Medicine and the old ‘Frontier West’…a very brief & modest look-back

First a little ‘back-story’…

Many years ago, when I was still somewhat romantically inclined, I was going with a lovely young doctor from China. This person, whom we shall fictitiously call ‘Mai’, was maintaining the typically arduous and exhaustive routines of a first year medical resident at the hospital I worked at in Oakland CA. Mai, whom I have written about in other contexts before, seldom had a chance to relax or get away from the demands that being a ‘student doctor’ place upon one. Consequently, whenever she had a chance, she sought escape in American murder mysteries, a genre well-established in the United States for more than a half-century.

Personally, I could not begin to fathom what she saw in that topic she had chosen for ‘relaxing reading’, since her work brought her into daily contact with gun-shot cases, murder victims, stabbings, child & spousal abuse, autopsies, slain cadavers, and God knows what all in the hospital’s ER…and since we’re talking about Alameda County’s ‘Highland General Hospital’ (regarded as the Western equivalent of Chicago’s Cook County Hospital), which is a major teaching center in California, there was always plenty of murder & mayhem (stabbings, shootings, etc.) on hand. Perhaps it was her ‘born-in-China’ origins that had something to do with her fascination with murder American style, but whatever it was, I personally found mainstream murder mysteries not at all relaxing or to my taste in recreational reading material.

What I myself did find of interest, curiously, was Old West frontier fiction. Stories about the old American frontier west, with its rugged heroes and gorgeous gals. Of course I had been raised as a child on the early (and uniquely 50s style) TV ‘cowboy’ series, such as the Hopalong Cassidy, Roy Rogers and Gene Autry shows, Death Valley Days, The Rifleman, Wagon Train, Laramie and so many others. Most kids in that day were brought up on a steady diet of ‘good guys’ (always handsome, clean shaven and wearing white hats) and ‘bad guys’ (almost always Indians of any kind, but a few surly black-hatted cowboys with mean, spiteful natures). Native Americans on such shows were categorically typified either as a deadly nuisance obsessed with scalping wagon train settlers and carrying off their women, or somewhat stupid cowboy hero sidekicks. The stereotypes were plentiful on TV and we children were thoroughly socialized to reflect the prevailing fantasy in our games. Whenever we played outside, we usually called our favorite game ‘Cowboys ‘n Injuns’. Formulaically, ‘Injuns’ always had to lose and ‘Cowboys’ had to win. It was that simple.

It may well have been that steady diet of TV westerns that prompted my original post-adolescent interest in the American ‘Old West’, but that interest soon extended into somewhat more refined reading about Western American history in general. Contributing to this budding fascination was the fact that my mother’s family had originally settled in South Central Idaho (the Twin Falls area, on the Snake River) and my well-educated and artistically sensitive mother herself was quite drawn to western US history and the saga of western expansion to the Pacific, with keen enthusiasm.

My mother’s brother, Charles A. Terhune (Jr.), was a successful mid-1900s physician/surgeon with a flourishing practice in the small town of Burley, Idaho, having graduated from the Northwestern University School of Medicine. His father (& mother) had been one of those wagon train settlers that followed the Oregon Trail, starting from Savannah, Missouri, and then branching off to settle in lower Idaho’s lush high prairie stretches along the beautiful Snake River in the mid-to-late 1800s.

Opening up a pharmacy in Burley, Grandpa Terhune soon established himself as a town fixture, since pharmacies in those early days (known more commonly as ‘drugstores’) were an important community gathering place. Grandma Terhune (whom we called simply ‘Nanna’), was quite a well-educated woman (she actually had a degree from lake Erie College at a time when most women never even attended high school) coming from a respectable family in Missouri and taught piano, also giving music lessons to the town’s children. Although Grandpa was not a credentialed ‘doctor’, he functioned pretty much as one in the Burley community, since back in those days the town’s ‘druggist’ performed a variety of useful civic functions including those of a doctor, when so availed. Grandpa determined to send his oldest son (Charles A. Terhune, Jr.) off to a respected medical school back east in hopes that he would return to open up a practice in Burley. He did, and therein lies the story below.

Meanwhile, ‘Uncle Charlie’, newly equipped with a degree in medicine from one of the first and most respected academic centers of ‘new’ medical learning in the United States, and identified on his shingle as both a physician & surgeon, went on to become a notable member of the American Medical Association, playing a significant part in the Idaho chapter of that organization. After returning from service as an Army surgeon in North Africa during the Second World War, he purchased a plot of land fronting the serenely bucolic Big Wood River, on the outskirts of Ketchum, located at the foot of Bald Mountain near what had in the 30s become the world famous ski resort of Sun Valley. Many wonderful days were spent there by both his family and my mother and I, since Mum spent her teacher’s summer-long vacation each year with the family in Burley, and at the family’s cabin in Ketchum. As an amateur geologist and western history buff, she literally haunted the old diggings, ghost towns and tailings of Blaine County’s Sawtooth Range silver & lead mining industry.

It was an idyllic place for anyone with an appreciation of the history and rugged splendor of the storied American Rocky Mountain wilderness areas to explore, but certainly no less so for a boy of my age. After all, how many kids of 8-11 years can claim to have occasionally fly-fished next to ‘Papa’ Hemingway and his many Hollywood friends (such as Gary Cooper, Clark Gable and other celebrities well-known to the Silver Screen)?

