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Prescribing drugs as a surgeon

Posted on Monday, February 1, 2016 at 7:50 am

Today if you have a headache, you just take an off the shelf pain killer for your symptom. The local pharmacy is within a 5 mile radius of your house. Some of them are open 24 hours. This was not the case in the mid 1800’s. Prior to and during the Civil War, doctors had a very different philosophy towards the use of drugs to “cure” or “reduce” symptoms of a disease or issue with the body.

This difference is seen in the introductory lecture for Materia Medica by medical staff to the new students. An example of this is the lecture of Dr. Edward Clark to the Medical Class of 1856-57 at Harvard University. Students, starting with their beginning lecture, were to learn the relationship which drugs bear to the treatment of diseases, how they rank in the process of treating disease, and the value of the use of drugs in patient treatment. New medical students needed to understand that the pharmacopeia available to them was not a cure all. Drugs of the age were considered dangerous by the doctor. He could over estimate their value to the patient by thinking that treatment of diseases consisted chiefly of administration of medicines. Drugs during this time were thought to play a role in managing a disease based upon the different body systems that they were to influence (like the bowels).

Drugs were used to “play with the body”. A doctor stimulated here and checked there much like a musician made his instrument respond to his playing. Drugs were used to accelerate or retard such things as the heartbeat, temperature, and respiration. Medical students were taught that the use of Senna purged the body and that Ipecac forced the person to vomit. Calomel was used by the doctors to force the patient to salivate. Finally, Opium was used by medical personnel to stupefy the body, reducing pain. All of these chemicals did not “cure”. Disease is fighting Nature in the eyes of the 1860’s doctor. The doctor was considered like a blind man armed with a club trying to resolve the conflict the disease is causing in the body. If the blind man (doctor) strikes the disease, the patient lives. If the blind man (doctor) strikes Nature (the body), the patient dies.

Doctors of the age also thought of disease as that which has made the person’s body get out of repair just like a car today. The patient may self-repair their body if left alone. This was the concept that if a person had a “good constitution” they could self-conquer the disease that they had acquired. If they had a poor constitution, they could die from the disease. The patient may also be injured by the doctor if he is unskilled in his handling of the disease. This could happen by the misuse of drugs in treatment through over or under prescribing dosage.

By this time some medical schools were looking at disease in three categories: self-limited diseases, diseases of indefinite duration, and fatal diseases. The self-limited disease is limited by its own nature. Based upon the constitution of the patient they may die or recover. The diseases in this category included: pertussis, scarlet fever, measles, smallpox, dysentery, typhoid fever, & pneumonia. Drugs that are used with this category can assist the patient, but is secondary to work of nature. They do not “cure” these diseases.

The diseases of indefinite duration are not limited by nature. Drugs can really “cure” some of these diseases. Anemia can be relieved by iron, syphilis by mercury, or iodine of potassium (at least in mid-century 1800’s), and chills/fever by quinine. The treatment is more curative than with the first group of diseases. Sometimes the drugs used will remove the cause, it might reduce the duration, or it might absolutely control the disease. Doctors were fully aware of the fact that the apothecary cannot contain all of the “weapons” necessary to work on the disease.

The necessarily fatal diseases progressively and steadily become worse. Each change that takes place moves closer to “the destruction of life.” These diseases include: consumption, carcinoma, apoplexy, softening of the brain, organic afflictions of the heart and kidneys. In this case drugs cannot “cure” the disease. The recuperative powers of nature will fail. Drugs are therefore used to prolong life, to keep up failing strength, and alleviate the “agonies of the inevitable hour.”

Even though the doctor of this age would focus on nature and drugs for “curing” the sick, doctors, like today, needed to treat both the “mind & the body.” Doctors of the mid-1800’s felt that this relationship was both obscure and “ill understood.” They did understand that fear, anxiety, want of confidence, or depressed mental condition would go a long way towards producing disease, preventing its relief, or preventing its cure. Even with the best nursing and the best administration of drugs, they felt that the mind could cause, cure, or prevent disease.

More than the pleasant manner or smile of a doctor, there are external influences that could help or hinder. Therapeutic agents used by the doctor included light, temperature, good air, diet, bathing, climate, clothing, and exercise. It was felt that these also belonged as part of the Materia Medica. If the doctor did not manage these resources, the drugs available to them would have had little impact on the patient. Perhaps because they felt that diet was critical is why there was so much emphasis on the diet provided to the sick and wounded during the Civil War. Looking at the diets prescribed, the regulation of diet for the sick was no simple matter, however simple it may have appeared to be. Food was considered the raw material out of which all tissues and organs are impacted. It regulated the blood, supplied the body’s fuel, and is therapeutic. The regulation of the quantity and frequency of the patient’s food and drink could be much more important than drugs.

Drugs did hold an important position for the medical professional. In their use they can be of “inestimable value” to the patient. Doctors of the age could not study the pharmacology too carefully. They could not understand the drugs too well. Their administration to patients could do a vast deal of either good or evil. They could relieve pain, promote sleep, stimulate or repress any action of the body. They could wake up a sluggish organ or reduce excitement in the body. Behind each drug was the admonishment that most drugs are not curative in their effects. The physician needed to first consider whether the patient should take anything. What else may cure this patient besides the pills, liquids, tinctures, etc. in the resources of the doctor? Dr. Clarke states this when he said in Latin, “tuto, cito et jucunde.” Translated it says “safely, quickly, and joyfully,” meaning with the least amount of drugging. After a thorough study of the Materia Medica in the medical school hopefully, the doctor will be prepared to prescribe drugs wisely for the relief of their patients.

Until next time
Your obt. Servant
Surgeon T.T. Steinbach

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