Introduction
Like nearly all periods in medical history, there were at least two theories out there for the cause of disease during each and every year of Cornelius Osborn’s lifespan. In fact, to date I have been able to link Osborn’s writings in his vade mecum to the followingtheories for disease: the four humours, iatrochemistry, an unnamed philosophy with an emphasis on fire and pyrollatry, the miasma or effluvium theory, the wandering “disease”/pathogen theory, passions and temperament, the phlogiston theory, and the philosopher’s stone (ens veneris, ca. 1645-60). To date I have not found anything directly leading me to a variation of the contagion theory. Dr. Osborn’s recipes reflect the following cultural influences ranging from English and Dutch to Iroquois and Mahican traditions. There is also the possibility he was influenced by some neighboring beliefs spread by the local French inhabitants to the north, and his comrade in the field Isaac Marks, a Jewish physician. Due to such complexity in Dr. Osborn’s life and medical practice, he uses several centuries of recipes, ranging from the most ancient proprietary and compositions, to the traditional domestic and Indian recipes of his home town where he grew up near Haverstraw, to the more recent patent medicines and official apothecarian formulas.
To Osborn, the philosophy of health and illness, like the most commonly accepted scientific premises for illnesses and disease, was in a constant state of change. So too were the philosophies he melds together in his work handwritten into his recipe book or vade mecum.
Medicine back then, is like medicine now. Every few years, new discoveries are made and new conclusions drawn about science and nature. These in turn lead to the next popular cultural interpretation of the cause for illness, and the next generation’s worth of professional opinions about why a sickness happens and how to get rid of it. If we add a modern science-based thinking to this commentary on past medical practices and their beliefs, we would easily argue that these changes occur because there was a constant search for the best explanation for illness, sickness, disease, chronic sicknesses, a sudden onset of physiologic and/or psychiatric disturbances, etc., etc.. In fact, these changes took place because the philosophical concepts underlying what was believed in and practiced in medicine underwent some sort of change. These changes, like today, are often not really a change from what is wrong to what is right, but rather a change from what is not the best way to interpret, explain and health things, to something that is often times, better, although not perfect in terms of understanding how to practice medicine and how to reverse or at least partially make better some sort of ill physiological state or mental condition.
Historians seem to focus heavily upon just one small aspect of colonial medicine that has been around since antiquity–the four humours/four elements theory. At times, it is as though this old ideology has undergone little to no change since the first description of this philosophy of disease in writing by Hippocrates as well as its philosophical makings by the philosophers of this period in human history. The fact is however that theories and philosophy constantly undergo change, and as a part of these changes often become slightly different and typically more complex. Although some of the basics remain within a new theory that rhyme pretty much with past beliefs touted by scholars and philosophers, the newer interpretation of this same piece of the much older information tend to seem or sound more true to the contemporary scholars and practitioners in the field. It is true that the four humours-four elements theory did make up some parts of colonial medical thinking, as many historians like to discuss. But it is also true that the 4-humour/4-element theory of past Greek or Roman times is not the same as that of the middle ages, the Renaissance, or the early, mid to late Colonial periods important to American history. Only a very few parts of these tetrad-based philosophies really ring tru with Osborn combinations of 17th and 18th century professional, domestic and paraprofessional medical thinking and philosophy. Osborn never even mentions anything to due with the four humours directly, although certain parts of his teachings seem to emphasize what were once interpreted as humours, in the past, as now having a different reason this part of the body, and its force, energy, etc., manifesting an illness of disease the way that it does.
In the least, there was another philosophical basis underlying much of Colonial medicine from the 16th century on. We can in retrospect look at the products or plants used and attached humoural-element components to the underlying philosophy of how and why it was used, but by doing this we are making the mistake of putting the right drug use into context based on the wrong philosophical principles. To Cornelius Osborn, the Sanguinaria canadensis was used because its latex, exuded by a cut or torn root, resembled the blood of the body. But he did not use it this way because it resembled the blood as a humour, he used it because it had other features that made it fit in very well with his formulas, due to Boerhaave’s and/or his own personal philosophical beliefs. He may have even been aware of come other writer’s philosophies about humour-derived reasons for disease, such as Helmont’s notion that the acidity of a humour was in fact the cause for some diseases, not just the kind of humour that was involved. Instead of believing in the archaic concept of a humour flowing through the body as the cause for some disease, Osborn probably believed in either the nervous energy in combination with some sort of animal energy that may be a cause, or the concept that nervous fluids and their manners of flow, their ebbs and their tides, could be the cause.