To this day, I am grateful beyond words for having had the chance to experience all of that spectacular natural wilderness that characterises this part of Idaho and savor true frontier-like simplicity, as a youth.

Early American medicine

The area of human activity known generally as the ‘healing arts’ in classical terms, and ‘health care’ in modern terms, is as old as humanity itself. Death, disease and physical injury, not to mention psychological illnesses and afflictions, are part and parcel of human experience immemorial. From ancient origins in Greece and even earlier in the Middle Eastern regions, ‘medicine’ as a special area of occupational work progressed over the centuries in a very slow manner due to the societal limitations of superstition, religious belief and constraining tradition imposed by primitive local ethics and moralities.

To trace and delineate the history of very early practices of ‘medicine’, or to fully outline the treating of human infirmities, is beyond the limited scope of this writing. Suffice it to say that by the time the English colonies that comprised the United States of America had been established, the practice of medicine was a very eclectic and non-uniform activity among all cultures, not least within the early American nation. It is helpful at this point to realise that, as has been evidenced by medical historians, fully 90% of so-called ‘modern medicine’ has arisen since the year 1900! Prior to that time, medicine as a calling relied heavily on a combination of traditional folk customs, faith healing, religious belief and natural herbal therapies. It is also useful to keep in mind here that a huge number of human afflictions are also inherently ‘self-limiting’ in that many will resolve themselves completely even without ‘tinkering’ interventions of members of society with medical aspirations. Of course many human disease entities are also inherently fatal (without precise treatment), but in most cases very little could be done by medical ‘practitioners’ to alter the outcome of the more serious conditions found back then. This was especially true for certain highly contagious diseases (such as smallpox), until immunization theories surfaced in the mid-to-late 1800s.

Therefore, for the most part, although many of the earliest American ‘physicians’ were academically well-educated in overall terms, medical training and actual courses of study were fundamentally quite limited. In early (1700s) America, the most prominent doctors were either formally educated or trained abroad (notably in England and/or France); Alexander Hamilton is a notable example. There were almost no standards on care or how to treat human infirmity whatsoever, seldom any agreement among so-called confreres, and social prominence played a disproportionate role in fostering common public regard for practitioners of the healing arts. If an individual was a graduate from a European higher institution of learning, his status was automatically elevated far above the extant norm. After all, in newly established America, as in most of the world, the ‘higher educated’ members of any society constituted a pitifully tiny percentage of the total population (less than a few percent).

Medicine in the first half of the 19th Century was therefore a relatively primitive undertaking, despite learned pretense. There was a tendency for certain ‘leading’ members of the medical establishment (such as it was in the late 1700s) to individually formulate and hypothesise often rather bizarre theories about both diseases and cures, and to stand firmly in support of them even in the face of factual evidence by others that they were more harmful than helpful. Thus, some of the ‘heroic’ practices of prominent early American physicians such as Dr. Benjamin Rush, one of the most influential physicians in Massachusetts, contradicted even common sense. Yet, due to his social prominence, few could actively question or criticize his practices. Moreover, despite the deleterious effects of many of his less helpful treatment theories, he is remembered today for much that was actually communally beneficial and his failures and ill-founded theories notwithstanding, Rush was a very intelligent man with remarkable insight & perception.

Due to the difficulties implicit in the invasive study of anatomy (religious proscriptions against desecration of bodies chief among them) back then, with a resulting scarcity of sufficient numbers of corpses to dissect in teaching anatomy, very little was actually known about the actual physiology and functional anatomy of the human body. Outside of certain learning centers in Europe, where anatomy had first begun to flourish, there were seldom similar opportunities to avail in early America (consequently, grave robbing was not uncommon near medical schools!). Medical beliefs at that time were predominantly based on certain completely unsupported precepts dating back to ancient Greece, one of which was the so-called ‘miasmas’ theory; another involved certain ‘ill humors’, that were supposed to cause disease. The role of micro-organisms (viruses and bacteria) as the root cause of most serious diseases was completely unknown until the invention of the microscope in Europe introduced that relatively startling hypothesis, but it was painfully slow to gain favor among physicians.

The concept of sterility was then also not just unknown, but more often than not deliberately rejected or ignored by doctors until much later in the century, when it began to be observed that physicians who went directly from autopsies & dissections of cadavers to the treatment of live patients seemed to somehow be spreading disease. Washing hands, using clean fabrics & bandages, and the use of protective barriers (including rubber gloves) to prevent the spread of germs (which practically speaking had not yet even been ‘invented’ yet) all had to wait until much later in the mid-to-late 19th Century.

At the time, many practitioners like Dr. Rush subscribed to so-called conventional ‘heroic’ practices such as ‘blood-letting’ or phlebotomy, in the belief that draining ‘ill humors’ from the body through this approach was a helpful medical adjunct that speeded healing. In fact, in cases of severe disease as well as in many physical trauma injuries, such unproven therapeutic interventions actually helped speed the demise of some patients. It is known, for example, that George Washington’s own death was considerably hastened by excessive ‘blood-letting’ therapy too enthusiastically undertaken by his doctors.

