Underschooled and ill-equipped, the men who attended the pioneers practiced a rugged brand of medicine—but they made some major advances all the same
Like the patients they treated, the pioneer physicians were long on courage and endurance, and short on almost everything else. The typical practitioner could stuff all his supplies and equipment into his saddlebags. Usually he carried homemade bandages, a few drugs, a mortar and pestle for mixing prescriptions, some syringes, perhaps some hot water bottles of pewter or crockery, and a small assortment of knives and saws. By 1840 the progressive, well-equipped frontier doctor had added tooth forceps, stethoscope, and obstetrical instruments to the meager list.
Some of them also used a device called a pulsometer. This was a dumbbell-shaped glass container partially filled with colored liquid. A stream of air bubbles rose through the liquid when the patient held the gadget while his pulse was taken. It was a fraud, of course-the bubbling liquid revealed nothing at all about the pulse—but it gave the patient the satisfying feeling that the latest marvels of science were being applied on his behalf.
Through the 1830’s most of the drugs at the doctor’s command were narcotics or purgatives, administered usually in staggering doses. Ipecac, which induced vomiting, was a particular favorite. Another was a chloride of mercury compound called calomel which supposedly cleansed the system by causing saliva to jxjur from the mouth. Unfortunately, it also softened the gums and caused the teeth to fall out. Not until the 1840’s, when the curative properties of quinine became widely appreciated, did the pioneer physician have a really sale and effective drug; but it was prohibitively expensive. As late as 1846 an Indiana doctor sold a heicl of fat cattle at $7.50 a head in order to buy the precious medicine at $6 to $8 an ounce.
The greatest shortage of all was in medical knowledge and training. Until the 1860’s—and in some sections long afterward—a frontier doctor was almost any man who called himself one. It is a safe guess that not more than a fourth of them held degrees from medical schools. Most learned by the apprentice system, and some were self-taught, self-appointed healers who hung out their shingles when they “got the call.”
In this institutional void, more than a dozen systems and theories of medicine sprang up. Steam baths, freezing baths, weird diets, secret Indian herbs, and the draining away of bad blood—each theory of healing had its partisans. The contending camps engaged in fierce disputes while borrowing so freely of each other’s methods that it was often hard to tell where one system ended and another began. The confusion gave rise to a group called eclectics, or people’s doctors, who practiced medicine on the democratic frontier principle that one man’s opinion was as good as another’s. Some people’s doctors claimed to be equally proficient in all methods, and allowed the patients to choose the treatments they preferred.
The one belief held in common by most systems was that serious ills called for drastic remedies. One doctor’s treatment for malaria advised: Carry then your patient into the passage between the two cabins—strip oil all his clothes that he may lie naked in the cold air and upon a bare sacking—and then and there pour over and upon him successive buckets of cold spring water, and continue until he has a decided and pretty powerful smart chance of a shake.
If the resultant tremors seemed a bit excessive, that could be countered by immersing the victim in warm water and administering stiff doses of a patent medicine containing opium.
Doctors who professed the precepts of orthodox medicine were called allopaths, or “regulars,” and were in their way quite as rough-hewn as their irregular colleagues. In the early part of the pioneer period the credo of the regulars was “bleed, blister, and purge.” How far they went with it is indicated by the teachings of Dr. Daniel Drake, who helped to found the first medical college in Ohio, which survives today as the Medical College of the University of Cincinnati. He was a brilliant man, far ahead of his time in many ways, but a traditionalist on the question of bleeding. In an 1832 medical periodical he advised: To bleed a patient who cannot be raised from his pillow without fainting, whose pulse is nearly imperceptible, whose skin is cold, and extremities shrunk up to half their ordinary size, would at first view, seem rash and unwarrantable. But experience … has sanctioned the use of the lancet even when all these and other symptoms of extreme prostration are present.
If the patient was so wasted away that blood would not flow from the veins, Dr. Drake urged “recourse to the jugulars.”
Another theory involved relief of illness through counterirritation-peeling away a section of epidermis and rubbing a strong irritant on the exposed flesh. Or a specially treated coil of cotton could be burned slowly on the skin. When infections were cauterized, an iron at gray heat was found to be most painful, and, therefore, was thought to be the most effective.
