Gilded Age Medicine: Why Ordering Heroin from the Sears Catalog Was A Step Up

My favorite stuffed animal as a child was a weird-looking turtle named Snoozie. My bedtime stories were mostly Snoozie skits—half-Muppet Show, half Lion King—as written and performed by my father. When my beloved Snoozie tore a seam, my father stitched him up. The surgeon of the house did all the sewing. My father also removed my splinters with the tip of an eight-inch butcher’s knife. Since I could not stand to look at the knife, I watched his face as he concentrated. He never missed one, and it never hurt.

As I grew older, I loved to hear tales of my father’s training in medical school, like when he had to draw his own blood because his partner had passed out. He filled the syringe and handed it over when the other guy woke up. Another classmate devoted only one line in his notebook to each day’s lecture. Later, if anyone had a question about what was said a month ago in physiology, this fellow would look up the right dated line and reprise the professor’s entire hour-long talk verbatim, even the bad jokes.

Despite this steady diet of stories, my father did not believe in pressuring his only child to follow in his footsteps—not that it was much of a choice for me after college. I am a bit embarrassed to admit that I did not take a single laboratory science course after high school, and that omission would have been a problem on my application—in the 1990s. In the 1890s, not so much. Harvard Medical School accepted nearly all applicants. Well, all male applicants. The president of the university considered coeducation “a thoroughly wrong idea which is rapidly disappearing.”

1896-fashion-plate
Sugar Communion’s heroine, Dr. Elizabeth “Liddy” Shepherd, as inspired by an 1896 fashion plate at the Met. (She will borrow the dress.)

Fortunately, coeducation did not disappear and, also fortunately, other medical schools at the time did accept women, including Ohio Medical University, where my next heroine, Liddy, will be trained. She will be one of about three women in her class of forty-nine. (My father went there too. By the 1960s, it was known as the Ohio State University College of Medicine. Go Bucks!)

Ohio-Medical-University-Protestant-Hospital-Goodale-Ohio-State
Ohio Medical University was one of the predecessor institutions of the eventual Ohio State University Medical School, and the affiliated Protestant Hospital would eventually become Riverside Methodist Hospital. This original campus was at Goodale Park. Postcard courtesy of Historical Reflections, the Ohio State Medical Heritage Center Blog.

Liddy will be unusual because she will have a bachelor’s degree when she starts medical school—something only eight percent of American medical students had in 1894, when she began. Typically those eight percent probably came from the bottom of their respective college classes. Scholars with promise went into teaching or the clergy. Physicians were considered “coarse and uncultivated . . . devoid of intellectual interests.” There was a real danger that too much science would “overcrowd” their limited minds. There were no written examinations at Harvard Medical School. None. In fact, that would have been impossible, one professor complained, because half of his students “could barely write.” He was not making a joke about doctors’ poor penmanship.

How could this be?

The Humoral System (Pre-Gilded Age)

Let’s talk first about what we know about what makes us sick. For far too long—from the ancient Greeks to the middle of the Victorian age—the European system of medicine described the human body as a balance of four substances called humors. If you had too much blood, the first of the four, it made you sanguine—courageous, hopeful, even amorous. Too much yellow bile turned you choleric, or hot-tempered. Black bile produced melancholic scholars, Shakespeare’s favorite. Too much phlegm slowed you down, made you apathetic. Your “sense of humor,” as it was known, even dictated which internal organs were most likely to fail you, like a combined CT-scan-slash-Meyers-Briggs personality test.

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James Gillray’s “Breathing a Vein” and “Taking Physick” (calomel), published by H. Humphrey, 27 St. James’s Street, London, January 26, 1804. Images courtesy of the Claude Moore Health Sciences Library at the University of Virginia.

