“Dysentery has been more deadly than all the cavalry charges of history.” – James Thomas Flexner

“‘Now, John,’ he said, ‘ride for your life – that is, for your mistress’ life; there is a not a moment to lose. Give this note to Dr. White; give your horse a rest at the inn, and be back as soon as you can.'” – Anna Sewell, Black Beauty

“Dear Cecil: I recently acquired a satellite dish and have become a shameless junkie of old westerns. In half of these B movies of plains life, it seems there is always a woman giving birth. After they give her the obligatory wooden spoon to bite on, someone always yells to boil some water. What’s with the water?” Question from Ryan Bailey to Cecil Adams. http://www.straightdope.com/columns/read/1109/when-a-woman-gives-birth-in-westerns-why-do-they-always-boil-water

“…Then a rider appeared over the crest of the slope. He was so tall that his legs almost touched the ground.

‘You’re Dr. McDowell?’

The newcomer nodded. In the gap between his coonskin cap and his fur collar nothing was visible but tiny, brilliant eyes and a huge nose blue with cold…” James Thomas Flexner,  A Backwoods Galahad in Doctors on Horseback

It began, as so many projects do, with an old book. This one was Doctors on Horseback, by James Thomas Flexner and it was published in the late 1930s. The book was a series of brief biographies of the founding fathers of medicine in the USA, some of whom also played prominent roles in politics in parallel with their medical careers. “The early doctors of America fought on two frontiers,” wrote Flexner, “riding the wilderness of a new continent, they explored the mysteries of the human body.”

Bloody litigation

And they fought on other fronts; with each other, with their patients and with their critics. Benjamin Rush (1745-1813), a committed, almost evangelical supporter of blood-letting, fell into litigation with William Cobbett (the author of “Rural Rides” and many other social and political essays), when Cobbett suggested that the blood-letting favoured by Rush killed more patients than it cured. Rush was successful, winning 500 dollars in compensation and Cobbett, who had sailed to the USA as an escape from revolutionary France, left the country and returned to England.

Another famous physician, John Morgan (1735-1789), became director-general of hospitals under the American revolutionary army. His duties were onerous and he loaded himself up with more and more responsibility: “At last some more doctors arrived. Morgan did not even take a day’s holiday; driven by that abnormal energy which pulls men through impossible crises, he galloped to Fort Lee to ask General Greene about supplies for the Hackensack Hospital.”

And fell into long-standing dispute with a former classmate, William Shippen, who, according to Flexner, had been politicking behind the scenes in Philadelphia whilst Morgan was galloping about as a serving doctor on the battlefields as well as building hospitals and collecting and storing drugs and other materials for the wounded. Shippen was destined for success and honours whilst Morgan, who was destined to play the role of scapegoat in the mismanagement of medical matters, was dismissed from his post.

However, called before an investigating committee, the records, notes and affadavits Morgan had amassed resulted in his vindication. He vowed to be avenged on Shippen.  He went to great extremes to achieve this, constantly demanding that Shippen attend hearings. Shippen complained that Morgan “…cited me to attend through the deepest snow this winter, which he first broke for 200 miles, and was once dug out of a snow hill, and was once froze to his saddle…”

Snake-eye

Morgan, who was a founder of the American Philosophical Society, was fascinated by the unusual.  One curious case he cited was that of the “horse with a snake in its eye…not only possessed of mere life but endowed with a very brisk locomotive faculty”, viewing it as a possible example of spontaneous generation. He was sure that it was “a real reptile ‘which from the vivacity and briskness of its motion exceeds any worm and equals that of any kind of serpent I have ever seen.'”

Dr Ephraim McDowell, like Morgan, was a medical student in Edinburgh for a time. In the company of two fellow Kentuckians he began a showy carriage tour of the Highlands in 1793, but “the instant they admitted they were from Kentucky, all formality was thrown aside and the delighted Scots haled them out  on horseback or in a coach and exhibited them….as gentlemen from the extreme backwoods…”

It is as a pioneer of the ovariotomy that McDowell is best remembered. In December 1809 he went to the bedside of one Jane Todd Crawford who was apparently getting towards the end of a tough pregnancy but could not be induced to give birth. McDowell quickly recognised that in fact she had a tumour and that the prognosis was bad. Mrs Crawford agreed to ride the sixty miles to McDowell’s home to undergo a pioneering operation. “The operation would be similar to spaying, and animals recovered from being spayed.”

