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Health Care for Early Explorers

11/18/2014

 
PicturePhotograph of bloodletting from 1860. Burns Archive







































​

From the time of the ancient Greeks through the Renaissance, medicine was dominated by the theory of the four humors or liquids; blood, phlegm, yellow bile, and black bile. Good health depended on their proper balance. All four humors existed in the blood in varying amounts, and if a person had too much of one humor they fell ill. The treatment for most illnesses required removal of certain bodily fluids which contained the humors. For example, if a person had a fever, which included most sicknesses, he must have too much blood. The treatment was to cut the patient and let him bleed. In addition to bleeding, evacuation of fluids in the bowel or stomach were common treatment. These ideas persisted into the Renaissance before changes in medical practices began to appear. 

In the Middle Ages people in Europe turned to religion for guidance in all matters of their lives. The view of Christians and Jews during the darkest ages was that illness  was usually God’s punishment for sin. (You may have noticed this idea is not yet totally dead.) Care for the sick was considered a noble thing, so Christian groups, often monasteries, set up hospitals. Despite the fact that monks preserved and copied ancient medical books, they made little effort to put the ancient practices to use. Mostly they directed their efforts toward keeping the sick comfortable during their affliction. St. Benedict actually ordered his monks not to study medicine, because he felt that only God could heal the sick. As a result of these practices, the early medical knowledge of the Greeks, Romans, was forgotten in Europe.

Islamic scholars preserved and practiced the ancient medicine, the theory of humors in the blood, translated it into Arabic, and spread it with their empire over North Africa, parts of Spain, and France.  They even produced medical encyclopedias that were owned by every practicing physician in the Islamic empire. During the Renaissance medical knowledge made a return to Europe and expanded beyond the works of Galen and other ancients, and a few doctors began to rely more on observations and experiments. Acceptance of this new approach to medicine was slow and required several hundred additional years. This brings us to the time of exploration at the beginning of the sixteenth century.

Explorers had little knowledge of the humors and a physician or surgeon seldom traveled with their expeditions. Their medical practice was often done by a crew member with barbering tools who cut hair, pulled teeth, and performed simple operations such as amputations and setting broken bones. Besides his razors, the designated barber-surgeon also carried saws, pliers, and ointments, and herbal medicines, along with a syringe used to clean wounds with sea water or rum. Internal surgery was a certain way to death by infection and was avoided except by a few daring surgeons. 

Sailors in the sixteenth century did extremely hazardous work and injuries were common. Wounds and broken bones headed the list of injuries and amputation was the universal treatment. The greatest danger, however, on long voyages was scurvy. The cause of scurvy  was unknown, but sailors were aware that certain foods could cure it. Unfortunately fresh fruits, vegetables, or meat on board were soon consumed, and the rest of the voyage was dangerously deficient of foods containing vitamin C. After about six weeks of salted meat and hardtack the first symptoms of scurvy began to appear—swelling of the gums and loosening of teeth, then blotches on the skin followed by a deep lethargy leading to death. Consumption of vitamin C could quickly correct these symptoms—except for the death part.

It was not until 1747 that a systematic experiment was conducted by James Lind, a British naval physician, to study the effects of citrus fruits on the disease. Lind, like others of his time, believed that scurvy was caused by putrefaction in the body, and that the acidity of citrus fruit corrected it. Even though Lind demonstrated the benefits of citrus, it was not until 1795 that lemon juice was required to be carried on ships of the English navy. In the mid-nineteenth century lemon juice was replaced by lime juice because of lower costs. Also they discovered that limes are only half as effective as lemons for preventing scurvy.

Many theories had been developed about the causes of illness and infections, and the term “fever” covered most illnesses. Ridding the body of unwanted elements involved strong laxatives, bleeding, and sometimes emetics (think vomiting). Nobody knew how much blood was enough, so there was an inclination to take some amount—up to a pint—and if the patient did not improve, draw more. They realized that too much blood loss could lead to death, but they often pushed the limits in an effort to remove enough of the bad element. Another cause of disease was believed to be the foul smelling emanation (miasma) from swamps, rotting organic matter, or raw sewage. Some fevers, particularly malaria, were believed to be related to these miasmas.