Blood was the only humor that could be spilled on command, so bleeding became a popular treatment for any imbalance. If you were sick in the eighteenth century, you headed off to your neighborhood barber-surgeon, maybe get a few teeth pulled while you were there. In 1793, when Founding Father Dr. Benjamin Rush faced a yellow fever epidemic in Philadelphia—then the nation’s capital—he treated one hundred people a day by draining two liters of blood per person. That’s about forty percent of the blood in their bodies! Half of Rush’s patients died. When George Washington fell ill from a throat infection in 1799, he was bled the same amount by his doctor. He died. Washington’s physician, like Rush before him, and like the barber-surgeons before them, used a specific scalpel named after a medieval weapon. It was called a “little lance,” or a lancet. A publication named The Lancet was and still is a leading medical journal. That’s like naming an education blog The Paddle.

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“Leeches, a type of worm with suckers at both ends of the body, were used in bloodletting. It was the job of the leech finders, usually women, to collect these creatures for medical use. The leeches attached themselves to the legs and feet of the women who plucked them off and stored them in the little barrels of water. Doctors grew rich at the expense of these low paid women. Leeches were such a popular treatment that by 1830 demand outstripped supply all over Europe. Today, leeches are used following plastic and reconstructive surgery as they help restore blood flow and circulation. The print appeared in Costume of Yorkshire, published by George Walker in 1814.” Image and caption from the Science Museum Group.

Less extreme than the lancet were leeches, or parasitic worms. At the beginning of the nineteenth century, Britain imported 42 million leeches a year, seven million for London alone. That was about three leeches per person, but it still wasn’t enough. One British doctor admitted to using the same leeches on fifty different patients in succession—not realizing that he was exposing that fiftieth patient to blood-borne diseases from the last forty-nine people he treated. No wonder Napoleon called medicine “the science of murderers.”

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Calomel display from the Musée Testut-Latarjet.

He should know. He had been given another favorite prescription of the age: calomel, or mercurous chloride, which was prescribed as a magical tonic for almost any ailment, from tuberculosis to ingrown toenails. It was another humoralist treatment: if you did not want to drain blood, you might choose purge your patient from both ends with powdered mercury. Among the many, many symptoms of mercury poisoning are tremors, loss of teeth, and amnesia. Oh, and death.

No, I’m not blowing smoke up your ass. Wait, did you ever wonder why we say such a thing? The biggest fear of the eighteenth and nineteenth centuries was, shockingly, not doctors themselves but their doctors burying them alive. George Washington’s last words were instructions not to conduct any funeral for three days, just in case his physicians were not capable of distinguishing between life and death. Apparently, he had not heard of the latest sure-fire test, a tobacco smoke enema. Blowing smoke through a tube into a person’s nether region was sure to animate any phlegmatic—even before Dr. Previnaire added a bellows, a hand-held blower like I use in my fireplace, to create his patented anal tobacco furnace. The Academy of Sciences in Brussels gave Dr. Previnaire a prize for his work (Bondeson 139).

Tobacco-Smoke-Anal-Furnace-Resuscitator
Resuscitation Set from the first half of the 19th century, courtesy of the Science Museum Group.

This is not medicine, you say; it’s snake oil! Absolutely, another popular remedy.

There were some bright spots. British Naval surgeon Dr. James Lind discovered that oranges and lemons helped his sailors recover from scurvy, but he did not know why. He did not even know what Vitamin C was. Still locked into a humoralist mindset, he believed scurvy was caused by cold, wet sea air and a lack of exercise. And, yes, vaccination did exist at this time—in fact, a form of vaccination has been around for a thousand years—but originally no one could explain how it worked.

It was not until the population medicine studies of Pierre Louis in 1820s and 1830s France that people looked at the data and said maybe bleeding doesn’t work. Louis introduced a new way of examining the efficacy of treatment: looking at large numbers of similar patients and studying their reactions to different applications of medicine. It was the first baby step toward clinical trials, though it was not yet randomized and his sample sizes were not very large.