Other treatments, such as the prescription of and use of certain questionable chemical preparations (chief among the favorites ‘Calomel’, a combination of toxic Mercury and chlorides that was frequently prescribed for treatment of venereal diseases and many other complaints) were not only commonplace but also quite poisonous, yet their use as commonly prescribed and unregulated drugs persisted well into the early 1900s! Every frontier doctor carried a goodly supply of Calomel with him in his saddlebags and satchel.

Enemas were another common ‘tool of the trade’ practiced since olden days, since it was believed that both oral and rectal purgatives would help clear out unhealthy humors contributing to sickness and also to have general restorative effects (ironically, to some extent this was true, but enemas were over-prescribed, at any rate, often leading to excessive dehydration and debilitation in conditions when adequate hydration was crucial for survival).

Of course one of the chief causes of sickness and disease was the unimaginably appalling lack of even the most primitive public hygiene in settled communities. Sewers were regularly located near public water supplies in communities and dwellings alike; outhouses (if they existed at all) were not cleaned or maintained, and personal bodily hygiene (such as regular bathing) hardly existed at all. Baths, when they were taken, may have occurred weekly in the higher class homes, but were seldom availed among the lower classes. Often the most obnoxious bodily odors were considered perfectly normal (even in polite circles) and dirty clothes were commonly worn without washing for long periods of time. Pest infestations such as Pediculosis (lice) and fleas were most common in both men & women alike.

Despite the often contradictory and/or downright unhelpful results of early ‘heroic’ medical treatments, public opinion at first did not seem to hold practitioners themselves responsible for untoward outcomes of physician treatment. If treatments appeared to be successful, on the other hand, and the patient emerged from his or her illness in good health, doctors were credited for the outcome and lauded; if the patient did not, most often it was regarded merely as ‘God’s will’ or ascribed to fate or unrelated circumstance. Then too, old fashioned religious beliefs often held that disease and ill health were actually God’s punishment for not living a good Christian life, hence reinforced religious instruction was often thought to be more helpful than medical treatment I dealing with disease.

Interestingly, as regards wealthy southern plantation owners and their many black slaves, doctors of the early 1800s took unwarranted risks and applied their (often dangerous) therapies without much regard when it came to treating indentured workers for ill-health. Since slaves were regarded as valuable property (much as were cattle), it was in the practical best interests of the slave holder to keep his slaves in good health, since otherwise they were useless to him. Black women in particular were most at risk for the adverse effects of overly enthusiastic conventional (white) medical care, given that doctors could and would readily perform fearsome procedures on them that would have been strictly forbidden on proper white women. Such was the fear that white medical practices of the early 1800s provoked in slaves that most actively resisted any attempts to treat or cure them by white medicine and would rather hide their illness from the owner than receive white medical attention. This in turn led to a recidivistic reliance on ancient African tribal remedies, folk customs and herbal treatments that continued to flourish covertly on plantations for decades.

Curiously, in the late 1700s, it was sometimes leading members of early American society with an amateur interest in healing (who were not actually professed ‘doctors’ themselves) who were more helpful in rectifying health problems, than those who characterised themselves as physicians. One excellent example of this is found in the Reverend Cotton Mather of Massachusetts, who although never having formally studied the healing arts, was nevertheless a very intelligent & intuitive individual who early-on recognised the value of the new technique of inoculating patients with a small amount of serum from smallpox patients and advocated it in the face of fierce ‘professional medical’ criticism back in the mid-to-late 1700s. Tellingly, although a few of the inoculated patients still died, the vast majority of inoculated individuals built resistant immunities to the smallpox virus and survived (vice an extremely high rate of mortality in those who did not receive inoculation). Yet, formal medical resistance by his contemporaries to such an outlandish concept as inoculation continued for decades. Regrettably, Cotton Mather (a direct genealogical descendant of ours, I am told) was also a very devout man of the cloth and, as we all know from our American History lessons, sent a number of innocent women in Salem to the stake to be burned as witches, in his zealous pursuit of evil!

Meanwhile, whilst medical education and learning was advancing quite significantly on the continent (especially in France), America’s relative geographic isolation, some 3000+ miles distant, resulted in the common perpetuation in many of the worst popular medical therapies and treatments, helping eventually to discredit the name of physicians everywhere in America among ordinary citizens, as the century progressed and westward expansion continued.

Another school of medical theory at this time also gained ground against traditional therapies and that was the practice of homeopathy, or the benign treatment of afflictions and disease with non-heroic measures (‘heroic’ being traditional purging and blood-letting practices, as well as more harshly physical treatments). Homeopathy was the invention of a German physician, Samuel Hahnemann, who in the early 1800s had noted that treatment of diseases with certain herbal remedies often produced remarkably similar symptoms to that of the actual illness being treated. He concluded that treating the ill with small doses of mildly compounded herbal remedies helped stimulate the body’s natural healing abilities. Since this form of treatment (with bland-tasting and not unpleasant oral preparations made from natural ingredients) was far more attractive (and less painful) than the conventional heroic medical practices, homeopathy quickly gained a considerably popular following in America. During the massive and deadly mid-century cholera epidemics homeopathy gained even further favor, although the mortality rate of all who were thus afflicted with the disease continued to soar remarkably, whether treated conventionally or homeopathically. At least homeopathy was relatively harmless!

