Category: TOPICS

DOMESTIC MEDICINE 

Diagnosis, prescription, medicine-making, and care of the sick have never been solely the province of licensed professionals. Even today, before we call the doctor or go to urgent care, most people try some self-dosing, whether with honey and lemon, dandelion tea, commercial herbal remedies, or chemical over-the-counter products from the drug store. Spouses and parents count rudimentary nursing as part of their commitments.

Before the 20th century, people diagnosed and dosed themselves for minor afflictions in many of the same ways we do today. They cleaned and bandaged small wounds and treated themselves for aches and pains, coughs and colds. But they also suffered from some different ailments. For people doing hard physical labor on farms, in factories, or in homes with open fires, bruises, muscle strains, and burns were everyday events that called for liniments and salves. People with no access to fresh vegetables through the long winter addressed digestive problems with tonics.

Self-dosage and family-based care with individual plants and with proprietary or “patent” medicines (most of them herbal) was most Americans’ initial treatment, and it was more likely than now to be their only treatment. Many people relied on domestic medicine because, in a primarily agricultural nation, they lived far from doctors. Others regarded physicians with skepticism, thanks to practices like bloodletting and the use of mercury, and because many diseases were then uncurable. Above all, for most circumstances, most people considered physicians prohibitively expensive, in an age with no health insurance. “‘No use going to a doctor,’” Ladies’ Home Journal editor Edward Bok portrayed patent medicine buyers arguing; “‘we can save that money,’ and instead of paying one or two dollars for honest, intelligent medical advice they invest from twenty-five to seventy-five cents for a bottle of this, or a box of that.” But the difference between a quarter and two dollars meant more to most people than it did to a successful magazine editor, and one or two dollars in 1904 when Bok wrote is equivalent to hundreds now.

Without antibiotics, modern hospital equipment, or vaccines for diseases other than smallpox, people did not expect quick cures. Many patients stayed in bed at home for long periods of time, while life continued for the rest of the household. In his memoirs, a Georgia governor described becoming “dangerously ill” in 1839. He was in bed for months, cared for by his wife, who had long lanced his tumors and cut out his decayed teeth. While he was bedridden she had the assistance of two doctors, their wives, and presumably (though he doesn’t mention them) some enslaved domestic workers, but his description suggests that nursing was her main occupation while he struggled for his life. Beth’s fatal illness in Little Women was particularly tragic, but a sister in bed was unexceptional. Measles, mumps, chicken pox, and other childhood diseases were common in American households until the 1960s, and scarlet fever (which killed Beth) was common until large-scale production of penicillin after World War II. For most women, caring for the sick was as much a part of housework as laundry or cooking.

Caregivers sought written instruction in almanacs, women’s magazines, farm journals, and the many self-help manuals that went through dozens of editions throughout the nineteenth century, including William Buchan’s Domestic Medicine, John C. Gunn’s book of the same title, A.W. Chase’s Dr. Chase’s Family Physician, and Beach’s Family Physician and Home Guide by Wooster Beach, the founder of the Eclectic school of botanical physicians. As medical historian Charles Rosenberg suggests, the popularity of these books is significant to the history of medicine. In addition to the many volumes issued by regular publishing companies, many manuals on general domestic health care were published by patent medicine companies, which also put out countless pamphlets with instructions for treating specific ailments.

Medicinal plants were recommended in books, administered by relatives, and prescribed by licensed doctors and uncertified practitioners, many with considerable experience. Prescription coexisted with self-medication and herbal commerce with backyard medicine; people used what would now be considered mainstream and alternative systems simultaneously.

RESOURCES NOT LINKED ABOVE

Edward Bok, “The ‘Patent-Medicine’ Curse,” Ladies’ Home Journal (May 1904), p. 18.

George Rockingham Gilmer, Sketches of some of the First Settlers of Upper Georgia, of the Cherokees, and the Author (Americus, GA: Americus Book Company, 1926), 384-385, 440-442.

Charles E. Rosenberg, “Medical Text and Social Context: Explaining William Buchan’s Domestic Medicine,” Bulletin of the History of Medicine 57 (1983), 22-42; see also Rosenberg’s introduction to Gunn’s Domestic Medicine: A Facsimile of the First Edition (Knoxville: University of Tennessee Press, 1986).

Norman Gevitz, “Domestic Medical Guides and the Drug Trade in Nineteenth-Century America,” Pharmacy in History, 32 (1990), p. 52.

HERBSTORY BACKSTORY & THEMES 

My approach to the commercialization of herbal medicine has developed from work on my books, which examine a fundamental transition in American daily experience as factory-made products transformed human relationships to the material world, turning producers into consumers. Never Done: A History of American Housework studies housework as women’s work and as economic activity; Satisfaction Guaranteed: The Making of the American Mass Market examines the creation of markets for household products; Waste and Want: A Social History of Trash investigates household reuse and disposal. All three concern the interface between private and public, the economic (though not necessarily monetary) relationships of households and the domestic consequences of economic activity. The history of plant-based medicine, too, casts light on the intersections between economic life and our bodies, our intimate relationships, and our everyday routines.

