House Calls and Home Care
1861 - Domestic Event
In the early 1800s, home bedrooms
often served as sickrooms and even emergency rooms. Hospitals as we now use the
term were unknown. Perhaps separate buildings or houses might be set aside
during an epidemic or wartime for special medical use, but in normal times. North
Carolinians generally received their health care at home. Rich or poor, sick
people treated themselves or received care from a family member or neighbor
whenever possible. Only as a last resort did they call for a doctor.
Getting the doctor to the patient
wasn’t always easy—or fast. First, a messenger had to go by buggy, by horse or
on foot to find a doctor. Then the doctor had to finish caring for other
patients and make his way to the house. The sick person might wait a few hours
or several days. Some died waiting for the doctor to arrive.
In rural North Carolina, even into the early
1900s, physicians continued to see patients in their homes, traveling by buggy
or horseback with their case of instruments and medicine vials. They needed to
bring a wide range of medical skills, too. Besides diagnosing and treating
illnesses and injuries, country doctors were expected to deliver babies, set
broken bones and perform surgery.
One account of kitchen table surgery performed
by Drs. Eustace and Mary Sloop around 1917 seems incredible by today’s
standards. A 13-year-old girl in the mountains of Avery County urgently needed
kidney surgery that winter. Impassable frozen creeks delayed the doctors for
days, but they finally reached the girl’s home by horseback. They placed the girl
on a sterile sheet on the kitchen table and had her mother administer ether.
Curious neighbors and relatives pressed in close to watch and kept trying to
touch the surgical instruments. A chicken strutted in, flew up in the air and
landed on the girl’s stomach. The doctors feared the worst, but amazingly, the
girl lived. Six weeks later, she walked down the mountain to visit her doctors.
Saddlebags used by Dr. William Calvin Tompkins in rural North Carolina, 1861 to 1895.
Doctoring without a Doctor
Whether because they thought physicians were misguided, too expensive or simply too scarce, many families kept home medical kits and self-help books. One of the most popular was Gunn’s Domestic Medicine, also known as Poor Man’s Friend. First published in 1830, the book suggested anyone could and should learn the secrets of medicine rather than call a doctor.
The rise of alternative healing systems in the 1800s stemmed from and added to widespread prejudice against conventional doctors. Physicians were often criticized for their excessive use of bloodletting and calomel.
Thomsonianism was one of the most popular alternative medicine systems in North Carolina. It maintained that the stomach acted as a kind of furnace, keeping the body warm and healthy. Sickness arose when this furnace became clogged, causing the body to lose heat. To cleanse the stomach, patients took lobelia, a common herb that induces vomiting in large doses.
Another alternative system, homeopathy, was based on the idea that “like cures like.” In other words, disease can be cured by medicines that produce the same symptoms as the disease itself. Homeopathic physicians did not begin practicing in North Carolina until the mid-1800s, but some people began treating themselves with homeopathic cures before that time.
When faced with serious illness, people in the early 1800s often looked to more than one source for help, much as we do today. They might turn to conventional medicine, home remedies and alternative healing as well. They also relied on their faith in God.
A home medical kit around 1830: mortar and pestle, syringes, two lancets with case, gourd medicine vial, suture needle and thread.
Treatment or Torture?
In the 1800s, patients and doctors believed the key to good health was balance, both internally and in relation to the environment. Almost anything could throw the body out of balance: stress, the weather, puberty, childbirth, too much food or alcohol, too little exercise and work, too much blood or even too much passion. Any of these imbalances could cause disease.
To restore balance, remedies and therapies were generally designed to make the sick person bleed, sweat, vomit, urinate or defecate. For example, doctors used ipecac, a root medicine, to induce vomiting. Calomel, a powerful laxative, was a popular form of mercury that could poison the patient if given in large and frequent doses. But perhaps the remedy that seems strangest to us now is bleeding, or bloodletting.
To remove blood from a specific area, doctors carried live leeches in pewter containers. A leech would attach itself to the patient by biting through the skin and injecting an anti-clotting substance into the wound. One leech could draw up to an ounce of blood at a time. (Although leeches fell out of favor during the 20th century, the FDA approved their use as “medical devices” in 2004. Today surgeons find them valuable when regrafting amputated appendages, such as fingers and toes.)
An alternative to leeches was a scarificator, an instrument used to draw blood. Upon the release of a trigger, 13 blades shot out of the bottom of the instrument into the patient’s flesh, creating a series of cuts. The incisions were often followed by cupping, placing a heated cup on the wound to form a vacuum and suck out blood. Dry cupping without an incision was also used at times to create blisters, believed to draw disease out of the body.
Fevers called for draining large amounts of blood. People believed the patient’s flushed skin and rapid pulse signaled an excess of “vital energy” in the body. Bloodletting weakened the pulse, viewed as a sign of healing. Some doctors drained up to 30 ounces of blood at one time—almost 1/3 of an average person’s blood. In fact, bleeding was often continued until the patient nearly fainted.
Understandably, many patients had mixed feelings about doctors and their harsh methods.
Physicians used leeches to remove what they considered excess blood from part of the body.