A number of other alternative modes of treatment grew up within this same time frame, not least of which was ‘hydrotherapy’, involving the use of various mineral water cures to heal. Long popular in Europe, this new idea from the continent also gained much following, but it too was joined by a great many other ‘fertile’ theories as to how to treat disease and medical infirmity. Advocates such as John Harvey Kellogg, a fierce and zealous advocate of vegetarianism and frequent gastric purging (enemas) also gained a remarkable following, as did others who promoted various ‘electrical’ and ‘magnetic’ devices that they believed helped cure maladies (Kellogg is the same man who originated & popularized ‘Kellogg’s Cornflakes’, a breakfast institution that still exists as a popular cereal; for a hilarious 1994 movie about Kellog and his medical empire, see 'The Road to Wellville').

Finally, in an effort to help control the rapidly growing number of sometimes bizarre alternative healing practices and to establish some kind of uniformity to medical treatment, in 1847 the American Medical Association was established. Among its aims was the intent to set forth high standards of medical care, impose rudimentary licensing and most particularly formulate higher preparatory requirements for medical education, since up to that time the quality of American medical learning varied wildly due principally to the rampant commercialization of medical training. Medical vetting of physicians at the time consisted of everything from diplomas sold by out-and-out diploma mills (from which one could literally ‘buy’ a medical degree) to a very few erudite and highly legitimate centers of academic excellence (usually associated with universities and requiring up to two years of study for graduation). One of the chief aspirations of the AMA was to require that before being admitted to any medical school, the prospective student be possessed of a certificate of graduation from a recognised college. Needless to say, although its objectives were enlightened, far-reaching in their insight and most admirable, the pitched battle (from 1847 to 1910) to establish these new standards continued for nearly a half-century. Unfortunately, professional arrogance personified by the august national self-regard of the AMA also proved resistant to many other forms of positive change and included in these latter areas was strongly entrenched chauvinistic male prejudice against women seeking to become doctors. Medicine was (or should be), it was felt, strictly a male calling…despite centuries of successful mid-wifery and inherent female familiarity with the birth process. To this day, some of this strident male bias still exists in medicine, amazingly. Despite this prevalence of male prejudice, there were a small number of bright and dedicated women who did manage to become doctors at more recognised medical ‘schools’; history has since shown that most were quite accomplished.

Consequently, by the time of the American Civil War, most American ‘doctors’ were still generally quite poorly trained and incompletely educated. In fact, at one point none other than the erstwhile Harvard Medical School deigned that subjecting medical students to the written examination process was impracticable and futile due to the high proportion of students who were fundamentally illiterate!

In the mid-1800s, the more or less common means of gaining a practical medical education was by then represented by the apprentice system. That is, a young man who wished for a career as a doctor would apprentice himself to an established doctor and essentially work for him in any manner the doctor wished. While this included a large number of menial chores and nuisance tasks, it also permitted the aspiring young would-be doctor to follow his mentor around on his rounds and house-calls where he would frequently take a direct role in the treatment (thereby gaining valuable hands-on experience). Due to the non-uniform level of varying professional knowledge and training many of the mentors had, it was often purely only through coincidence that native intelligence, dilligence and good powers of observation permitted an aspiring student doctor to gain the insights and intuition that would enable him to respond appropriately to a patient’s needs.

To complicate formal, academic centers of medical learning and the wide-spread and common ‘apprentice’ internships, the vast carnage of the Civil War suddenly created a huge demand for what were called ‘regimental surgeons’. These men, who frequently had little actual medical training and/or experience (their claims as doctors frequently based merely on their own testimony to that fact), would be commissioned as junior officers in state regiments and tasked with treating the many tragic victims of that war’s battlefields as best they could. Some of them were, as historical accounts have shown, quite good, while others were barely better than bloody butchers, since given the lack of adequate sanitation and rampant wound contamination that prevailed, mortal wounds leading to gangrenous infections often required rather rapid resort to saws and bone-cutters. Amputations, therefore, were a hallmark stigma of many surviving Civil War veterans and they were vivid visual evidence of the battlefield regimental surgeon’s skill (or lack of it) for decades after the war.

Due to a shortage of suitable anaesthetics, despite discovery of nitrous oxide (‘laughing gas’), chloroform and ether earlier in the century, physically heroic measures were often carried out under the most barbaric conditions and the press of severely injured soldiers in every case quite overwhelmed all available medical services. More often than not, the only available anaesthesia of choice was a bottle of whiskey, but a great number of traumatic operations (such as amputations) were performed without any anaesthesia whatsoever.

Further, given the haphazard nature of many of the Army’s so-called regimental surgeons’ abilities, even the more enlightened calls by doctors for adequate provision for and supervision of personal hygiene and sanitation in the Army units typically fell unheeded by higher command, and field commanders generally took a dim view of medical personnel at any rate. Things grew so bad, as the war progressed, that eventually the US Army felt forced to take matters into its own hands, wresting field medical treatment from the proprietary state regiments and instituted its own US Army Department of Medicine. While this helped to some extent to reverse the appalling status of medical care soldiers received and somewhat standardized treatment, it also created a number of complex bureaucratic problems of its own and things largely continued more or less the same until after the war had finally ended.