Bloodletting faded from life slower than the patients who were being bled. Despite a very public debate between doctors in the 1850s, the practice persisted in textbooks as late as 1942. One part of the appeal may have been its accessibility and affordability. There were bloodletters everywhere, and they were cheap “health care.”

Another reason it persisted: no one had yet proven another theory of disease. All the pieces were there. Contagion was not a new concept: even as far back as the Islamic scholar Ibn Sina, there was an idea that disease could be spread by touch. Animalcules, or microscopic organisms had been seen as early as the 1670s. Dr. John Snow (not that Jon Snow) had shown it was not miasma, noxious urban gasses, that caused cholera but something the sick had passed to the water through their feces. Snow did not make this discovery with a microscope, though, but with a map showing clusters of cases around certain well pumps.

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Snow’s map of cholera deaths in the Broad Street area, courtesy of the Department of Epidemiology, at the University of California Los Angeles School of Public Health.

But Snow did not really change long-term thinking. The handle was reinstalled on the Broad Street pump in London a couple of weeks later, after the cholera crisis had passed. Maybe, they thought, Snow did not really know what he was talking about. Mysterious waterborne poison, indeed.

Gilded Age Medicine

You cannot change the answers until you change the questions. And you cannot change the questions until you admit what you don’t know. What was in the air—or water—that we were not seeing? At the beginning of the Gilded Age, Louis Pasteur introduced an anthrax vaccine in 1881 and a rabies vaccine in 1885. Pasteur’s best frenemy, German physician Robert Koch, isolated the bacterium that causes tuberculosis in 1882. In 1884, he did the same for cholera. These were four of the worst disease bogeymen of the modern age. Modern bacteriology and immunology were born.

history-major-vaccines
Once the bacteriology-immunology ball got rolling, lots of diseases were ready to be prevented. This chart of the history of major vaccine development is from Bioinformatics for Vaccinology by Darren R. Flowers.

By the way, the man who introduced these two rivals, Koch and Pasteur, was Dr. Joseph Lister, the first surgeon to disinfect wounds and sterilize surgical equipment. You know his name as the root of the brand name Listerine. Yes, you are rinsing your mouth with surgical antiseptic. Please continue to do so.

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A compound microscope from the 1880s and a vintage bottle of Listerine, courtesy of Wikimedia Commons.

It would take time before the best and brightest of the American college set would pursue a career in medicine. And, like my character Liddy, if you wanted the best post-graduate education, you really had to go to Europe. While earlier in the century that may have meant Edinburgh or Paris, by 1890 that meant Germany or Austria, and in particular the Allgemeines Krankenhaus (General Hospital) of Vienna. (And you ate dinner at the Riedhof too!)

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Wien Wickenburggasse mit Riedhof, outside the Vienna General Hospital. Photo from vintage postcard.

Back in the US, it was not until 1910 that medical education truly changed. Two of the richest men to ever live, John D. Rockefeller and Andrew Carnegie, funded the Flexner Report, which was like an early US News & World Report ranking guide to medical schools—and like all of those publications, it was deeply flawed. The publication of the Flexner Report in 1910 is credited with creating the modern scientific medical school system in the US, but it also directly or indirectly caused the closure of many medical schools for women and African Americans. Those that had been coeducational reduced their admission of women, partly because they had a rise in male applicants. One study calls an unintended consequence of Flexner’s report “the near elimination of women in the physician workforce between 1910 and 1970.”

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The General Hospital of Vienna, a favorite place for post-graduate study for American medical students in the late 1800s. Illustration from Wikimedia Commons.

Nevertheless, the Gilded Age must have been very exciting to live through. Every day, it would seem, more diseases were being identified and explained. Notice that I did not say cured. Calomel was still popular in the early 1880s, as were chocolate-covered arsenic tablets. Aspirin existed, but no one knew how it worked until 1971! Cannabis was legal until the xenophobic backlash against refugees fleeing unrest south of the border after the 1910 Mexican Revolution, and then this effective pain reliever was demonized.