Medicine and health concerns have always been at the edges of my work on consumer culture. I now see that nursing is a missing chapter in Never Done, for it was an essential function of housework well into the 20th century. Before industrialized medicine, most people depended on a kind of care that has largely disappeared. Women whose primary work was in their homes routinely cared for sick people, using garden plants, homemade remedies, and the bland recipes for invalids that can be found in most nineteenth-century cookbooks, in addition to whatever medicine they might purchase. If they had the money, they sought the help of professionals for serious ailments. But caring for the sick was an essential part of most women’s household work during much of their lives. Some women took to nursing more than others, as some did to sewing or cooking, and some earned money offering their services to other families.

Like other household tasks, medicine-making was commercialized and industrialized, and like other artifacts of home production, first-level remedies were transformed into factory-made consumer goods. But this was not a straightforward story of homemade goods moving to the market. Industrial society created new relationships to nature and new perceptions of both bodies and plants. More than the companies and production processes that industrialized other housework, medicine-making operated in the new scientific culture that triumphed during the decades around the turn of the twentieth century. During that same period, the medical establishment consolidated professional control over diagnosis and prescription, distinguishing medicines from other kinds of products. Paid professional care displaced self-care and the unpaid care of intimates, and medicalization became a form of commodification. And because their products had the potential to affect life and death, medicine makers were among the first manufacturers to be subject to government regulation.

The commodification of plant-based medicine raised special issues. If we think about coffee or tomatoes, it’s clear that different plants of the same species and even the same variety can look, taste, and smell different. Soil, weather, latitude, altitude, and cultivation methods produce plants with different proportions of their chemical constituents. It matters how things are harvested — when roots are dug, how ripe the berries are. People gathering plants from the wild might misidentify what they found, or substitute easy-to-find or easy-to-dig plants for labor-intensive ones. Even high quality plant materials might be damaged in shipment or storage, arriving moldy or full of insects. All of these issues explain why business people hoping to profit from plant medicines confronted challenges creating standardized products, which demanded that every package be identical, like every bar of Ivory soap.

Treatment with medicinal plants before the 20th century — and, in some communities, for many decades into it — was not an alternative to seeing a doctor. All doctors employed herbs; herbal medicine was conventional medicine. Interest in botanical remedies now often suggests dissatisfaction with doctors and their cures, and indeed Americans have long sought alternatives to the approaches of mainstream physicians. But regular physicians used opium, digitalis, and many other plants along with mineral and chemical substances, while some medical sects prescribed botanicals exclusively. Drug exploration was an essential part of New World botanizing; isolation of “active ingredients” was crucial to the history of chemistry.

A substantial trade in medicinal plants developed to serve American practitioners, manufacturers of patent medicines, and self-dosing consumers, with wholesale druggists in every American city. Global trade in raw drugs was centered in London, thanks to colonial cultivation. American domestic trade in cultivated plants developed from pioneering efforts by communities in the Shaker religious sect. Wild-harvested drugs such as goldenseal, ginseng, and black cohosh in the Appalachians and echinacea on the prairie became popular enough to cause concern about overharvesting, long before the term “endangered species” became common. During the decades after the Civil War, drug manufacturing firms — including early Big Pharma firms including Merck, Eli Lilly, and Parke-Davis — offered many plant preparations, as well as chemicals derived from plants but standardized in laboratories and factories. Other companies produced “patent medicines” with secret formulas – many of them botanical – which became central products in the development of American consumer culture and the history of advertising.

Around 1880-1920, a network of changes turned plant medicines into an old-fashioned way of helping sick people get better. The triumph of the germ theory of disease, the institutionalizing of patient care, and the ascendance of scientific medicine transformed American medicine. At the same time, the industrial production of chemical drugs coincided with the exploitation of new marketing techniques. And people treated their bodies in new ways, thanks to artificial light, industrial work schedules, new sleep and exercise patterns, and an industrial diet.

Like other consumption habits, everyday medical practices changed piecemeal. Daily habits incorporate products and practices both old and new, and people adopt new ones in ways that vary by age, gender, ethnicity, region, and personality. Throughout the early history of industrialization, healing with plants – based on tradition, observation, and experience – was universal. In the United States, it was practiced by people of all ethnic backgrounds. As a consumer culture developed, Americans solved problems by purchasing goods and services rather than by cultivating skills and knowledge for self-reliance. Medicines made from plants became old-fashioned compared with new chemicals, and self-dosing came under serious attack.

Herbal medicine survived, especially in rural areas and urban ethnic neighborhoods, often among the poor and the elderly. Doctors were expensive–for many, the last resort, their assistance sought only for very serious illness. Local healers continued to grow, gather, prepare, and prescribe herbs. Immigrants brought medicinal plants and home remedies from the old country. Gardeners cultivated “mint for the tummy” and spread the lore of herbal medicine even if they didn’t quite believe in it. Plant healing persisted even as it got commodified, a representation of producer habits in consumer society and consumer resistance to a commercializing medical system.

Today, after more than 150 years of industrial pharmaceutical development, medicines extracted from some powerful plants are still used, and drug companies continue to bioprospect for new ones. Despite organized opposition, effective chemical drugs, government support for scientific medicine and the durability of stereotypical views of herbalism as quackery, Americans’ interest in herbal remedies persists, and they demonstrate it in the marketplace. Some of the companies they patronize began as hippie businesses, expressions of rural life and of countercultural rebellion.

Historians of medicine have described some of these topics, especially domestic medicine and the botanical medical sects. Herbstory views herbal medicine, as an industry and as a body of knowledge, through the additional lenses of consumer history, business history, and environmental history. The people of industrial cultures conduct complicated and ambivalent relationships with plants, and they have done so particularly with medicinal herbs. There is much to know.