Living in Dutchess County in very close proximity to Cadwallader Colden, and during the war in close association with Dr. Schopf from Europe, Osborn was probably also familiar with the alternative argument out there for the cause for disease–climate and weather patterns in relation to local environmental settings. This kind of argument can be quite convincing at the time in the valley, for some of the winters to come during the war were the coldest the region had experience in quite some time. As some Dutch writers have described, the summer storms were most active when it came to thunder and lightning activities, and the surrounding air at times quite humid, one part of the Hudson Valley experience that for years to come seemed to never change. So, along with his philosophy about disease based on Helmont’s acid, Boerhaave’s take on the humours as an energy concept with some underlying iatrochemical theme, and Thacher’s teachings about the nerve force and disease, Osborn had to incorporate Colden’s and Schopf’s newer versions of the various environmental theories for illness and disease out there in the medical philosophical writings. The Hudson Valley was neither the Torrid Zone densely packed with most of the world’s most epidemic and often fatal disease, nor was it densely packed with the disease specific to Frigid Climates, such as disease of the lungs in the form of influenza and such. The Hudson Valley was a place that resuided latitudinally within the temperate zone is early medical geographic terms, but it had summers that were Torrid, and winters that could often be frigid. To practice medicine the vallye meant that as a physician you had to take all of the different philosophies of past and present medicine into consideration. This apparently what Cornelius Osborn did.
The point to be made here is that to best understanding colonial medicine, we have to unfortunately look at hos the medical philosophy was changing, almost on a decade by decade basis. In 1740, as Osborn was learning medicine, he was trained in the most recent publications by Daniel Turner, a physician who introduced his version of the idea that the semeni (seed) could be the cause for some diseases, using this to explain hos sexually transmitted diseases are born and spread from one person to the next. For disease for which no obvious environmental or physical cause could be defined, Osborn had to come up with some form of energy-based theory to believe in and adhere to. Whereas a few generations before this may have been a philosophy that stated that some sort of humor representative or nerve or animal energy (electricity) may be an underlying cause, Osborn’s term assigned to this was the old Paracelsian alchemical terms, redefined to meet the needs of iatrochemists a century later, in the form of entia or ens veneris, a new name given to the energy within the philosopher’s stone. Osborn’s mention of muscular twitches and energy, his mention of the use of the ens veneris, his reference to the need use harsh odoriferous spirits to help tame the energies or state of the body responsible for a missed period, the body’s ability to produce too much heat and thereby result in a fever, or the need to strengthen the tone of weak and debilitated muscles incapable of holding the body’s tissues and inner organs in place, are all suggesting of a body energy-based ideology regarding what sorts of imbalances are occurring within the body in order for diseases to develop. Very few of these concepts directly relate to the four elements-four humours. Nevertheless, there are treatment modalities that Osborn employs which can in some way be likened to the traditional, centuries old humoural theory, only not based on the same reasoning as it originators once followed. The Colonial humours were in no way, shape or form, equivalent to the ancient Greek humours concepts.
In many ways, the same natural elements or substances responsible for the imbalances of the body associated with disease, are also associated with universe, stellar, solar system and planetary (especially earth) related changes. This interpretation of energy and the human body, in relation to disease behaviors and incidence, is often a hard concept to get an accurate interpretation of. Nevertheless, in various forms, this concept remains active throughout most of the history of medicine. This part of the natural philosophy of medicine is somewhat difficult to assign reasoning and meaning to with regard to the Colonial period of New York history (ca. 1600-1785), but we can extract the reasonings that make up this part of the medical philosophy from about 1800 forward, due largely to well localized publications of various parts of these new or “modern” traditions and philosophies. Between 1785 and 1800, there is a transition in this thinking that had as its most important element, a strong religious revival type of theme. Were it not for the trine-based behaviors of the recurring epidemic yellow fever, in Pennsylvania and New York history, and the previous malinger trunal alchemical/iatrochemical components of certain parts of traditional medicine, the whole questions about disease as a matter of God’s choice and discretion, versus one of scientific reasoning and basis, would never have had the impact that it did on local history in the Hudson Valley. For this reason, it is easy to assume that just 10 to 20 years earlier, there are also other philosophical and/or religious teachings that could have had similar impacts of Hudson valley medicine. Natural philosophy was as important and active in the medical field during this time, as it was in the religious and scientific fields.