Marijuana in the Gilded Age
Who won the 2016 election? Marijuana, of course. But beware! Gilded Age America preferred cocaine tooth drops. Find out more.

There still was no real anesthesia for surgery except ether and cocaine. Cocaine was quite handy, actually, and it was sold in lozenge form for toothaches. Bayer Pharmaceuticals introduced a new form of cough relief that they said was just as good as morphine, but not as habit-forming. They trademarked this miracle compound: Heroin. You could buy two vials for $1.50 from Sears, complete with carrying case and dosage instructions for children!

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Heroin advertisement from p. 377 the November 1899 issue of the New York Lancet, accessed at Wikipedia Commons.

Paul Ehrlich was playing around with dye stains when he stumbled upon the inspiration for a chemotherapy treatment for syphilis that would eventually be known as Salvarsan. He and his assistant, Sahachirō Hata, introduced their “magic bullet” to the world in 1909. It was an actual medicine with laboratory-tested results, and really the importance of this fact cannot be overstated. There was no other treatment for syphilis at this time. (And masturbation was discouraged in the strongest moral terms. See more on syphilis in historical romance—or, really, the lack of it.) The administration of Salvarsan was technically complicated and cumbersome, though, and the disease had to be caught in time. Ehrlich had wanted to discover a “magic bullet” for what ailed us, but nothing was that simple. Eventually, post-Gilded Age, sulfa drugs were introduced (1930s) and penicillin and other antibiotics shortly thereafter, but old habits of calomel and bloodletting died harder than they should have.

Modern Parallels

Opioid addiction rates are not the only modern parallels to Gilded Age medicine. We still distribute poisons that would make the merchants of mercury blush. For example, botulism bacteria produce a paralyzing substance so toxic that one teaspoon could kill as many as a million people. You know it as Botox, a medically recognized treatment for Cerebral Palsy and chronic migraines. Or you might have it injected into your face to smooth your wrinkles. No judgment.

Progress is not always a straight line. Leeches and maggots are making a comeback—raised in sterile conditions, fortunately, and shipped to an intensive care unit near you. The leech releases an enzyme that keeps blood vessels open, which is essential in reattachment surgery particularly in fingers and toes. Maggots are good for recurring ulcers of the skin caused by drug-resistant infections like MRSA. Maggots only eat dead tissue—as long as you get the right type—and also release an enzyme that promotes healing. And even bloodletting, or phlebotomy therapy, may be used today for specific diseases of overproduction of red and white blood cells and excess iron.

The medicine of World War I is also making a comeback. Bacteriophages are viruses that destroy bacteria. Honestly, they look like creepy spiders from a horror movie. They are hard to keep alive in transport—which is why they were tossed aside when antibiotics were discovered—but in an era of resistant superbugs, they may be the answer.

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Microscopic images of nanostructural and biological bacteriophages, courtesy of Wikipedia Commons.

My father is now retired from stitching up humans and stuffed animals. There are many talented, highly-trained, and impressive women and men who have taken his place. This Thanksgiving I am grateful for them all, from emergency room nurses to the scientists behind messenger RNA vaccine development. But if this somewhat sordid tour of medical history has taught us anything, it is this: whether you are doctor or patient, teacher or student, we need to keep in mind the wise words of 12th-century rabbi, scientist, and physician Maimonides: “Teach thy tongue to say ‘I do not know,’ and thou shalt progress.”

Even Maimonides should have trained his tongue better. After all, he believed in bloodletting.

Further Reading

Want to know more about the history of medicine? I used a collection of podcasts introduced in my previous post, and I cannot recommend them highly enough! For more on sex education manuals of the time, check out my random sampling.