One of the more unrecognized aspects of the American medical establishment (as contrasted to Europe’s) was that while in Europe, professional identity as a physician was stringently defined by law, in the United States at mid-century professional bona fides were far more casually determined. In America a doctor’s professional recognition was chiefly influenced by whom he was personally. Much depended upon his personal character, his ability to inspire a following, his mannerisms, his ability to amplify his own special adroitness as a pillar of society, his acceptance by peers (and yes, even his actual educational achievements)…all played a part in his public personae and credibility as a recognised, respected & legitimate healer. It was, clearly, often hard to separate the legitimately trained and astute medical practitioner from the charlatan, poser or patent medicine merchant (‘snake-oil seller’), as a consequence.

In a nation that would soon become known for its P.T Barnum flim-flammery and hucksterism, doctors in America, by mid-century, were often what they claimed to be solely on the faith of their own testimony to that effect. This obstinance demonstrated by the ‘orthodox’ medical profession to indignantly stand upon its own dignity and austerity in the face of documentable verification helped set the many competing elements of health care providers against each other, and the broader overall result of that was eventually a widespread distrust by the general public for anyone claiming medical expertise as a healer. Regrettably, the more insecure the practitioner, the more shrill were his claims of legitimacy, and the often advanced scientific nature of rapidly developing European medical practice was sometimes reactively rejected as ‘inappropriate to America’ or even derided by American doctors as abjectly fallacious and insubstantial poppycock.

No wonder then, that so many average Americans had little faith in the young doctors who chose the remoter areas of the developing country in which to initiate a practice. Another trend that further complicated regard for legitimate doctors was the rise of so-called ‘patent medicine’ that made a bizarre range of claims to cure ills, stretching from the sublime to the ridiculous. Since the typical patent medicine of the time was typically (disproportionately) formulated from ETOH (ethyl alcohol), patent medicines received widespread favor by nearly everyone. Even intensely religious mothers and wives who felt that alcohol of any kind was a mortal sin kept bottles of ‘patient medicine’ in the cabinet for an occasional nip to help cure whatever they felt they were suffering from (hence ‘medicinal whiskey’). And lacking any sort of uniform national regulation governing their contents, these generally ineffectual but invariably euphoric preparations typically contained as much as 45% ETOH (plus just as often a healthy percentage of highly addictive narcotic substances such as opium; one of the most common pharmaceutical tools in any rural doctor’s bag was an ample supply of ‘Laudenum’, a liquid formulation of opium that was liberally handed out for almost any health problem). The popularity of patent medicine, as typically sold by itinerant so-called ‘snake-oil’ salesmen, who traveled about in wagons hawking their fares to the accompaniment of colorful side-show entertainment acts, was extraordinary, especially in sparsely settled frontier areas west of the Mississippi, but more about that later.

The Westward Movement and Medicine in the ‘Old West’

As wagon trains of the early-to-mid 1800s pushed westwards to help claim & settle the new territories being literally stolen from Native Americans, there was a persistent higher-than-normal need for medical services, both on the wagon trains themselves and in the small frontier communities that were established along the way as the number of settlers grew.

This attracted a fair number of doctors who could not establish a practice in the older, eastern cities...both those who were more educated & legitimate and those who were barely possessed of a purchased diploma. Life was difficult at best for these practitioners, since their patients were invariably extremely poor themselves and never had the money to pay cash for medical services they might need. As a result, young doctors often had to work in other capacities, simultaneous with hanging out a medical practice shingle. Patients often could only pay for medical care with homegrown goods, perhaps a chicken, a jar of preserves, a cord of wood and so forth. Payment in kind was the norm. Clearly, one did not become wealthy taking care of human ills and maladies in the frontier west. Those who did manage to gain the acceptance of a town’s population, particularly those who married well and had a family, could and would find respectability at some point in fledgling settlements, but the life was a very hard and demanding one at best, and gaining a positive public regard was never an easy or assured process.

In the 1950s television western series ‘Gunsmoke’, surely one of the favorites of that era, the character known as ‘Doc’ was one of the central figures. Always neatly dressed, personable and sagacious, fatherly ‘Doc’ was actually quite atypical of the average frontier doctor. Many real Old West doctors from more questionable backgrounds, not unusually fleeing from some sort of medical fiasco back east, were also very fond of their ‘medicinal whiskey’ bottle and frequently the town’s doctor was one and the same as the town drunk.

Fortunately, that wasn’t always the case and there were, mixed in among that very variegated population of would-be healers, a number of exceptionally committed medical practitioners, men who were genuinely and selflessly dedicated to helping others, no matter how demanding or thankless were the duties they were called upon to perform.

