Healthcare During Lucy's Lifetime

Life was fragile and fleeting during Lucy’s lifetime and good health was treasured. Diseases like smallpox, and malaria made it difficult to predict with certainty that you would wake alive and well to enjoy another day. Life in rural Albemarle County was fraught with the physical challenges and accidents associated with carving farms out of undeveloped land. The birth of the Nation itself with its associated wars and its territorial expansion, which stimulated travel over rugged terrain, also contributed to morbidity and mortality. Lucy’s first husband Lieutenant William Lewis died of pneumonia after falling in the Rivanna River on his way back to join the Continental Line, his American Revolutionary War unit. Her second husband Captain John Marks had to resign from the military in 1781 because of poor health. The personal correspondence of individuals who lived during Lucy’s years was filled with information and questions about the health and welfare of family and loved ones. These were not idle inquiries. Life expectancy was very different during Lucy’s lifetime from what is today. According to a 1789 survey of individuals who lived in some sixty Massachusetts and New Hampshire towns, the average life span for men was 34.5 years and two years longer for women (Shryock, p. 108). There are few complete eighteenth century life expectancy and healthcare statistics available, but even allowing for regional variations in epidemics; there is no reason to believe that Albemarle County residents fared much better. However, as can be seen in the genealogical chart many members of the Lewis - Meriwether clans seem to have enjoyed a longer life than the general population, including Lucy herself who was 85 years old when she died.

The purpose of this essay is to describe how healthcare was provided in Lucy’s day. I have highlighted the roles of individual practitioners and associated institutions, as well as the philosophy and beliefs in vogue that shaped medical practice. Particular attention is given to medications employed, especially remedies derived from native medicinal plants that Lucy might have used. A chart comparing some nineteenth century herbal remedies with today’s over-the-counter medicines for common ailments provides a practical perspective. Lastly, I have included Dr. Todd Savitt’s essay describing care in 1840 for a white individual living in antebellum Virginia.

Hospitals and Physicians

Compared with the services we enjoy today, the 18th-century healthcare system was rudimentary at best. Care was provided at home. A knowledgeable family member or overseer or member of the community cared for the sick. A temporary Army hospital was created in 1781 for sick and wounded Revolutionary soldiers in Charlottesville (Blanton, p. 281), but not until more than fifty years after Lucy’s death was there a hospital serving the general population in Albemarle County. In 1886 the Piedmont Hospital, formerly known as The Cottage, was established in Charlottesville (Lay, p. 276). Some physicians who owned plantations maintained a doctor’s office on their property. Lucy’s nephew, Dr. Thomas Walker Meriwether (b.1803 – d.1863) was among these – his office remains today at “Clover Fields,” Lucy’s birthplace (Lay, p. 216).

For most of Lucy’s life, doctors were few and far between. Those who did exist practiced in cities and towns. The majority were trained through an apprenticeship with a practicing local physician, sometimes a family member. Between 14 and 18 years of age, a young man would begin his apprenticeship for three to seven years of indentured service, during which he would have access to the doctor’s library, learn about the preparation of drugs and specific medical procedures and accompany the master physician on patient visits (Blanton, p. 76). The first medical school in America opened in 1765 as the College of Philadelphia, which became the University of Pennsylvania in 1779 (University of Pennsylvania On-line Archive). Although the College of William and Mary established a graduate program of law and medicine in 1779 to support preliminary medical education, the first Virginian medical school opened at the University of Virginia in 1825, (Blanton, p.75). Young men from well-born Virginia families were often sent to Europe for medical training, with many completing their education at the University of Edinburgh, which was regarded as one of the centers of medicine in the world at that time (Ackerknecht, p.220).

Lucy’s family included a number of trained physicians, some formally schooled and others through apprenticeships. Dr. Thomas Walker, who cared for Thomas Jefferson’s father Peter, was Lucy’s uncle through marriage. He studied under Dr. George Gilmer of Williamsburg, who was a graduate of the University of Edinburgh. His son Dr. George Gilmer, Jr. (b. 1742 – d. 1795), one of the most prominent physicians in Albemarle County, cared for those who lived at Monticello and Montpelier (Speed, p. 49). He married Lucy’s cousin, Lucy Walker and lived at “Pen Park,” just 6 miles from Locust Hill. Lucy’s brother Francis Meriwether studied medicine at the College of William and Mary before moving to Georgia where he cared for the transplanted Albemarle community along the Broad River. John Hastings Marks, Lucy’s youngest son, received some medical training in Philadelphia and perhaps at the College of William and Mary, but it is not known if he completed his training and established a medical practice. Additional family member physicians include Dr. Thomas Walker Meriwether (“Clover Hill”) – Lucy’s nephew and Dr. Mann Page (“Keswick”) – a first cousin. Lest you think that physicians were widely available, in 1835, just two years before Lucy’s death only six physicians served Charlottesville town (Lay, p. 215).