Not surprisingly, many people feared physicians at least as much as they dreaded disease. Popular distrust of medicine was expressed in derisive journalistic comments such as, “When we hear of a man’s getting well, after being given over by the doctors, we can’t help thinking how lucky he was to be given over by the doctors.” When a system appeared called homeopathy, whose treatments in those rugged clays often amounted to little more than letting nature take its course, skeptics saw it as a Hobson’s choice. The alternatives were spelled out in an irreverent jest. “The patients of the homeopaths died of the disease, and the patients of the allopaths died of the cure.”
Despite their mistakes, however, not all pioneer doctors can be dismissed as bumbling quacks. Many were dedicated men, struggling earnestly to solve terrible problems at a time when medicine everywhere was burdened with much ignorance. If they were more freewheeling than doctors elsewhere, more prone to extreme measures and violent experiments, that was part of the frontier spirit.
The calling was hard and dangerous, even by frontier standards.
When epidemics raged, the pioneer doctor often laborederoically, riding from one lonely dwelling to another, snatching his sleep in the saddle, never really resting until the threat abated. He risked his life every time he set foot in a cabin where someone lay stricken with a deadly, highly contagious disease. And he did it for very little money. A typical fee in some areas during the early 1800’s was twenty-five to fifty cents a visit, perhaps a dollar if the doctor stayed all night; payment was made in goods, services, or promises more often than in cash.
Here and there the frontier produced a physician of extraordinary vision and skill. Dr. Benjamin Dudley was one of these. He taught anatomy and surgery at Transylvania University, Lexington, Kentucky, the West’s first medical school. A hot-tempered man, Dr. Dudley was constantly embroiled in quarrels with his colleagues. Fortunately for medicine he also quarrelled with some of the established ideas of his day. Long before germs were discovered, Dr. Dudley was advocating the quite novel notion that infection could be reduced by cleansing surgical instruments in boiling water.
Dr. Dudley was inclined to take personal offense at those who dared to dispute his views. He fought at least one duel, with a colleague, a Dr. Richardson, felling his opponent with a pistol ball in the thigh. Whether stricken by regret or merely moved by professional instincts, the cantankerous Dudley then rushed forward to treat the wound he had just inflicted. The duellists thereupon became fast friends.
A quite different type was Dr. Ephraim McDowell. Modest, soft-spoken, and gentle, McDowell began practicing at Danville, Kentucky, in 1795, and soon became known as one of the great surgeons of what was then the frontier territory. As his fame spread, he travelled throughout the Ohio and Mississippi valleys, sometimes riding hundreds of miles to take charge of particularly difficult cases. Once he operated on a youth suffering from a painful bladder stone and fourteen years afterward received a grateful letter telling how much the patient’s fortunes had improved since the day when he was brought to Dr. McDowell as a “meagre boy, with pallid cheeks, oppressed and worn down with disease.” The testimonial was from James K. Polk, later President of the United States. Dr. McDowell also performed a delicate and dangerous operation for a friend and neighbor of President Jackson. These, however, were only incidents in Dr. McDowell’s career. His enduring place in medical annals rests on the operation he performed on a forty-five-year-old Kentucky housewife named Jane Crawford.
In 1809 McDowell was summoned to the Crawford farmhouse at Caney Fork to assist in what was thought to be a long-overdue childbirth. He found at once that Mrs. Crawford was not pregnant. She was suffering from an enormous ovarian tumor and could expect to live only a year, perhaps two at most. There might be a chance for recovery if the tumor were removed, but that was an expedient so desperate that it had never been attempted, most medical authorities being certain that it could only hasten the end. Dr. McDowell recommended the operation as the only hope, but added that he would not risk it under the primitive conditions at the farmhouse. If Mrs. Crawford could come to his home at Danville, he would operate there.
The sufferer had to choose between the probability of death at once, and the certainty of death a little later. She had to weigh her responsibilities to her four small children. And she must have thought a lot about the sheer physical ordeal which a decision in favor of surgery entailed. It was winter, and Danville lay about sixty miles away over steep and twisting trails. Every mile would be an agony in her condition, but in that direction only lay life. On a December day she made her decision. Leaving her husband, Thomas, in charge of the children, she set off on horseback, resting her swollen abdomen on the pommel of the saddle. The details of her heroic journey are now clouded by legend, but somehow she made it. At Danville, Dr. McDowell put her to bed for two days’ rest before the operation.