On a tangential note, life in Old West frontier settlements was vastly different, of course, than that depicted in the television Westerns I so much enjoyed back in the 50s (and still do). In most of those programs, the women are always strikingly pretty and all have very prominent (1950s style) bosoms barely restrained within tight fitting, perfectly tailored blouses, with perfectly coifed hair and fresh, fair complexions, looking as if they had just stepped out of a Hollywood studio’s make-up department (since of course they had). The male characters in those series are similarly grossly stereotyped. All have chiseled good looks, wear perfectly sized, custom tailored shirts (that defined their manly muscles), vests and tight-fitting pants (unthinkable back in those days) that defined, er… ‘other attributes’. Until the art of western film-making became slightly more refined in the 60s, our heroes’ hats were always similarly spotless, clean with nary a sweat-stain to be seen, despite the extreme high temperatures experienced under the hot western sun of desert regions. The nuisancesome and semi-retarded appearing Indian characters they battled against were almost laughingly obvious as dressed-up White men, and town life in even the tiniest of settlements had an appealing, almost Disneyesque hygienic character.

The actual reality that existed then was far different. As mentioned earlier, potable water was frequently scarce and even when it was available, it was used strictly to assuage thirst…not to bathe in. As a result, bodily odors were both very common and extremely ripe, in men and in women alike, and most people were lucky if they bathed several times a year. The idea of romantic intimacy at dances (let alone in bed) must have taken a keen ability to resist attendant odoriferous nuances of the most extreme type!

In fact, far too often available water sources were frequently grossly contaminated by effluent and livestock, serving as common reservoirs of disease. Some vague awareness of this did exist, although steps to prevent water contamination were seldom undertaken, and as a result whiskey became the single most popular drink preferred by most men (interestingly, one of the chief reasons why drinking liquor was so popular throughout America), since one did not get sick with disease from whiskey (unlike water) and alcohol also had a natural sterilizing effect (which made it popular for pouring over the doctor’s hands before delivering a baby, if such a need even occurred to him…more often it did not). Smaller dead animals were routinely left to rot where they fell in small towns and one of the town marshal’s chief regular duties, incidentally, was to remove and dispose of dead critters.

Clothes couldn’t be easily washed without a nearby natural water source, so the norm was to wear them for prolonged periods without cleaning; this was particularly true out on the cattle range. One documented instance records a frontier family actually ‘sewing’ their children into their clothes every fall and only ‘unsewing’ them in the spring. As for the 50s era ‘perky bra’ look popularized by young Hollywood stars posing as frontier ladies, the real norm was either unsupported bosoms in shapeless shifts worn under drab clothes or (somewhat later) constraining corsets and decidedly unrevealing, conservative attire. Cleavage displayed by bargirls back in those days was far less common than old TV westerns would have one believe.

The level of attractiveness typified by leading male & female actors in television westerns was, as has been pointed out, also grossly misleading and purposefully overstated. ‘Ugly, or at best drab ‘plainness’ was the actual norm and rare was the sartorially fresh, appealingly attractive man or woman in most frontier settlements.

But returning to frontier medical practices, as the field of medical healing further fragmented and diversified into many competing schools of theory and practice the cumulative effect was to cast a very poor light on the profession as a whole. Small frontier settlements typically were exposed to a wide range of competency as the west opened up further. Although sooner or later a moderately competent practitioner would manage to establish a practice, it was still no sure way to make money. As a result the existing documentation for the period from about 1850 through 1900 shows that most who called themselves ‘doctors’ were forced to supplement their income by performing other services and kinds of work in the communities. In numerous cases, ‘doctors’ went on to open gold mines (prospecting), run for civic office, contract to the railroads and in some instances even worked as cowhands, and at various odd unskilled labor jobs. Many were initially drawn to the Old West by virtue of their having been regimental surgeons for the US Army’s cavalry detachments that helped protect settlers against reprisals by hostile Native American tribes, and a fair number remained in the west after release from Army service.

The general low-regard for medical healing by many people notwithstanding, good doctors often did end up with grateful patients, since the mere presence of a supposed ‘man of the healing arts’ was a comforting thing in itself when a child was sick, a woman faced with a delivery, and/or a ranch-hand stricken with a snakebite, broken bone or gastrointestinal problem. By word of mouth in the case of successful cures or treatment, the reputation of such truly skilled practitioners most commonly spread. However, there always seemed to be a shortage of these gifted healers and most frontier doctors had to be quite accomplished at traveling substantial distances to often remote areas by horse, sled or sleigh in order to care for their patients.

Belief in the healer was fully as important as his actual skill in providing beneficial care, a principal that was frequently at work behind the many less harmful medicines and elixirs that were commonly used. This, of course, had been a given from earliest times, since the mere faith (prayer has been shown to have a similar effect on people) that someone has healing skills has a beneficial effect on the body’s own immune system, thereby speeding up and enhancing whatever self-limiting effects an illness may have (and of course many illness were in fact self-limited, meaning that they would run their course and resolve themselves regardless of any external assistance). This is the well-established ‘Placebo effect’ and it should never be underestimated as a useful medical tool.

Native Americans in the Old West had long held their own healers (‘medicine men’ or shamans) in extremely high regard and to a surprising extent, many of their ‘cures’ and/or potions were successfully based on natural herbs and ingredients found commonly in nature. However, tribal esteem varied from tribe to tribe and in some of the tribes, if a medicine man failed to effect a cure (such as in the massive smallpox & cholera epidemics that plagued the mid-to-late 1800s, decimating Indian populations of many thousands who lacked no natural immunity against the whiteman’s diseases), he was sometimes put to death. Many Indian shamen learned that it was at least to their benefit to put on a good show, regardless of any actual help that they could convey, since failure to do so could be fatal.