There was a pecking order within the community of trained providers, especially those trained and found in Europe. Physicians, who mostly focused on what we would call today internal medicine, were held in the highest esteem. Barber-surgeons who provided surgical and dental services were ranked below physicians. On the bottom rung of the prestige ladder were midwives who delivered most of the obstetrical care, women who nursed their families, and slave “root doctors”. By the late 18th century, however, physicians began to expand their practices to include both obstetrical and surgical services, no doubt driven by the rural nature of his practice and a scarcity of healthcare practitioners. In 1769 in the Virginia Gazette, Dr. George Gilmer Jr. announced his intent to pursue the practice of medicine along with the art of midwifery (Blanton, p. 23).

Nonetheless, physicians were the choice of last resort for most Albemarle families, especially early in Lucy’s lifetime. Doctors’ fees were expensive and there was a general distrust of their so-called “heroic” methods, which included the copious use of bleeding and blistering along with powerful and sometimes toxic drugs intended to restore the body’s humoral balance by, for example, purging the gastrointestinal tract and inducing perspiration. Thomas Jefferson was extremely skeptical of physician care, observing that “nature and kind nursing save a much greater proportion …and with less abuse” (Holmes, p. 22). Many patients became worse or even died from the doctor’s treatment, thereby encouraging people to self-treat with more natural remedies and smaller doses. Samuel Thomson (b. 1769 – d. 1843) of New Hampshire was a “root and herb doctor” without a medical degree, who developed a botanic system which encouraged every man to be his own doctor. He eschewed bleeding, blistering and the administration of poisons like opium and mercury, instead relying on “simples” created from roots and plants to “promote digestion and aid nature” (Simillie, p. 195-6). Thomson had a genius for organization and business. He successfully patented his remedies and marketed them around the country, including Virginia. Thomsonianism appealed to Virginians who were disillusioned with “regular” physicians’ expensive and ineffective treatments, though even Thomsonian remedies included harsh steam baths and emetics like lobelia inflata (Savitt, p. 168).

Midwives and Plantation Mistresses

Childbirth, though a natural phenomenon, was the most recurrent event that required additional medical assistance, most of which was delivered by female midwives. Childbirth was a highly risky affair that accounted for much of the ill-health and mortality among women (Shryock, p. 92). Women were often pregnant every eighteen to twenty four months because, other than abstinence, contraception was non-existent. Large families were expected and necessary to populate the growing Nation. You will see this was very much the case for Lucy’s family and her neighbors as detailed in the family genealogical and neighbors’ charts. Many families had 10 and 12 children. Midwifery was one of the earliest components of the healthcare system that supported families across rural America (Ulrich, p. 33). Just as was true of physicians, midwives possessed a variety of skills, though formal midwife apprenticeships were uncommon and there was no higher education available (Shryock, p. 4). However, midwives did not practice alone. They relied on the assistance of neighbors and family members during childbirth, and often turned to women like Lucy who had earned a reputation for medical skill within their community.

The plantation mistress served as doctor and nurse for all who lived on the farm by assuming responsibility for most healthcare-related activities such as growing, harvesting, preparing and administering homemade medicines and providing nursing care to the sick (Clinton, p. 143). Interestingly, Lucy may have learned some of these skills from her father, Thomas Meriwether, who was known as a “healer” (Gilmer). For women, healthcare responsibilities added significant work to what was already a daunting list of household chores. Being prepared for a wide range of life threatening and common illnesses and accidents was essential to the family’s welfare. Medicinal plant remedies were prepared according to family and popular folk recipes and augmented by commercial drugs purchased from apothecaries or country stores. Every plantation had a garden that included plants thought to have healing qualities. We assume that Lucy grew medicinal plants in her garden at Locust Hill as she was celebrated as a “yarb (herb) doctor. She likely gathered plants in the wild as well. It is believed that she passed her knowledge of healing plants on to her son Captain Meriwether Lewis, who then used them in the care of his sick soldiers (Bakeless, p. 16). Historian Gary Moulton observes in his Herbarium of the Lewis and Clark Expedition that every naturalist must have had instruction about the medical properties of plants and Lewis was fortunate to have seen Lucy “prescribe and dispense simple vegetable drugs to ailing friends, families and neighbors” (p. 1). Her son Reuben Lewis was also referred to as a “doctor,” but there is no evidence that he received formal or informal medical training, so he may have learned “healer” skills from Lucy. We imagine that both of Lucy’s daughters, Jane Lewis Anderson and Mary Garland Marks Moore learned these skills from their mother, especially Jane with whom Lucy lived the longest. Sadly, there are few eighteenth century and early nineteenth century documents written by or about women healers.