He scheduled it for a Sunday morning, as was his custom in difficult cases, so that the prayers of his church might be with him in his task. On this occasion, however, some of the townsmen thought he was doing the work of the devil. Superstition and sexual taboos contributed to dark murmurs that the doctor was “butchering a woman’; according to some accounts a threatening crowd gathered outside his house. His nephew and medical assistant begged him not to go through with the operation. In vain.
Two assistants and a nurse stood by to help, part of their duty being to hold and comfort the patient. Anesthetics did not yet exist. It was Mrs. Crawford’s turn to seek divine aid now; as pain and fear came, she gritted her teeth and recited the Psalms. A foot-long incision was made, and almost instantly there was a crisis. “The intestines rushed out,” Dr. McDowell reported. “So completely was the abdomen filled with the tumor that they could not be replaced until the massive lesion was removed.” Those who worked with the surgeon said that his face flushed and perspired at such moments, but his hands remained marvelously steady. Quickly he turned the patient on her side, so that the sprawling intestines would not block his view of what had to be done. He cut out a tumor which weighed about twenty-two pounds, removing at the same time much of the Fallopian tube. The task was accomplished in about twenty-five minutes.
Five days later Dr. McDowell looked in on his patient for a morning checkup and found to his astonishment that she was up and about, making her bed. He gave her, in his own dry phrase, “particular caution for the future,” but she was not a woman to lie abed when urgent duties were calling her back to the workaday world. Some three weeks after the operation, this incredibly hardy woman climbed on her horse and rode back to a joyous reunion with her family.
Dr. McDowell repeated the success twice more in the next seven years before he deemed it worthy of reporting to a medical journal. It is a measure of what he had achieved that his account simply was not believed. In Europe especially, the medical authorities thought it impossible that this unknown man in a raw, new country had achieved something beyond the grasp of the most renowned surgeons of London, Paris, and Berlin. British physicians deplored the operation as “dangerous to the character of the profession,” and the French dismissed it as “among the prerogatives of the executioner.” The reception in this country was not much better. Dr. McDowell did not argue the point but went his way, repeating the feat when circumstances required, achieving eight successes in thirteen attempts. About half a century later medicine caught up with him, and he was recognized, posthumously, as a giant of his time, the first man to perform an ovariotomy. A memorial to him stands at Danville today. As for tough Mrs. Crawford, she lived to be seventy-eight.
Dr. William Beaumont was another who gained fame with the help of an almost indestructible patient. Beaumont was a United States Army physician assigned to a fort and trading post on Mackinac Island in Lake Michigan during the 1820’s. Several thousand Indians and French-Canadian voyageurs swarmed through the post each year, bringing pelts from the wilderness. These trappers were a rough lot; knife and gunshot wounds figured prominently in the doctor’s busy practice. One of these, in 1822, resulted in a now-famous chapter in medical history. A nineteen-year-old voyageur named Alexis St. Martin was all but torn apart by the accidental blast of a shotgun. The shot poured into his stomach at three-foot range, the flash from the muzzle setting his clothes afire.
The prospect of success was dim. Dr. Beaumont found “a portion of the Lungs as large as a turkey’s egg protruding through the external wound, lacerated and burnt, and below this … a portion of the Stomach which at first view I could not believe possible to be that organ in that situation with the subject surviving.” Further examination revealed a stomach puncture large enough to admit a finger. Said Dr. Beaumont: “I proceeded to cleanse the wound and gave it a superficial dressing, not believing it possible for him to survive twenty minutes.”
If the physician was prepared to give up, however, the patient was not. All the wild vigor of St. Martin’s young body rallied to his defense. The man simply refused to die. For a long time he lingered, then slowly he gained strength and began to recover. But the abdominal wound would not close. Dr. Beaumont kept it covered with compresses so that when St. Martin ate, the food would not leak out through the hole in his stomach. At the end of a year the patient was on his feet again, weak and crippled but hobbling about. His stomach cavity was still not sealed, and never would be again, but his body had effected a rough repair. Overlapping layers of skin had grown over the wound, creating a valve which could be opened by lifting a flap.