Women in western white settlements at that time were thought to be, as a rule, rather fragile creatures to be sheltered and protected by their menfolk, although we now know this to be a glaring fallacy, since it was often the female gender that provided the real backbone and enduring strength to pull a family through hard times. That did not prevent the so-called ‘snake-oil’ sellers from targeting women’s supposed gender-related weaknesses with a wild array of potions, solutions and preparations that were mostly harmless at best (but which typically contained a large percentage of alcohol and often opium), but that provided a certain sense of comfort from the belief that they would actually help. One of the best known was Lydia Pinkham’s patient medicine (‘Lydia E. Pinkham’s Vegetable Compound’), a preparation that contained 15% alcohol, Vitamin B, Black Cohosh, Unicorn Life Root Plant, Dandelion, Chamomile, and a few other ‘secret’ ingredients (among them a high percentage of opium). Advertised as ‘the only positive cure and legitimate remedy for the peculiar weaknesses and ailments of women’, this herbal remedy was introduced in 1873 and before long became a staple in every Western household (and most Eastern ones, as well). By 1881 Pinkham’s company was clearing over $30,000 a month. In late 1800s dollars, that’s a huge sum.

Some of the more famous Native American related cures included the so-called Kickapoo Medicine series. Based in Connecticut but deceptively named after the Kickapoo Indian Tribe in Oklahoma, the Kickapoo Tonic claimed to cure just about any ailment under the sun, but its principal effect was typically that of a strong purgative (laxative). There was also Kickapoo Indian Salve for skin problems and several other preparations sold under the Kickapoo name, all of which were equally harmless but kept the bowels regular. Not uncommonly the Kickapoo Medicine Company sold its wares through colorful side-show promotions featuring performers in Indian clothing (who were most often white men, when real Indians were scarce or hard to find). Amusingly, the ‘Kickapoo’ name lived on for many years in 1940s/50s cartoonist Al Capp’s ‘Lil Abner cartoon strip (featured in the newspaper funnies), Capp showcasing it therein as a potent illegal moonshine named ‘Kickapoo Joy Juice’.

Back in the 1800s there were no laws against the sale or use of what we now regard as potentially dangerous (if misused or taken for recreational purposes) narcotic substances and almost all patient medicines contain varying amounts of opium, cocaine, morphine and the ever present alcohol (ETOH). Even the earliest iteration of the popular soft-drink Coca-Cola included a surprising percentage of cocaine (derived from coca leaves used in its original mixture). As a partial result, many people actually became addicted to some of the patent medicines, women in particular since they co-dependently allowed themselves to believe in the need for such ‘medicines’ to help alleviate ‘female weaknesses’. And of course ‘bitters’ were a favorite of many men when they ate and drank (‘bitters’ eventually became a generic term for ‘alcohol with herbs mixed in it) and as mentioned before, many women who would have been aghast at the idea of taking even a drop of so-called ‘strong drink’ would regularly consume varying amounts of patent medicines that often had as much as 45% alcohol in them. [It helps here to picture sober, little old God-fearing, church-going Grannie taking a liberal snort in the pantry, when no one else was about.]

Another feature of western frontier towns was the town pharmacy, most commonly called a ‘drugstore’ (the term remains in common use today), that was generally owned and operated by a person with at least some medical training and background in the healing arts (as mentioned at the outset of this piece, my own grandfather, Charles A. Terhune, Sr., was such an entrepreneur, opening up a drugstore in Burley, Idaho, in the late 1800s). The typical drugstore contained not only a diverse range of medicinal preparations but functioned also as a gathering place (like the town general store) and it became the custom for many men to frequent the town pharmacy and while away their spare hours to the point where it became a regular nuisance. Since spitting was an accepted male custom back then (that continued into the early-to-mid 1900s), spittoons were strategically placed for their use, but aim was generally poor and much disease ended up being spread by poorly placed wads of chewing tobacco on the typical sawdust floors of such gathering places. Drugstores also carried a useful line of sundries and miscellaneous goods, in addition to medicines, with most of the medicines actually compounded and prescribed by the druggists themselves, since authorization by a ‘doctor’ was not required before regulations changed all this in the early 1900s. [The Ice Cream Soda was also invented in a western late 1800s drugstore, when a hired helper (the world’s very first ‘soda jerk’) accidentally dropped some ice-cream he was eating into a glass of soda phosphate and the result was so tasty that it began to be featured as a regular item, to be conveniently consumed at a counter in the front of the drugstore much like those in a bar, but complete with rudimentary stools to sit on.]

In summary, so-called medical care in the American Frontier West was as wildly variable and unpredictable as most other aspects of settlers' lives and it was this general breakdown of legitimacy that prompted measures to be spearheaded in the very late 1800s by the American Medical Association to set stringent standards for anyone wishing to qualify himself (or herself) as a recognised ‘doctor of medicine’.

By the early 1900s, advances in science & technology (most taking place in Europe) finally began to change the face of rural, often primitive frontier medicine, as purpose-made medical instruments (stethoscopes, microscopes, etc.) became more comonplace in sparsely settled regions, and the recognition of germ theory, immunisation and the importance of sterile technique resulted in adoption of gloves, masks and other barriers to help control contamination and halt the casual spread of bacteria. Medicine began a massive sea change at that time that has since merely unfolded exponentially.

