Cancer Prevention Specialist Reviews Bloodletting and Germs
A Review: Bloodletting and Germs: A doctor in Nineteenth Century Rural New York By Thomas Rosenthal
By James R. Marshall, PhD, Professor of Cancer Prevention at Roswell Park Comprehensive Cancer Center in Buffalo, New York.
The COVID pandemic of 2020 has exposed the vulnerability of society to communicable disease and has pointed to some of the limitations of modern medicine. But there have been vast changes and improvements. The author, Dr. Rosenthal has assembled a needed perspective, with this reconstruction of the life of Dr. Jabez Allen, a physician who settled, in the early 1800s, in the farming village of East Aurora, New York. This account, a fictional first-person narrative, is based on deeds, vital statistics documents, minutes of the Erie County Medical Society, newspaper accounts, letters, and a family bible. It describes the professional and personal life of Dr. Allen, who arrived by horseback in 1834.
Dr. Allen had recently graduated from the Castleton Medical College in Vermont: one of ten in the US. Medical education at Castleton consisted of readings from Virgil and Cicero, with courses in anatomy and physiology; chemistry; medicine and therapeutics; the sources and natures of medicines in use; and surgery and obstetrics. Lectures and recitations were conducted over 2 fifteen-week terms. After classwork, students served a 2-year apprenticeship. Since his brother already had a medical practice in his small hometown in Vermont, Dr. Allen moved west after his apprenticeship; he stopped in East Aurora, New York, intending to travel on: he impressed the local leaders and townspeople, and was welcomed and invited to stay. He practiced medicine in East Aurora for close to 60 years.
Several themes mark the advance of medicine during Dr. Allen’s practice life. His account describes how little, apart from extending comfort, could be done for the sick. Depletives, purgatives and stimulants were commonly used, often with mixed results. Medicine’s impact upon infectious disease was limited: tuberculosis, scarlet fever, cholera, typhoid, anthrax, diphtheria and dysentery routinely killed people. During a cholera outbreak in East Aurora, Dr. Allen treated 74 patients: 41 died, 33 survived. In another outbreak, 148 of 233 patients admitted to the Sisters of Charity Hospital in Buffalo died. Dr. Allen lost a teenage son to tuberculosis; several years later, an older son, conducting a post-mortem examination of an anthrax victim, suffered a cut on his hand, was infected, and died a few days later. Dr. Allen’s brother, who had moved to East Aurora from Vermont, was called to care for two cholera patients; stricken, he, his wife and son all died.
Bloodletting persisted as a means of treatment, even into the early years of the 20th century. Although Dr. Allen recognized its likely limitations, he often employed bloodletting. The technique had been advocated by Dr. Benjamin Rush in the prior century. A vein was opened, or leeches were applied to the skin. It was supposed that the procedure allowed toxins to be depleted and removed from the body. Although it had been shown statistically to have little to no positive impact on recovery from illness or injury, the practice persisted. According to his account, Dr. Allen used bloodletting to treat a child with an intestinal obstruction; women in labor; patients seeking merely to promote their health; patients who had been overdosed by patent medicines; patients with tetanus, with tuberculosis, with scarlet fever, with pneumonia After he suffered a stroke in 1885, Dr. Allen was treated by bloodletting.
The nineteenth century saw a variety of drugs, including laudanum and aspirin, as well as alcohol, used to lessen pain and discomfort. Chloroform and ether were introduced to enable surgery. Dr. Allen formulated and dispensed drugs to his patients.
In the middle of the century, Dr. Allen was asked to consult on an outbreak of typhoid fever in and around an inn near East Aurora; he invited Dr. Austin Flint, Professor of Medicine at the University of Buffalo, to direct the investigation. Dr. Flint concluded that a traveling salesman’s typhoid fever had led to contamination of the inn’s water supply, and that that contamination led to the outbreak. Dr. Flint’s publication of his observations and conclusions—that a communicable disease could be transmitted by water--guided Dr. John Snow in England to identify the likely source of a cholera outbreak in London as the water supply. Dr. Snow, then London health officer, disabled what he deemed a contaminated but widely-used public water pump, effectively ending the epidemic. The importance of germs was increasingly recognized: microscopy came to be appreciated as a means of discovering the presence of infective pathogens in water and human tissue.
Medical licensing emerged as an issue during Dr. Allen’s life: he was repeatedly confronted by the challenges of quacks—whose knowledge of biology and medicine was absent or highly limited—selling worthless or harmful nostrums. Dr. Allen and other competent physicians sold drugs, although the American Medical Association (AMA), founded in 1847, sought to regulate medical education and medical practice, including the prescription and dispensing of drugs. Western New York emerged during Dr. Allen’s lifetime as an important center of American medicine. The AMA met in Buffalo in 1878; Dr. Allen was recognized as a past president and vice president of the Erie County Medical Society.
As Dr. Lewis Thomas has recognized, advances in hygiene and sanitation, which began during Dr. Allen’s lifetime, had a huge impact on morbidity and mortality. As hygiene became increasingly recognized as a means of preventing disease transmission, Dr. Allen played his own leading role in public health promotion in Western New York. A common practice in East Aurora was for a family to purchase a piglet in the spring for a nominal sum, then allow it to forage on garbage, refuse and and sewage through the summer; by the fall, the pig would weigh over 200 lbs and could be slaughtered to provide food for the family for the winter. The village’s pigs, though, presented a considerable challenge to sanitation. Dr. Allen sought, without success, to limit the free ranging of pigs within the village; the availability of a seemingly free food source outweighed concern over their impact upon hygiene and sanitation. Nonetheless, as advances in hygiene promotion proceeded and came to fruition at the end of the 19th and the beginning of the 20th century, infant and maternal mortality, and death due to typhoid, diphtheria, cholera and tuberculosis fell markedly. Today, advances in medicine have combined with public health policy to lessen the burdens of infectious and noninfectious disease.
This account, summarizing the life of a thoughtful medical practitioner, provides an insightful and readable view of the nature of medical practice and its emergence as a store of interventions that make a difference in the outcomes of our ailments. We need to be reminded: This account fills a need, reminding us where medicine has been, and how a country doctor sought to advance its ability to prevent and cure disease.