More Medical Advertisements from the gilded age
Allison-operating-table-fishnet-stockings
I just could not help including this. It is the Allison “operating” table, as advertised on page 352 in the New York Lancet. Maybe they’re going to try the tobacco smoke enema?
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Bisedia advertisement from a 1908 edition of the Lancet. The compound included bismuth, “Pepsina liquida” (“a palatable, standardized solution of gastric juice from the pig”), morphine hydrochloride, hydrocyanic acid, and tincture of nux vomica (strychnine). Yikes, please don’t take this.
Glyco-Heroin-Smith-Lancet
Want more heroin? This advertisement was in the 1908 volume of The Lancet. Notice the dosing for children.
Allenburys-Cocaine-Throat-Pastilles
Cocaine drops, anyone? This advertisement is from the 1908 Lancet.
Antikamnia-Heroin-Lancet
Yet more heroin advertisements from the 1908 Lancet.
Valentine-Meat-Juice-Lancet
I got nothing. Also from the 1908 Lancet.

Gilded Age Ganja

By now you have heard the results of the 2016 election: marijuana won. Well, at least in four states. California, Maine, Massachusetts, and Nevada legalized recreational use. Also, Arkansas, Florida, and North Dakota legalized certain medical uses. You can see which way the smoke is blowing. Maine’s marijuana question passed by less than one percent of the vote, but that ambivalence does not express the sea-change in American attitudes towards pot. According to the Washington Post, more than 1 in 5 Americans now “now live in states where the recreational use of marijuana is, or soon will be, legal.”

But how long has it been illegal? Would it surprise you to know only 80 years, since 1937? In fact, would it surprise you know that during the colonial era, cannabis was not only legal but—in 1619— required of all farmers in Virginia to plant? And that cannabis served as legal tender in Virginia, Pennsylvania, and Maryland? This may be stretching the truth a little, but only a little. I am conflating two strains of plants: hemp and marijuana. What is the difference? Well, both are the same species—cannabis sativa—but marijuana has significantly higher levels of the intoxicant delta-9-tetrahydrocannabinol (THC). However, until recently, hemp has been more commercially productive. Its strong fibers can be used for rope, paper, textiles, plastic, food, biofuel, and animal feed.

In the colonial era, it was cordage and textile uses that made cannabis so versatile. Not that people throughout history did not know of the more recreational properties, of course. Throughout Asia and Europe, cannabis was used for pain relief, spiritual escapes, and a nice little high after work. But we do not need to go that far back. After all, this blog focuses on the Gilded Age at the turn of the twentieth century—and this is when attitudes towards marijuana changed.

An advertisement for Dr. James's cannabis tonic, courtesy of The Library of Congress.
An advertisement for Dr. James’s cannabis tonic, courtesy of The Library of Congress.

You see, in the Edwardian era, cannabis was legal. That is what they called it, too: cannabis. Or, if one wanted to be a little more flash: Indian hemp, ganja, or (in a more potent preparation) hashish. One of the most popular Edwardian uses for cannabis was as a foot soak for corns. But it was also sold as a cure for consumption, bronchitis, asthma, veterinary indigestion, and simple coughs. It was not until 1906 that over-the-counter products had to declare any cannabis on their labels, but before then any number of “remedies” could have given a nice tipple.

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Keep in mind that this was also the era when cocaine was sold for toothaches, heroin was advertised in medical journals, and tincture of opium (laudanum) was packed in doses for infants. So, there was that.

A smattering of Edwardian remedies, courtesy of The Telegraph, ProCon.org, and Wikimedia Commons.
A smattering of Edwardian remedies, courtesy of The Telegraph, ProCon.org, and Wikimedia Commons.

At this point, cannabis customers considered themselves more “cosmopolitan” than the average drug user. Some men believed cannabis to be a female aphrodisiac: “It is just the thing to rouse the wild demimondaine instinct that lurks in the back of the heads of some romantic girls.” A more broadminded pot philosopher said: “It has been contended by an astute philosopher that true happiness will only be possible when time and space are abolished. Well, this is what hashish temporarily accomplishes.”