The Beginnings of so-called ‘Modern Medicine’

In 1910, a landmark study of medical care practitioners and facilities, begun under the aegis of the Carnegie Institute, was published. This was the famous ‘Flexner Report’ that categorized and highlighted the vast number of problems that needed to be addressed & resolved if medicine was to become a truly sophisticated, respected, legitimate and fully competent profession.

Among the recommendations of the Flexner Report was a call for the establishment of regional receiving hospitals, clinical treatment centers and medical schools where stringently supervised academic training could be completed by prospective medical students. These were in almost every case associated with an established & reputable university or college, and required as a basic admission requirement a college degree for entry. Prior to this time, due to the fact that medicine had been so heavily ‘commmercialised’ (with diplomas often being sold for set fees and requiring in some cases no actual training whatsoever), the range of competence and actual medical skill found among so-called ‘doctors’ had heretofore varied immensely. That was all soon to change rather dramatically by 1915 (and even further after the end of WW1).

With the established acknowledgement of the Flexner Report’s findings, a profound change occurred in the practice of medicine and the modern professional calling we now regard as being among the highest and most respected in the nation; the ‘doctor of medicine’, or MD as we know it today, came into being for the first time. Since 1910 medicine has become so carefully regulated and controlled many actually feel there’s presently almost too much regulation. However, due to the growth of that other ‘top-of-the-food-chain’ profession, law, intensive regulation of the medical and pharmacological professions has become absolutely mandatory. With tort law and medical malpractice lawsuits now commonplace and encouraged everywhere in a nation that presently has more lawyers than it knows what to do with, there is no turning back.

Whether or not the overall quality of life in those wild, early decades of Old West medical healing was ‘good’ or not depends largely upon how one looks at things and to what extent one regards the advances of science and technology as being beneficial (or not). Science and technology, proeprly to be regarded only as useful tools, have taken on an aura of supreme omnipotence. There is today a concurrently disturbing trend to over-regard doctors as god-like totems, all-knowing and omniscient beings with absolute knowledge of what does or does not benefit human life. In one sense this overweeningly arrogant, elevated self-regard of the profession ironically acts as an inhibitor to actual improvement of the quality of human life, since the erstwhile ‘Hippocritical Oath’ (my term) is regularly invoked as a justification to outlaw the practice of euthanasia (even when it is actually more merciful than painfully extending the life of a terminally ill person). Religion is most often the biggest obstacle in the way of medical ethics becoming more malleably suited to modern day human life-quality issues, of course, but the profession itself (in the person of the American Medical Association, with its immensely powerful lobbying resources, or the similarly powerful international commercial pharmaceutical companies) also shows a remarkably unfortunate tendency to calcify its outlook in ways that favor the fortunes of physicians and medical people more than the basic needs of ordinary people. With the rise of the modern HMO system (first undertaken by Henry J. Kaiser with his Kaiser Health Foundation enterprises in the late 30s), modern medicine has become both unfathomably complex and resistant to the precepts of true humane regard and care for human life (despite all the blathering ‘horse exhaust’ PR sentiment of medical provider corporations to the contrary; as in "We CARE for you!"), since the matter of profitable bottom-lining is firmly lodged among its chief institutional priorities.

All of this is far beyond and outside the scope of my very modest efforts here to give a quite tiny and casual glimpse into how the healing arts were taken up and practiced in the mid-to-late 1800s Frontier West, as America expanded its territorial boundaries. Hopefully, this piece will stimulate readers to read the books listed immediately below, all of which constitute an absolutely fascinating source of information bearing upon this subject. Anyone who reads all of them will know about as much as anyone needs to understand about what it was like to be either a physician and/or a patient in those wild & wooly days of heathcare yore. And it is an amazing story indeed!

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Suggested Further Reading:

1) ‘Medicine in the Old West: A History, 1850-1900’, by Jeremy Agnew, McFarland & Company, 2010, ISBN 978-0-7864-4623-0.

2) ‘Bleed, Blister & Purge: A History of Medicine on the American Frontier’, by Volney Steele, MD, Mountain Press Publishers, 2005, ISBN-13: 978-0-87842-505-1.

3) ‘Lotions, Potions, Pills & Magic: Health Care in Early America’, by Elaine G. Breslaw, New York University Press, 2012, ISBN 978-0-8147-8717-5 (hardbound, but also available as an E-book). [This is a particularly informative and well researched book that is fortunately also a great read.]

4) ‘Doctors of the Old West: A Pictorial History of Medicine on the Frontier’, by Robert F. Karoleuitz, Superior Publishing Company, 1967, (no ISBN, but Library of Congress Catalogue Card Number 67-20239. [A beautifully and thoroughly detailed pictorial history, with many very interesting early B&W photographs dating from the mid-to-late 1800s.]

5) ‘Rugged Mercy: A Country Doctor in Idaho’s Sun Valley’, by Robert Wright, Washington State University Press, 2013, ISBN 978-0-87422-314-9. [An account of what it was like to provide medical care to settlers in this rugged part of Idaho’s Rocky Mountain Range, location of the famous and historic Sun Valley Resort.]