Dr. Beaumont slowly recognized in St. Martin a remarkable opportunity to advance medical science. Medicine at that period had almost no knowledge of the vital chemical action which transforms food into the fuel of life. There were theories about it—dozens of theories—but very few facts. With grave excitement the doctor confided to his notebook: “The case provides an excellent opportunity for [experiment] … I can look directly into the cavity of the Stomach, observe its motion, and almost see the process of digestion. I can pour in water with a funnel, or put in food with a spoon, and draw them out again with a syphon. … It would give no pain nor cause the least uneasiness.”
Dr. Beaumont was not trained for such exacting research; he had picked up his knowledge of medicine by rolling pills and mixing powders for another doctor and had never set foot in a medical school. But he saw the opportunity and pursued it, and his very ignorance may have been an advantage. Knowing little about the learned disputes on the digestive process, he was never tempted to distort his findings in defense of established views. He was imbued, moreover, with the show-me attitude of the typical frontiersman. Once, for instance, he siphoned off samples of the gastric juices and sent them to some of the world’s leading chemists for analysis. The reports that came back indicated hydrochloric acid. Dr. Beaumont put it to the test. Filling one vial with gastric juices, and another with hydrochloric and acetic acid, he placed some well-chewed boiled beef in each. The beef in the gastric juice was completely dissolved, while a jelly-like residue remained in the vial of acid. Three years later, pepsin was isolated as an important factor in digestion.
If Beaumont was enterprising and persistent, other aspects of his personality were not so admirable. He was overbearing, proud of the status conferred by his rank and profession, and he insisted on treating St. Martin as a menial servant. The voyageur sometimes retaliated by refusing to let his stomach be probed. The two often quarrelled bitterly. But Dr. Beaumont turned even this to scientific advantage; he noted that violent anger produced some quite interesting changes in the patient’s digestive chemistry. When St. Martin got drunk, which he quite frequently did, Dr. Beaumont would turn to the notebook and record his observations on the effects of alcohol in the stomach.
Several times St. Martin decamped for the wilderness, swearing that he would never let the doctor lay hands on him again. He found, however, that he was no longer fit for the old wild, free life, and after a while he would come trudging back, offering to resume the experiments in exchange for his board and keep. Over the years, this cost the doctor more and more, for St. Martin progressively acquired a wife and four children. Dr. Beaumont was by now a family man himself; he railed at the vexatious demands on his slender purse, but in the end he always agreed to pay. He was a man obsessed. Whatever the cost, he had to find out what was going on in that stomach.
The curious association continued for nearly ten years. Finally there was a last, angry, irreconcilable quarrel. St. Martin packed up his family and returned to Canada, leaving Dr. Beaumont to sputter over the “villainous obstinacy” of his unwilling partner. But by then, Dr. Beaumont had completed more than two hundred experiments, learning nearly all that could be learned by the methods then available. He had contributed an exact description of the stomach’s action, providing detailed information which was not materially expanded until X-ray procedures came into use. He had discovered almost singlehandedly what digestion is, and how it works. When his findings were published, he received world-wide medical acclaim.
Along with such epic figures as Dr. McDowell and Dr. Beaumont, frontier medicine produced dozens of lesser but still brilliant men. Most were surgeons. They performed the first cholecystotomies, laryngotomies, and nephrectomies in pioneer country, the first heart sutures and skull perforations. Their names and achievements are scattered through the footnotes of medical histories, and they make dull reading. But the events behind the footnotes were far from dull.
Take what was probably the first successful Caesarean section in the American West, performed in 1827 by Dr. Jonn Richmond at a farmhouse near Newton, Ohio. The operation at that time was fatal to three women out of four, even when done under the best of circumstances. Dr. Richmond accomplished it at night, by the uncertain light of flickering candles, in a primitive setting typical of frontier surgery. He did it, moreover, despite his own grave doubts that he was equal to such a challenge.
