John Adams and Colonial Era Medicine
I recently finished the audiobook version of John Adams, David McCullough’s masterwork biography of the second President. Listening to Edward Hermann’s narration completed my third tour through the adventure of John Adams’ life. I had already read the book, then viewed the HBO miniseries starring Paul Giamatti and Laura Linney.
The book is of course the most complete version, as editorial decisions needed to be made for the miniseries. Although a few historical changes were made, the miniseries brings the era to life in vivid detail.
I have a particular interest in the medical elements of the story. Let’s take a look at three of them:
One scene depicts an early form of smallpox vaccination. Technically speaking this is variolation – the inoculation from a smallpox pustule into a small cut on the individual being immunized. Given the 30% mortality rate of smallpox, the 1-2% chance of death from the variolation procedure seemed an acceptable risk. This would remain the procedure of choice until Edward Jenner popularized inoculation with cowpox, which carried a far lower chance of death while still achieving immunity from smallpox. Smallpox was eradicated in the 20th century, now found only in laboratories in the U.S. and Russia. The debate today concerns whether the remaining smallpox should be preserved or destroyed.
Another interesting and harrowing scene features Adams’ daughter Nabby, who was diagnosed with breast cancer, and underwent a mastectomy. In the early 19th century the only possible cure was “the knife”, as Benjamin Rush told Adams. It is likely that anyone cured in that era likely had a diagnosis other than invasive adenocarcinoma, or had a very small tumor. We know today that breast cancer is treated both as a systemic disease as well as a local one. Nabby’s mastectomy allowed for local control, though it probably wasn’t worth the suffering she endured in that awful pre-anesthetic era of surgery. It struck me as unlikely that her longevity was improved by undergoing the operation.
A final consideration is John Adams’ long life, which extended into his 91st year. It seems apparent that good genes and good luck were as important to a long life then as they are now. His smallpox variolation was helpful in avoiding contracting that scourge. It is also noted that Adams badly cut his leg “to the bone” in a fall after retiring to his farm. His healing of this wound is another testament to a hardy constitution. Through most of his life, he drank hard cider, smoked a pipe, and carried a decent amount of weight. Compared to 21st century medicine, most forms of medical intervention in Adams’ day were worthless at best and often harmful. Good genes and good luck go a long way in any century.