Medicines and Apothecaries

 

Among early Albemarle settlers, religious belief helped inform the application of herbs and roots to maintain or restore health. In his popular Gunn’s Domestic Medicine or Poor Man’s Friend, a reference published in 1830 and displayed at this exhibit. Dr. John Gunn wrote: “Our wise and beneficent CREATOR has placed within the reach of his feeble creature man, herbs and plants for the cure of all diseases but old age, could we but obtain knowledge of their real uses and intrinsic virtues” (p. 161-62). According to the “Doctrine of Signatures,” God had marked plants in a manner to signify their healing purposes. Thus many ‘worts’ - plants used for medicine – were named after an organ they resembled (liverwort, lungwort,) or a disease they treated (toothwort and lousewort). Interest in finding the right ‘materia medica’ to cure devastating diseases, as well as the hope of making a fortune from such a find, fueled numerous botanical expeditions.

 

America’s first native-born botanist, John Bartram (1699 -1777) of Philadelphia, collected American specimens for London’s Quaker merchant Peter Collinson (Minter, p. 18). Colonial settlers imported medicinal plants and roots used in their country of origin and augmented them with indigenous plants whose healing properties were learned from American Indians as well as captive Africans. There were a number of popular self-care hand books that set forth methods for harvest, preparation, delivery and doses of herbal medicines. One of these was John Tennent’s, Every Man his Own Doctor or The Poor Planter’s Physician published in 1736 and another was The Family Nurse or Companion of The American Frugal Housewife published by Mrs. Lydia Child in 1837. Medicinal recipes were routinely published in newspapers and, by the end of Lucy’s lifetime; a growing pharmaceutical industry had begun to take hold. Family medicinal recipes were treasured and handed down from one generation to the next. Unfortunately, we believe that none of Lucy’s recipes survived because of the fire that destroyed “Locust Hill,” the year after she died.

 

While many medicines could be home-grown or collected in the wild, others had to be purchased. Mercurous chloride, (called calomel), castor oil, ipecac, quinine jalap (a Mexican purgative from the tuberous roots of Ipomoea) as well as laudanum, opium, camphor, all had to be purchased along with essential implements like lancets, scales, mortars and pestles, syringes, blister powders and cupping instruments, to name only a few (Savitt, p. 155). For the most part apothecary shops or drug stores were found in large towns and cities. The Pasteur & Galt Apothecary Shop opened in Williamsburg in 1759. Hugh Mercer’s 1760 Apothecary was located in Fredericksburg and in 1791 Dr. Elisha Hall opened Bonds Drug Store in the same town (Blanton, p. 41). Either of these apothecary shops may have sold medicaments to Lucy since Fredericksburg on the Rappahannock River was a port town to which Lucy may have sent her tobacco and other crops for sale. Both Mercer’s Apothecary in Fredericksburg and Pasteur and Galt’s in Williamsburg can be visited today as museums. Although no physician’s prescription was required to purchase medications, many physicians controlled and sold medications out of their practices. In 1780, for example, Dr. George Gilmer Jr., advertised a list of medications available for purchase in his Charlottesville office (Blanton, p. 28). General stores also carried remedies and medical equipment. Lucy might have shopped for medical supplies in Charlottesville stores. Her grandson-in-law, Benjamin Wood opened a store in Ivy (see map) – the first in the Locust Hill neighborhood - sometime before he died in 1876 (Ivy Depot Film Project Website). Among well-born Virginians, medicine or “physic” chests were a popular way of both organizing and transporting medications. Thomas Jefferson had a physic chest in his bedroom at Monticello.

19th Century Remedies Compared to Those in Your Medicine Cabinet

The purpose of the chart below is to provide some examples of medications for common ailments or for first aid treatments that Lucy might have used. Unlike today’s over-the-counter remedies which come pre-packed, Lucy would have had to prepare her plant medicines according to her personal recipes. The chart is not comprehensive but a sampling of early 19 Century treatments. Plants in bold-face type are linked to this website’s Gallery pages where you can find the plant’s portrait, information about its historical uses and recent research into its pharmacological properties. Three main sources were used for this chart: Every Man His Own Doctor or The Poor Planter’s Physician, 1736; The Domestic Physician and Family Assistant, 1836; and The Family Nurse, 1837. The details for each reference can be found in the exhibit bibliography. Please note, this chart is provided for historic interest only and should not be considered safe or recommended for personal use.