Dr. Richmond was an itinerant preacher who had taken up medicine after listening to lectures at a medical school where he worked temporarily as a janitor. He had never seen a Caesarean performed, or even heard it described by another physician; he had only a rudimentary knowledge of how to proceed, based on reading ancient accounts in Greek and Latin. For many hours he sat by the patient’s bed, working with her, waiting, then working again, hoping that birth would occur in the natural way. He wanted to call in a more experienced physician, but a storm-swollen river cut him off from help. Finally, he had to act. His report conveys the drama of men in like circumstances fighting against odds for the lives of their patients: Finding that whatever was done must be done soon, and feeling a deep and solemn sense of my responsibility, with only a case of common pocket instruments, about one o’clock at night I commenced the Caesarean Section. … The house … was made of logs that were green, and put together not more than a week before. The crevices were not chinked, there was no chimney, nor chamber floor. The night was stormy and windy, insomuch, that the assistants had to hold blankets to keep the candles from being blown out. … The patient never complained of pain during the whole course of the cure.
The last line of Dr. Richmond’s account strikes a note encountered often in the chronicles of pioneer medicine. Typical, too, was the quite off-hand way in which the tribute was paid. Courage was necessary, and so it was taken for granted. It was a long time before anesthesia came to relieve the need for sheer endurance in the face of pain.
In the gold camps of the Far West medicine was practiced on much the same level as on the shifting frontiers inland. But the patients were different, and so were the doctors. These were no homesteaders come to raise crops and families, but adventurers, gamblers, fugitives, wanderers of every description. They suffered from gold fever, and while that in itself was not a recognized medical condition, it produced violent side effects which quite often came to a physician’s attention.
The gold seekers piled into overcrowded ships, and died by the thousands on the trip around the Horn; quite often those who lived brought the germs of epidemics with them when they staggered ashore in California. Or they arrived sick and half-starved sometimes after similarly hasty and ill-planned stampedes across the plains. They suffered terribly from scurvy, a disease easily prevented by eating a lemon a day. But no one spent time raising fruit when gold was waiting to be plucked from the ground.
Physicians were stricken with gold fever along with everyone else. When news of the first big strike came in, all three of San Francisco’s doctors closed their offices to head for the hills. And it was prospecting, not medical opportunity, that drew many of the 1,500 doctors who arrived in the Gold Rush. Shortly, however, the doctors discovered that there was more money to be made with lancet and stethoscope than with pickaxe and crowbar. For all the tales of rich veins of metal, a miner could expect to average only $500 for a year’s hard work. Some doctors made more in a week.
The money to be made in medicine attracted hordes of quacks. In the gold field’s community of strangers, where a man’s credentials were as good as his bluff, such a development was almost impossible to check. One prominent “physician” turned out to be an escaped convict, another was a notorious horse thief. The prevalence of impostors can be seen in old California death certificates which list such causes of demise as “Effect of Jiggers” and “Evil in the Bladder.”
One impostor who came to grief was a swaggering, gaudily dressed alcoholic who called himself Dr. Hullings. He set up an office at Placerville, known earlier as Hangtown, and announced that he would fight anyone who jumped his medical claim. Into this same camp came Dr. Edward Willis, an Englishman with a European medical diploma. Hullings stalked into Dr. Willis’ tent, tore up his diploma, and spat tobacco juice in his face. Hullings, however, had misjudged his man. Dr. Willis dispatched the challenger in a duel, and settled down to medical practice undisturbed.
Generally the doctors had no need to fight over patients. There were more than enough to go around. In Rich Bar, California, for instance, twenty-nine doctors kept busy tending to the needs of one thousand brawling miners. The wife of one of these doctors passed on an account of what the life was like. “In the short space of 24 days,” she wrote, “we have had several murders, fearful accidents, bloody deaths, whippings, a hanging, an attempt at suicide and a fatal duel.” The first five years of the Gold Rush, it has been estimated, produced 4,200 murders and 1,400 suicides.
Even in this violent land, however, there was a kind of unwritten compact which made all men allies against the common enemies of disease and death. The doctor who was respected could move among toughs and cutthroats, knowing that his profession was a better protection than a gun at his hip. It was not just sentiment. These men had needed him before, and they knew they would almost certainly need him again.
Among those who enjoyed such status was Dr. William B. Eichelroth. He was a Saxon aristocrat who had fled from his native land with a price on his head after participating unsuccessfully in one of the liberal uprisings which marked Europe in the late 1840*8. In the West he became so well known and liked that miners used him as a gold courier, confident that bandits would not molest him. Dr. Eichelroth reported this dialogue with a bandit he met on the trail:
Bandit: Hands up and hold ’em high!
Doctor: What the hell do you want of me?