Hemp had its partisans, too. At the turn of the twentieth century, there was a worldwide shortage of naval cordage. When the United States took the Philippines as a colony, they found a local substitute: abaca, or Manila hemp. This is an entirely different species—a type of banana plant, actually—but its fibers were similar to cannabis sativa. This was the only export of the Philippines that the American colonial government allowed to be freely traded, as long as it was sold only to the States. (Later, during World War II, another hemp shortage so threatened the naval war effort that the government handed out seeds and gave draft deferments for farmers willing to grow it. They even made a film called “Hemp for Victory.”) The problem for Mr. Hemp, though, was that his cousin ruined the party, at least in the United States.

If everyone was so happy with their cannabis—both plants—in the Edwardian era, what happened? The 1910 Mexican Revolution! Um, what? No, really. The unrest south of the border sent large numbers of refugees into the United States. Cue the xenophobic backlash. What better evidence of the insidious social ills brought by these new immigrants than a dangerous new drug that turned American children into imbeciles?

A 1922 diatribe against the evils of marijuana in the Ogden Standard-Examiner, courtesy of The Library of Congress. That is a pretty risqué illustration.
A 1922 diatribe against the evils of marijuana in the Ogden Standard-Examiner, courtesy of The Library of Congress. That is a pretty risqué illustration.

That is when the name of the intoxicant changed. It was no longer cannabis, or Indian hemp, or ganja. It was marijuana—an Anglicization of the Latin American term marihuana, which itself came from either Chinese immigrants, Angolan slaves, or just a spontaneous combination of Maria and Juana. We don’t really know. The point was to portray the drug as something new, something wicked, something “loco” that would cause “incurable insanity.” The delivery system used by Mexicans—smoking—was evidence of this distinction.

One newspaper account said:

After three or four puffs the beginner’s mind becomes confused. There is, at first, a harmless sort of mental exhilaration. All the worries and sordidness in the user’s life fade away. He finds himself floating through space as if on a cloud and doing everything, in fancy, that he ever wanted to do….Then comes a period in which hallucinations dominate the addict. Motive-less merriment or maudlin emotion usually follows, after which a pugnacious attitude ensues.

Pugnacious? Yep. Others agreed. They said that marijuana was “more ruinous in its effects than cocaine, heroin, opium, morphine, or any of the others.” Another suggests curing a marijuana addiction with cocaine, which he believes is less habit-forming. It may be true that the drug then was not the same as the drug today, but racism was also a factor, at least in the late 1910s and the 1920s. The irony is that Mexico banned marijuana in 1920—17 years before the United States—and yet Americans still blamed the “infection” on them. For example, a Mohave County sheriff wrote up a public account of a run-in he had with a “bad Mexican,” a man appropriately named Marijuana for the substance that he sold. This kind of tale filled the papers.

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Learn more about medical history from my favorite podcasts.

But the anti-marijuana movement really gained traction in the Great Depression. This may be because this is when the drug became more popular with white Americans, or it may be because of the breakdown in social norms that came with high unemployment and population dispersal. And then a movie called Reefer Madness hit the screens in 1936. In the movie, a group of young smokers see their enjoyable evening go from casual fun to promiscuous sex to crushing depression to suicide. Within a year, the Marijuana Tax Act was passed, “restricting possession of the drug to individuals who paid an excise tax for certain authorized medical and industrial uses” (PBS).

That’s not the same thing as totally illegal, right? It took the conservative backlash of the 1970s and 1980s to do that. But maybe we have come full circle to the Summer of Love—or, as the case may be, to the Winter of Love. But, who knows? Pot is still illegal under federal law, and though the Obama administration adopted a policy of noninterference with the states in 2013, President-Elect Donald Trump might not feel the same way. As a boarding school teacher in Massachusetts, I am not terribly excited about the idea of patrolling dorms in a pot-accessible state. But maybe I will buy some for my mother for her corns…

(Featured image is an ad for Pico’s cough remedy, courtesy of the Library of Congress.)