did have some effect on syphilis, even if it could be dangerous and debilitating. (Some doctors still believed that mercury compounds were not exerting a curative effect until the patient was “salivated”—that is, beginning to show symptoms of what we would now regard as mercury poisoning.)