Bandit: Oh, it’s you, Doc. Go ahead.
In Denver, Dr. F. J. Bancroft reacted coolly to another kind of threat. A cowboy brought in his badly wounded brother, dumped him on the operating table, and announced that he would shoot the doctor if the patient died. Dr. Bancroft proceeded to do the necessary thing, which in this case was amputating a limb. Later he told friends that he had not worried much. After all, he was armed, too. And if a patient were going to die, the doctor would be the first to know.
For the most part, though, the Wild West physician didn’t need or want a gun. Typical was the attitude of Dr. Charles Buck, who habitually travelled unarmed through the Rio Grande Valley of Texas when that area was a meeting ground for ruffians from both sides of the border. At one point the Texas Rangers offered to provide him with armed escort for his journeys. Dr. Buck declined emphatically. It was his view that the Rangers had many enemies, while he, so far as he knew, had no enemies at all. He had no wish to be shot by mistake or accident in some other man’s quarrel.
Eventually the West settled down. And when they came to write their memoirs, the doctors who had experienced the wild days very often found that their most vivid memories concerned not shootings and brushes with outlaws but the old, elemental dramas which are the stuff of medicine everywhere. Dr. Coe, for instance, reminisced about the midnight chase down the lonely road, but one of his most terrible experiences involved the time he arrived too late to assist at a birth. The woman’s husband had taken over, bungling the job with fatal results. Dr. Coe remembered the scene thus: On the bare simmering sand near the water hole, quailing under the hot mid-day sun, stood a tent. In front on the hot sand lay the body of an almost naked woman smeared with sand and blood from head to feet. Grouped around it in a circle were eight ragged, dirty children, from three to eighteen years old, crying and wailing in the most abject misery and grief. A tall, powerfully built man, wild-eyed, ragged and dirty, with a three-weeks’ growth of beard, the wide brim of his sombrero flopping in time with his movements, was doing the Piute War Dance around the children. He held a naked unwashed baby in his left arm and was brandishing a big six-shooter at the sky with his right hand. In a vituperative stream of blood-curdling profanity he threatened all the gods in Heaven and defied Jesus Christ to come down to earth in person and fight him in mortal combat. … It was a pathetic, ghastly and soul-sickening sight.
Along with such tragedies went many triumphs. Dr. Charles Gardiner recalled that shortly after he arrived in Colorado, a greenhorn both to medicine and to the West, he was asked to operate on a woman suffering from a huge tumor on the head. The deformity had so embarrassed her that for months she had locked herself in her home, refusing to see even her closest friends. When the nervous, uncertain young doctor was ready to perform the operation, he learned to his horror that it had become a public event. Scores of miners and cowmen gathered about. One big, confident fellow bulled his way into the operating room, opened a window, and draped his body over the sill, announcing that “I’m a-going to tell folks how things is going.”
“I should have not chosen him for a clinic reporter,” Dr. Gardiner wrote later. But since he didn’t seem to have much choice he bent to his task, finding relief in the fact that his skill increased with tension. So complete was his concentration that he barely heard the man at the window bellow out the progress reports: “He’s a-cutting into it. He’s got it roped and hog-tied. She’s a-doing fine, folks. The Doc’s giving her a drink. … It’s all over but the shouting, boys.”
The last announcement was greeted with wild cheers and a general discharge of firearms, following which the festive crowd dragged the doctor off to a nearby saloon for drinks all around. In his new-found dignity Dr. Gardiner stated his frank preference for soda water, and such was his position as hero of the hour that this eccentricity of taste was entirely overlooked.
That saloon celebration is probably as good a place as any to take leave of pioneer medicine. It is nicely symbolic of the much larger triumph that took place when the pioneer doctors and their successors could state that disease generally had been pretty well “roped and hog-tied.”
In the process, the more rugged aspects of pioneer medicine came to an end with the disappearance of America’s geographical frontiers and the advance of medicine. Changing conditions of life in a more settled land saw the slow refinement of the haphazard credentials—and sometimes practices—on the basis of which some frontiersmen called themselves physicians. Texas was the first state to establish a licensing board for physicians, in 1873. By 1895 most states had followed suit. The twentieth century has made the practice of medicine ever more sophisticated, more institutionalized, inevitably relegating a brave and colorful and often ingenious character to America’s earthier past.