One reason even historians don’t often write about this is that the natural philosophy of a historical figure is not as easy to witness and write about as his behaviors and practices. To better understand the natural philosophy of such a person, one has to understand the philosophy separate from the science, learning each separately, and only later putting the two back together to form one individual’s way of thinking and behaving as a human. In this case, Osborn’s practice and practicum are different from his traditional-trainings. His practice is different from his learned philosophy, but not that different from his personal experiences. Therefore, one other approach one has to take to better understand a physicians manner and reason for practicing the way he does, is to learn his/her teachings, the theory of the practice, and then produce a totally separate interpretation of the philosophy based on what is actually done.
As an example of this manner of approaching the subject of theory versus practice in a past physician, consider how mercury is used to treat the Revolutionary War soldier’s rattlesnake bite by William Thacher. Is this mercury used for archaic alchemical reasons? or perhaps Paracelsus’s 3-states (Mercury-Sulphur-Earth) concepts? or perhaps due to some experiences noted by many physicians? The closest answer for this question is the latter statement. In this case, experience overrides initial theories, and had to result in either acceptance without question, or acceptance but with personal reservations. In the latter case, the physician himself or herself then defines his or her own theory as to why this medicine is being used, basing this philosophy of course mostly upon the contemporary teachings for the time, so as to avoid becoming labelled as too eccentric by others in the same field, but making sure it best fits the innermost, most personal sense of the best reason to adhere to this use when treating any future cases of similar problems.
When we learn about Colonial and Revolutionary War physicians, we also often read the belief that anything and everything possible was tried and used. Some refer to this practice as a heroic practice, in which those methods that succeed are retained, and those that fail go away. Others refer to these practices as being a mixture of various philosophies being carried out under the same roof, treating the same patient. this may in part be true. However, it is best to interpret what forms of medicine a physician is practicing based on the ruling requirements for the practice at the time, in combination with the individual’s personal ability to make the best decision on behalf of the patient, keeping his/her own personal philosophy and experiences in mind. Relating this to the Fishkill encampment hospital setting, we have to assume that the bulk of medicine that is practiced was done according to the status quo, as believed in, taught to, and known by the highest medical officers, on down in military rank. When medicine were ordered for the fever, Osborn ordered Cinchona, in accordance with military protocols, rules, needs and requirements. He did not make use of any local plants that he was perhaps more familiar with, and maybe even found to be more effective at times for treating certain kinds of fevers. Osborn ordered what he had to order, according to military regulations. Instead of using a local emetic or blistering agent Dirca palustris, he ordered South American Ipecac and Mustard plasters. Instead of Ens Veneris, he ordered Sal Ammoniac.
Most likely, Osborn had two periods of time in his medical thinking, composed of related but very differently stated medical philosophies. It is perhaps even possible that Osborn began his practice with several or more fairly archaic beliefs for the time, a philosophy not atypical of rural settings, seemingly out of touch to some extent with the most recent scientific writings and publications. With this in mind, I suspect Osborn had an initial philosophy that he began his practice with, consisting mostly of what he had learned as an apprentice. This virginal period in his medical practice was then followed by one that was more practical and real, an experiential period in his practice in which he clarified that which he had not understood as of yet, and defined even better his take on how and why diseases occur and do what they do based upon his experiences with patients. This period may even had periods in which improvements were made, as he tried to keep up with new discoveries and new writings. The third period in Osborn’s life as a physician consisted of his learning, contemplating, understanding and further training of the more modern medicine being practiced by Colonial physicians and surgeons during their years of service to their country. Perhaps it is best to review Osborn’s potential beliefs, actual beliefs, and wartime beliefs in this fashion:
- Theories Learned
- Theories Practiced
- Theories at War.
Paul-Joseph Barthez (1734-1806).
One possibility is that Osborn was much like Paul Barthez (1734-1806), a French physician who followed up on the teachings of Theophilus Borden (1722-1776). Borden’s traditional views had several parallels with chinese medicine due to the way in which the diagnosis based on the pulse was further defined, and how the various organs were professed to have different forms of vital energy, a philosophy akin to the Chinese philosophy of chi which states that the lungs, stomach, kidney, and heart all produce a form of chi, add this to another form of chi already moving about the body from organ system to the next, in the end producing the perfect chi that is responsible for the entire body’s life and well being.
Brian Altonen, MPH, MS 