On April 5, 1797, Elizabeth DeWitt penned a letter to her father, presumably located in Europe at the time. In this letter, she referenced “the ill state of health of [her] friends” and let her father know that in the states, “a great many people die of different disorders the most common [being] pleurisy…” (“Letter from Elizabeth DeWitt to her father”). Pleurisy is defined as “a condition in which the pleura – two large, thin layers of tissue that separate your lungs from your chest wall – becomes inflamed” (“Pleurisy”). This condition causes difficulty breathing and chest pain, but in the modern era, it is not life-threatening with timely diagnosis and proper treatment. Pleurisy is a condition caused by underlying disorders, most often an infection of some sort. According to Mayo Clinic’s entry on “Pleurisy,” the condition can be caused by “viral infection, such as the flu (influenza); bacterial infection, such as pneumonia… [and] Tuberculosis (TB),” to name a few. So, why is it that during the 18th century, people were commonly dying from this secondary disorder? To answer that question, one must first understand the medicinal beliefs and practices of the 18th century.
Prior to the 18th century, the prevailing theory on how disease was contracted and spread was based on a miasmic, humoral model: “traditional theory held that disease was caused by bad air, a miasma that upset the balance of humors” (Breslaw 29). It was not until 1721 that this theory was challenged by a Cotton Mather, who believed that “’little animals’ that existed in pus from smallpox victims had something to do with causing the contagion” (29). Mather was a revolutionary thinker in this regard, as he took his theory further and “also suggested that the eggs from that ‘animicular’ matter could invade the body through the pores or the mouth” (29). In the present-day, we can recognize that Mather was referring to microscopic organisms called viruses spreading through droplets in the air. While Mather was taking a different approach to the causes and treatment of illness, other diseases were still being treated with outdated methods. When measles epidemics affected communities, “doctors followed the usual regime of bleeding, vomiting, and purging, which probably increased the danger of death” (39). Methods of purging could involve “laxatives… [which] could leach nutrients and electrolytes from the body,” or “calomel (a combination of mercury and chloride)” which is now an ingredient in “insecticide and fungicide” (46). While bloodletting could have had medicinal properties – “by lowering the availability of iron in the blood, some pathogens lose their ability to grow and multiply” – such a practice hardly helped treat the disorders it was typically used for, such as “smallpox, yellow fever, [or] pneumonia” (46-47). Moreover, physicians relied more on their perceived ability than any other tool they might have had at their disposal. Even if a physician’s methods caused 80% of his patients to become seriously injured or to die, “the doctor was considered successful if he seemingly cured one person” (47). This way of practicing medicine is harmful to patients at any time. If a doctor is unwilling to explore other options when their treatment methods are outdated, harmful, or outright dangerous, then patients cannot get adequate and informed care. Physicians were put on a pedestal, patients “[endowing] their medical practitioners with enormous authority” (47). Additionally, it was much more difficult to diagnose illness in the 18th century than it is now. Typically:
Diagnoses were generally based on symptoms as described by the patient. The doctor seldom touched the patient except to take a pulse or check for fever and thus was dependent on how individuals described their pains or discomforts. He would then diagnose a flux as anything from simple diarrhea, to dysentery, typhoid, or typhus… A pleurisy referred to respiratory or lung diseases such [as] influenza or pneumonia. (45-46)
This is a significant contrast to methods of diagnosing illnesses and disorders today. According to Noah Webster’s “A Brief History of Epidemic and Pestilential Diseases…” published in 1799, “in periods when plague and other mortal epidemics rage in summer, the diseases of winter assume new symptoms. The pleurisy, at such times, has often become epidemic and even infectious” (331). Based on the methods of diagnosis during this time, it can be presumed that the “epidemic” or “infectious” pleurisy being referenced was a respiratory disease, such as influenza. It is possible misdiagnoses or missed diagnoses were more common during the 18th century due first to a misunderstanding of illness, which was then compounded by the lack of reliable diagnostic tools. Physicians during this time did not believe, and often rejected, notions that “science [or] technology had any application to medicine” (47). For example, even though a “very primitive form” of the thermometer was available during the 18th century, physicians did not use them until “at least… the middle of the nineteenth century” (47). Diagnosing “pleurisy” or any other respiratory illness would not have been able to be done accurately during the 18th century, undoubtedly resulting in the deaths of “a great many people” Elizabeth DeWitt would come to write about in the letter to her father.
In the present-day United States, “we have antibiotics to cure contagious diseases and vaccines to prevent them” (Breslaw 1). In the 18th century, this was most certainly not the case. Elizabeth DeWitt lived in the states at a time that medicine was not making many strides. Outdated thinking and a refusal to be open to new or improved methods of treatment prevented advancement. Doctors not having reliable and consistent methods of treatment meant that they believed “diseases were peculiar to individuals; each individual required different medications or combinations and depended on the physician’s special understanding of illness” (48). Rather than recognizing that a standard approach would probably be best for the patient, physicians rejected newer ideas or modes of treatment “in favor of established practices” (44). People were exposed to illnesses and diseases that they had no experience with in their homeland, they then relied on the authority of physicians who were not open to new ideas – even if those new ideas could prevent injury or death – and, due to a lack of understanding by the general public, patients took their doctors at their word and did not question their diagnoses or treatment methods. When one takes these facts into consideration, it is not difficult to understand why people were dying due to secondary disorders such as pleurisy. It is possible that these people were afflicted with such infections as influenza, pneumonia, or tuberculosis, but received improper or incorrect treatment, leading to the development of the aforementioned condition. However, it is also possible that when Elizabeth DeWitt mentioned “pleurisy,” she was not referring to the inflammation of tissues within the lungs at all but was rather referring to an epidemic caused by influenza, the measles, or any of the other contagious respiratory diseases that afflicted communities. Thinking about the medicinal practices of the 18thcentury can help us to understand the conditions of individuals living during these times.
Breslaw, Elaine G. Lotions, Potions, Pills, and Magic Health Care in Early America. New York Univ. Press, 2014.
“Letter from Elizabeth DeWitt to her father,” Hudson River Valley Heritage Exhibits, accessed November 22, 2021, https://omeka.hrvh.org/items/show/2908.
“Pleurisy.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 3 Jan. 2020, https://www.mayoclinic.org/diseases-conditions/pleurisy/symptoms-causes/syc-20351863.
Webster, Noah. A Brief History of Epidemic and Pestilential Diseases: With the Principal Phenomena of the Physical World, which Precede and Accompany Them, and Observations Deduced from the Facts Stated …. United States, Hudson & Goodwin, 1799.