Editor’s note: Mark Bushnell is a Vermont journalist and historian. He is the author of “Hidden History of Vermont” and “It Happened in Vermont.”
[J]oseph Gallup was looking for answers. He had witnessed wave after wave of diseases wash across Vermont, killing hundreds and sometimes thousands of people each year. He and his fellow physicians had been almost powerless to stop the epidemics.
In 1815, after a particularly deadly run of outbreaks, Gallup published Epidemic Diseases in Vermont. He wrote the book, he explains in the introduction, “first, because nothing is more needed; and secondly, because the subject has been neglected by those better qualified.” Gallup was being humble. He was one of early Vermont’s most prominent doctors.
The book makes for chilling reading. In it, Gallup pours out his knowledge of the diseases that ravaged Vermont. His account is roughly chronological in that he catalogued the outbreaks by years. But within each section, the information he provides is scattered and far from complete, much like the understanding Gallup and his contemporaries had of disease.
In 1798, Gallup reports, dysentery hit eastern Vermont hard. The term “dysentery” covered a variety of ailments marked by painful and bloody diarrhea. That year, it killed 17 in the Pomfret area over the course of two months, 10 to 12 near Bethel and another 30 in Norwich, he writes.
Then Gallup struggles to deduce what might have caused the dysentery. This outbreak occurred during a drought, he writes, but then adds that dysentery often arises when there is no drought. He wonders why it struck equally in places that were low and boggy and those that were hilly and dry. His line of inquiry is understandable: doctors at the time believed that topography and microclimates played a large role in disease.
In discussing other epidemics in his book, he mentions the appearance of a comet coinciding with particular outbreaks. But apparently people saw no comet in 1798 that could have been a contributing factor.
Gallup then looks for clues in the facts surrounding a dysentery epidemic that hit Connecticut the same year. “It is said to have been caused by miasmata from stagnant water, or the overflowing of the meadows by a previous freshet (minor flooding),” he writes. By “miasmata,” Gallup refers to air vapors that his contemporaries believed spread disease.
The understanding of Western doctors had changed slowly over time. Many physicians like Gallup still believed that disease was caused by miasma, invisible substances in the air that occurred in wet or dirty places, or were passed from person to person in noxious vapors called effluvia. The miasma theory had changed little since the ancient Greeks developed it.
But by Gallup’s time, a century of doctors had moved past another ancient Greek medical theory – that health was determined by the interplay of “the four humors”: blood, phlegm, yellow bile and black bile – but not very far past it.
Under that theory, each humor had two qualities: one of temperature, the other of moisture. Blood, for example, represented heat and wetness; black bile was characterized by coldness and dryness. A doctor’s job was to keep these humors in balance, thereby keeping their patients healthy.
Beginning in about 1700, however, doctors began to believe disease could also be caused by the condition of a patient’s blood vessels and nerves, which they viewed as passageways that had to be maintained in proper tone. A healthy patient was one through whom blood, sweat, urine and feces would pass or circulate easily, though not too easily.
By Gallup’s time, doctors viewed the human body much like a fire they were trying to keep stoked to the right temperature. If, for example, a patient had a fast pulse and fever, doctors assumed their system was burning too hot, the result of having breathed some miasma or effluvia. So doctors would try to purge the patient’s body. They did this primarily by administering enemas (which acted as strong laxatives) and emetics (which caused vomiting). Doctors coupled this treatment with narcotics that calmed the patient.
Feverish patients were also denied meat and other foods that doctors feared would only feed the metaphorical fire burning inside the patient and therefore increase inflammation. In contrast, patients with colds, whom doctors thought needed to raise their temperatures, were fed red meat. Laypeople remembered these opposing treatments by memorizing the phrase “feed a cold, starve a fever.”
Another popular treatment for a feverish, and thus overactive, system was bleeding, which doctors believed reduced pressure on the blood vessels.
In 1813, an epidemic of epidemics hit Vermont. Gallup reports widespread cases of patients with symptoms consistent with what we would call influenza, pneumonia, typhus and meningitis. He doesn’t use those terms. His book is full of now-antiquated names for diseases that sometimes take in complaints we classify as separate ailments. He refers frequently to “spotted fever,” a phrase covering either meningitis or typhus.
Often Gallup doesn’t even try to assign a name to an illness. He just records the symptoms and explains how he tried to treat them. Like his colleagues, Gallup found the most effective tricks in his medical bag to treat severe maladies involved purgative medicines and regular bleedings.
Writing of an 1813 outbreak of what might have been typhus, Gallup advises his readers that “greater diligence was necessary to counteract its fatal tendency. The application ought to be earlier made; more external warmth and I think I am right in saying more blood will need to be lost, in the course of the disease, under proper restrictions, to ensure a favourable issue.”
Gallup can’t be accused of prescribing cures he was unwilling to take. That year, he writes, “I was severely attacked myself.” Though he fails to say even what his symptoms were. “It was not until four full bleedings were practiced that I gained tolerable ease,” he reports.
Understandably, Gallup and others took comfort in any treatment that showed promise, because so many of their neighbors were dying of disease that year. Based on reports he had received from other towns, he estimates that during the five worst months of 1813 roughly 6,400 people – including 750 soldiers stationed in Burlington to defend the city against the British – died in epidemics.
Despite what we would regard as the rudimentary medicine practiced by doctors like Gallup, their patients had faith in them, and for good reason. According to one study, as many as 96 percent of patients treated by doctors during Gallup’s day eventually recovered. Although that was almost entirely due to the body’s recuperative powers, doctors and patients understandably gave credit to their medical treatment.
It is easy to look back 200 years at doctors like Joseph Gallup and mock the medicine they practiced. Perhaps it is fairer, however, to glimpse Gallup and marvel not at what they didn’t know then, but how much we have learned since. And how much more we may have yet to learn.