“Fifteen pounds of dirty, gelatinous substance”

As an aside, spaying of animals had been carried out for many centuries: mares included. Peter Edwards, in “Horse and Man in Early Modern England” cites the example of the “waif mare, Stagg” of Brandsby in the 17th century. However, although there had been a huge amount of discussion regarding the possibility of performing a similar operation on women who were suffering from ovarian tumours, or cysts, until the case of Jane Crawford none had been carried out. Abdominal surgery of any kind was extremely dangerous. Post-operative peritonitis was the biggest fear. However, after Jane Crawford agreed to the agonising ride of sixty miles, in the middle of winter, with her “huge tumour pressed against the pommel of the saddle” (Flexner), a successful operation was performed. “We took out fifteen pounds of a dirty, gelatinous looking substance. After which we cut through the fallopian tube, and extracted the sac, which weighed seven pounds and one half.”

Jane Crawford made an excellent recovery from the operation and lived for over thirty years more. The success of the operation was probably partly due to McDowell’s insistence on cleanliness. However, controversy surrounded McDowell’s techniques and even as she lay on the wooden “operating table,” people were calling for the operation to be ended. Some wanted to hang the doctor.  Afterwards, McDowell’s reputation as a butcher who slit open the stomachs of women would follow him around, despite the success of his technique.

Musty saddle-bags

Medical journals of the early 20th century had poems such as this, honouring the country doctor on horseback who seems to favour the travelling herbalist more than the university trained medical man :

“When the whooping cough was ragin’
And the measles were around;
Then he’d mount his rhubarb pony
And go trotting out of town.
With his saddle skirts a-floppin’,
And his leggins all in rags,
And roots and herbs a-stuffin
Out his pussy saddle-bags;

And when mam was down with fever
And we thought that she would die,
That old fellow wouldn’t leave her,
And he never shut an eye.
But he set there like a pilot
For to keep her from the snags,
And he brought her through the riffles
With his musty saddle-bags.”

(Quoted in Medicine in Richmond 1900 – 1975  by Charles M. Caravati, M.D.)

Flexner tells us that Dr. Daniel Drake, of Cincinnati, carried in his saddle bags: “a few instruments and some stock remedies: Glauber’s salts, Dover’s powder, strong paragorics, vermifuges, blisters, Peruvian bark for fevers, dragon’s blood, gamboge, and nux vomica. The ordinary charge was twenty-five cents a mile, one-half being deducted if the horse was fed.”

The only pain killer that McDowell could give Jane Crawford was opium, in pill form. However, things were about to change, for by the time of Jane’s operation, Sir Humphrey Davey’s  suggestion that laughing gas (nitrous oxide) might have a place in surgery was already a decade old. His suggestion took a long time to catch on, though. It was primarily used as a novelty in medical schools where students got off their heads on it (“drunk on the gas”). And, as Flexner relates, “there set out over the land a little horde of chemical lecturers…who depended principally on demonstrations of the drunkenness produced by laughing gas.”

Ether sprees

Flexner describes the arrival of one of these “Lyceum lecturers” in Jefferson, Georgia, home to Dr. Crawford W. Long, in the winter of 1841: “we can visualise his long black beard that terrified the yokels flowing from beneath a broad-brimmed black hat of the type now worn only by Senators. As he rode in his brightly painted cart behind an under-fed nag, he could not have realised that he was making history…”

After watching the results of the lecturer inhaling some of the gas, according to Flexner some of Long’s friends clustered around and joined in. They enjoyed the sensation so much that they begged Long to make some gas for them so they could do it all over again. He was familiar with the use of ether for the same purposes and “ether sprees” became a regular activity. When the young women of the town heard about it and wanted to see what happened, Long saw his chance: “I’ll inhale some if you all promise not to hold me responsible for anything I may do.” Long then went round the room in an ether-fuelled version of “Postman’s knock”.

Eventually Long used the ether for medical purposes when he removed two small growths from a friend’s neck after the patient had inhaled the ether from a towel. He went on to perform more successful operations using the gas. Long made the cardinal error of medical (and academic) practice: he did not publish what he was doing. His seniors warned that it was only a matter of time before one of his patients died. Just as with other doctors, he was castigated and “changed from a hero into an object of terror.” Long had lost the edge and it was others who would take the claim for the use of early anaesthetics in surgery and dentistry.

Whether riding in the country, or in a carriage in town, doctors depended on the horse to do their rounds right into the 20th century. Many a paper was probably written in the minds of the riders and Dr. Masen Good of London translated “Lucretius”  whilst journeying between patients in his carriage (“The Story of Medicine”, Vernon Coleman). Nostradamus and Paracelsus, both 16th physicians whose careers and lives took different paths, must have relied on horses and mules as they travelled about. Without the equids used by all these doctors, how would patients have faired? And yet, as always, we know so little about those animals and what they thought or felt. We’ll leave the last word to Black Beauty, then:

“The doctor came out with his riding-whip.

‘You need not take that, sir,’ said John; ‘Black Beauty will go till he drops. Take care of him, sir, if you can; I should not like any harm to come to him.’

I will not tell you about our way back. The doctor was a heavier man than John, and not so good a rider; however, I did my very best.”

Anna Sewell, Black Beauty.