In 1803 the Corps of Discovery, headed by Lewis and Clark, was making preparations for the journey up the MIssouri River and to the west coast of the continent. Part of their preparation included planning for medical needs, both for the men on the journey and for Indians they encountered along the way. For this purpose they sought the advice of one of the most respected physicians of the day, Dr. Benjamin Rush. Dr. Rush was a strong advocate of bleeding. To him there was only one kind of fever and one disease, and it was based on imbalance in the vascular system, especially in the brain. Accordingly his advice to Lewis and Clark involved laxatives, emetics, and tools for bleeding. Men on the Lewis and Clark expedition had diets low in fruits, vegetables, and other sources of fiber, so they frequently had need for Dr. Rush’s powerful laxative remedy, which they called “thunderclappers.” Rush also believed in a concept called “heroic medicine” with bleeding to the point of fainting and purging at dosages sufficient for a horse. I think the heroic part was mere survival of the treatment. Surprisingly, patients often said they felt better after a blood draw, even an amount that caused them to faint. In fact Benjamin Rush often advocated bleeding until faintness, then bleeding again the next day. If this was repeated several times, the patient would become severely anemic and require weeks to recover a normal red blood cell count. 

An adult male in good health has about 10 pints (4.7 liters) of blood, females slightly less. Removal of 3 pints causes a big drop in blood pressure and fainting. Removal of 4 pints suddenly can be fatal if not replaced quickly. One of the best known examples is the final illness of George Washington on December 14, 1799. He was deathly ill with a severe throat infection and pneumonia. At 7:30 A.M. Washington was bled 14 ounces, almost a pint. At 9:30 he was bled a pint and a half, and again at 11:00 A.M. A short time later Washington felt enough better to get out of bed and walk around the room. At 3 P.M. another 2 pints were removed and at 4:00 P.M. he was given both a laxative and an emetic. Washington again improved briefly but was acutely short of breath to the point that the attending physicians considered a tracheotomy. At 10:20 P.M. Washington died after a total loss of 5 pints of blood in twelve hours. Pneumonia was given as the cause of death, but the treatment must have hastened his passing.

References
McCoy, R.M. On the edge: Mapping North America’s Coasts. New York: Oxford University Press, 2012

Paton, B.C. Lewis and Clark: Doctors in the wilderness. Golden, CO: Fulcrum Publishing. 2001



Yount, Lisa, The history of medicine, San Diego: Lucent Books, 2002


John Cabot: The Italian who brought England to the New World, 1497.

11/1/2014

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Picture
Cabot's route to Newfoundland. Map by author.

Roger M. McCoy

After watching Spain and Portugal reap the riches of the New World, King Henry VII of England could not help wanting part of the action. After hearing of Columbus’s great discovery, the merchants of Bristol, one of England’s prominent ports, saw a chance to start a lucrative trade with the Orient and perhaps find some new fishing areas. Also at just this right moment a Genoese navigator named Giovanni Cabotto was in Bristol to present a plan for finding a passage through the new continent. Today we usually regard him as an Englishman and call him John Cabot.

Little is known about Cabot, but it is quite likely that he and Columbus knew each other as young boys in Genoa between 1451 and 1461. Perhaps they spent time together at the pier watching ships and talking to sailors. It is certain they both learned the seafaring trade by signing on with ships out of Genoa.

It is known that in March 1496, Henry VII granted letters patent to John Cabot and his sons, Lewes, Sebastian, and Santius. Cabot was granted authority to sail under Henry’s banner to all parts of the east, west, and north with five ships to “seek and find lands of the infidels and heathens” which were not previously known to Christians. Cabot and his sons could govern these newly claimed lands in the King’s name and could profit from the produce of these lands, paying 20 percent to the crown.

International recognition of Cabot’s discoveries was doubtful from the beginning. Spain and Portugal expected England and all others to stay out of their global land grab. On that basis the Spanish king protested when he heard of Cabot’s plans to sail into the new lands. Henry VII was unimpressed and ignored the protest.

The First Voyage
After an abortive start in 1496, Cabot sailed west from England in May, 1497, five years after Columbus sailed from Spain. Although the letters patent authorized five ships, Cabot had financial support for only one; a small, fifty ton caravel, the Mathew. Aboard were Cabot, his young son Sebastian, and a crew of eighteen men. His course was due west along latitude 51˚ 33′  which he expected would take him to northern coast of China.

The Mathew reached Newfoundland late in the afternoon on June 24th. The exact location is unknown, however the most probable site is the northeast portion of the northern peninsula of Newfoundland Island. The voyage from Dursey Head, Ireland, the last point of land in the British Isles, to Newfoundland was only 32 days, a record speed that held for almost a century.