Medical Intervention	19c Physic Chest	Your Medicine Cabinet
First Aid Kit
Bandages for injuries	Clean rags or cloth	Sterile band-aids and gauze
Cuts and sores	- Black oak bark decoction - Gilead tree leaf buds in rum - Mullein leaves moistened in hot water - Wormwood decoction	Antiseptic solutions and antibiotic ointments
Itching	- Reduced crushed poke weed berry juice, simmered with lard - Bruised plantain leaves	- Antihistamine cream or pills - Calamine lotion
Muscle sprains and strains	- Essence of wormwood or bruised green leaves applied - Milkweed root decoction - Cold water, then a poultice of clay and strong vinegar, allowed to dry	- Anti-inflammatory over-the-counter medications like aspirin and non-steroidal drugs - Ace bandage - Ice pack
Stings	Common clay moistened with water	- Antihistamine cream - Calamine lotion
Common Ailments	19c Physic Chest	Today’s Home Medicine Cabinet
Cathartic (accelerates defecation)	- Castor oil (mild cathartic) - Butterfly weed decoction in large doses - May apple root decoction	- Enema - Metamucil
Cold	Anderson’s Pills (composed of aloes, jalap and oil of aniseed)	Decongestant and antihistamine medication
Cough	- Ground ivy tea sweetened with syrup of horehound - Butterfly weed decoction for expectoration	Cough suppressant and expectorant
Diarrhea	- Cranesbill or spotted geranium root decoction or powdered - Flax seed tea - Mullein leaf decoction	Pepto Bismol Imodium
Emetic (induces vomiting)	- Boneset or Thoroughwort infusion - Buck bean tonic - Warm horehound infusion	Ipecac syrup
Fever	- Sumac berry infusion - Balm infusion	Tylenol, aspirin, non-steroidal anti-inflammatory medication
Headache	- Sage leaf infusion - Burdock leaves	Tylenol, aspirin, non-steroidal anti-inflammatory medication
Hemorrhoids	- Slippery elm bark decoction - Chicory infusion - Sassafras bark infusion	- Preparation-H - Zinc oxide ointment
Indigestion	- Ground ginger infusion - Mustard seeds - Sage tea - Chew sassafras bark	- Pepto Bismol - Milk of magnesia
Laxative	- Mustard seeds in molasses or softened in hot water - White pine tree bark decoction - Manna - Rhubarb	Milk of magnesia
Menstrual cramps	The root of blood root	Tylenol, aspirin, non-steroidal anti-inflammatory medication
Nausea	Peppermint essence in hot water	Clear rehydration liquids such as Gatorade
Pain	- Opium - Laudanum	Tylenol, aspirin, non-steroidal anti inflammatory medication
Sore Throat	Sage tea	- Salt water gargle - Throat lozenges with local anesthetic
Swollen joint	Powdered brimstone with the juice of Jamestown weed combined with hog lard to make an ointment applied 2-3 times a day	Aspirin, non-steroidal anti- inflammatory medication
Toothache	Horse radish leaves applied to the face	Non-steroidal anti-inflammatory
Vomiting	- Virginia snake root steeped in boiling water - Spearmint infusion	Clear hydration liquids
Worms	- Carolina pink root - Juice of wormwood - Wild carrot tea - Garlic in slices made into a syrup with milk	Prescription medicines only

You now have better sense of the overall healthcare system that existed during Lucy’s lifetime, including the institutions, healthcare practitioners, and types of medications that might have been used. To understand the experience from a patient’s point of view, I encourage you to read a telling essay written by Todd L. Savitt, PhD, from the Department of Medical Humanities at The Brody School of Medicine at East Carolina University. Dr. Savitt created the essay as part of an exhibit at the Virginia Historical Society in 1991 entitled Fevers, Agues, and Cures: Medical Life in Old Virginia. The essay, which can be read at http://www.history.vt.edu/Jones/priv_hist3724/SlaveMed/sickwhite.html, describes what a healthcare experience might be like if you were white and sick in antebellum Virginia in 1840, just three years after Lucy died. The experience of West African slaves, who were found on most Albemarle County plantations and farms during Lucy’s lifetime, was similar to that of their white owners with notable differences that Christine Andreae describes in her essay on “Slave Medicine.”
 

Eileen B. Malone-Brown, RN MSN, MS