Cabot’s probable landfall was remarkably close to L’Anse aux Meadows, the site of  Leif Ericson’s Viking settlement established nearly 500 years earlier in 1001. English sailors in the 15th century had no knowledge of that settlement, so Cabot would have assumed that he was the first European to visit that site. Cabot did not anchor there, and his probable landing is a bay a few miles to the south. Some historians and residents of Nova Scotia claim Cabot landed at Cape Breton, over 300 miles to the south. This assumption discounts the accuracy of Cabot’s latitude measurement by an amount that would be very unlikely for such a seasoned navigator.

At this spot Cabot would have gone ashore for a stable place to measure latitude and to perform a brief ceremony taking possession of the land for King Henry VII. The ceremony included implanting the flag of St. George, the emblem of England. Such possession usually implied inclusion of all adjacent land not previously claimed, and so could be, and often was, interpreted to mean the entire continent. This was the only time Cabot recorded going ashore. Four years after Cabot’s landing, the Portuguese explorer, Gaspar Corte Real, came to this site and noticed the native Beotuks had an Italian-made sword and earrings made in Venice, which must have come from one of Cabot’s two voyages.

Cabot sailed down the east coast of Newfoundland Island to the south end of the island. There he looked westward and saw no land on the horizon. Thinking he had found the sought-for passage to Asia, he turned back. He retraced his route northward along the east side of Newfoundland, completing his mapping of the coast. Cabot wrote of dropping weighted baskets in the Grand Banks area and pulling up loads of codfish. This report of codfish brought a quick response from English fishermen, who soon began harvesting cod from the Grand Banks off Newfoundland. Cabot then turned eastward to England on July 20, 1497 along the same latitude as his outward voyage.

After greetings in Bristol Cabot left for London, arriving August 10th in Westminster to report to King Henry. The king paid Cabot £10 and granted him an annual pension of £20 (roughly equivalent to about $90,000 today) for his discovery. Ship’s captains then earned about £8.5 per year, so the £10 bonus plus £20 annually was a handsome amount. The king also made it clear that the pension was to be paid from the customs income at the Bristol port. It was easy for the king to be generous, as it cost him nothing. The king discussed plans for another voyage and promised armed ships and prisoners to go with Cabot, suggesting the intention to establish a colony. 

It’s hard for us to imagine the enormous effect of hearing about a new land that was totally unknown before. Many people in England avidly devoured all information about the new discoveries. Cabot was called “Grand Admiral” as a sign of great esteem and honor, and people gathered wherever he went. The nearest similar experience in the 20th century was perhaps the first moon walk or Lindberg’s flight to Paris.

Political expedience induced Spain’s acceptance of England’s claim in the New World. Ferdinand V was disturbed by Henry’s discovery in “Spanish” territories but could not protest too strongly as he needed England’s support against the French in Italy. Henry VII, on the other hand, wanted to stay on Ferdinand’s good side because he hoped for his son, Arthur, to wed Ferdinand’s daughter, Catherine of Aragon.

The Second Voyage
In February 1498 Henry VII provided new letters patent granting Cabot permission to represent England for a second voyage, to “subdue, occupy and possess isles, countries, regions, or provinces of the heathen and infidels unknown to Christians, and to enjoy their fruits, profits, and commodities.” He was provided five ships and directed to sail until he reached the island of Cipango (Japan), which they considered to be the primary source of spices. There Cabot was to establish a colony as a trade center for goods to be shipped to England.

The five ships left Bristol in early May, 1498, outfitted with trade items and a year’s provisions. One ship suffered damage from a storm and had to return, but the other four proceeded and were never seen or heard from again. Cabot did not achieve his objectives, and he probably never knew the significance of his discoveries. In Bristol his pension was paid until  1499 when the lease of his house was terminated, leaving his wife, Mattea, and children in the care of the city authorities. By 1512 John Cabot was declared lost at sea.

In 1997 Cabot's voyage was celebrated again by the construction of a replica of the Mathew, which successfully crossed the Atlantic to Newfoundland, touring the east coast of Canada and the United States before returning to stay permanently in Bristol harbor.

Cabot established that a new and substantial land mass existed within a reasonable sailing distance from Europe, and he showed the potential for a fishery in the Grand Banks. The most significant result, however, was that Cabot established the basis for a long-term British presence in North America.

References
McCoy, Roger M., On the Edge: Mapping North America’s Coasts, New York:  Oxford University Press, 2012.

Morison, Samuel E. The European Discovery of America: The Northern Voyages, New York: Oxford University Press, 1971.

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