Friday, March 4, 2016

1769: Buchan and Smellie's self help book

Cover page from "Domestic medicine"
Almost all medical books prior to the late 18th century were written for medical students and physicians, and were therefore long-winded, dry, and full of complicated medical terms that made them difficult for the common person to read.  This all changed in 1769 when two men joined forces to publish a medical book that anyone could understand.

The two men were William Buchan, a physician, and William Smellie, a printer. Buchan is generally given credit for the book, as his name is on the cover and Smellie's is not.  Still, some people believe that Smellie wrote the book, and Buchan's name was put on it simply to give the book credibility.

Smellie  was a printer, editor and encyclopedist who also had an interest in medicine.  His name would only appear in the first edition of the book as the printer.

While the two men probably wrote the book for "economic reasons," they also did it "for the humanitarian purpose of providing substitute for the deficiancies of medial care.  But, besides this, its author saw a useful, even necessary virtue in 'laying Medine more open to mankind'."

The book essentially brought a basic knowledge of medicine, which included information and treatment of respiratory diseases such as asthma and tuberculosis, into the homes of thousands of Europeans and Americans.

In this way, a common housewife could easily learn how to treat the common diseases or injuries of the day simply by flipping through the pages of the book.  It would be the 18th century equivalent to doing a Google search for "how to treat asthma," or "what are the common signs and symptoms of pneumonia."

Their book brought scientific ideas about diseases known to physicians, and placed them in an easy to read format, replete with preventative measures and remedies. Their book, "Domestic Medicine" was first published in 1769.

The authors -- be it Buchan or Smellie or both -- believed that if the populace was better educated about medicine, fewer lives would be lost to the diseases mankind faces.

In the preface to the 11th edition, the author said that as a...
...malancholy fact: that almost one half of the human species perish in infancy, by improper management or neglect."
He believed that most of these deaths were due to the "ignorance,"  and that "it is hoped, that when nurses are better informed, their conduct will be very different." (4, page x)

Dr. William Buchan (1708-1809)
So the humanitarian intent was obvious.

Whether the authors succeeded in educating the public cannot be known, although what is known is their book was a huge economic success.  (1, page 217)

"Domestic Medicine" was the most popular "self help book" prior to the 20th century, with over 80,000 copies being sold prior to Buchan's death in 1805.

The book was ultimately translated into every European language, and over the next 200 years would go through 19 editions.  (1, page 217) (2)(5, page 20)

The book was also "published in Philadelphia in 1771," and "continued to appear from a variety of towns and at frequent intervals until its demise at Boston in 1913. Throughout its many variations the basic form of the book remained unchanged." (5, page 20)

While Buchan was credited as writing the book, little else is known of his life. Although we do know that one of his teachers was William Cullen.  Smellie, on the other hand, "compiled, edited and contributed to the first edition of the Encyclopedia Britannica published in 1771."  He also wrote "Philosophy of natural history," another book that had a successful run.  (5, page 21)

William Smellie (1740-1795)
Buchan was a physician, and Smellie extensively studied medicine.  Most evidence suggests Buchan wrote the original copy of the book, and "Smellie compressed, corrected, and to some extent rewrote (it)."  (5, page 21)

Although, to what extent each of these authors actually contributed to the book no one really knows.  Some even, as noted above, go as far to say that Smellie wrote the book himself.  (5, page 21)

Like Cullen and other of his contemporaries of the day, the author of "Domestic Medicine" wrote against following the writings of quacks, which was probably a reference to root and herb doctors, or doctors of botanic medicine.  (3, page 72)

So, a housewife is coddling a 9-year-old boy who is struggling to breathe.  He is sitting in her wooden rocker, pressing his arms firmly on the arms of the chair in order to hold his shoulders up to create more space for air.  He appears stiff, and his entire body rocks with each breath.  She suspects the boy has asthma, so she pulls out her copy of "Domestic Medicine" to learn if this is true.  She yearns for a remedy, and is 20 miles from the physician, and the ground is covered with snow.

She flips through the pages until she got to page 406, and reads:(4, page 406)
The asthma is a disease of the lungs, which seldom admits of a cure. Persons in the decline of life are most liable to it. It is distinguished into the moist and dry, or the humoural and nervous. The former is attended with expectoration of spitting; but in the latter the patient seldom spits, unless sometimes a little tough phlegm by the mere force of coughing." (4, page 406)
She learns that asthma has quite a few causes: (4)
  • Hereditary 
  • Bad formation of the breast 
  • Fumes of metals or minerals
  • Violent exercise, especially running 
  • Haemorrhoids
  • Gout
  • Small pox
  • Measles
  • Sudden fear or suprise
  • Any cause that either impedes circulation of the blood through the lungs, or prevents their being duly expanded by the air (4, pages 406-411)
She learns the signs and symptoms of the disease (4, pages 406-411)
Quick laborious breathing, which is generally performed with a kind of wheezing noise. Sometimes the difficulty of breathing is so great, that the patient is obliged to keep in an erect posture, otherwise he is in danger of being suffocated. A fit or paroxysm of the asthma generally happens after a person has been exposed to cold easterly winds, or has been abroad in thick foggy weather, or has got wee, or continued long in a damp place under ground, or has taken some food which the stomach could not digest, as pastries, toasted cheese, or the like. (4, page 407)
This confirms for her that she has the proper diagnosis.  Now for the remedy, if there was one.  She remembers when she was a child her mother made her brother, who suffered from asthma, drink a shot of some liquor, but she couldn't remember exactly what it was.   

She learns that to treat and prevent a fit of asthma, the asthmatic -- in this case her son -- must follow a specific regimen.  If this alone doesn't prevent or allay symptoms, there are certain medicines that can be trialed.  (4, pages 406-410)
  • The food ought to be light, and of easy digestion
  • Boiled meats are to be preferred to roasted, and the flesh of young animals to that of old
  • All windy food, and whatever is apt to swell in the stomach, is to be avoided
  • Light puddings, white broths, and ripe fruits baked, boiled, or roasted, are proper
  • Strong liquors of all kinds, especially make liquor, are hurtful
  • The patient should eat a very light supper, or rather none at all, and should never suffer himself to be long costive. 
  • His clothing should be warm, especially in the winter-season.
  • Nothing is of so great importance in the asthma as pine and moderately warm air
  • Asthmatic people can seldom bear either the close heavy air of a large town, or the sharp, keen atmosphere of a bleak hilly country a medium therefore between these is to be chosen.
  • The air near a large tpwn is often better than at a distance, provided the patient be removed so far as not to be affected by the smoke. 
  • Some asthmatic patients indeed breathe easier in town than in the country; but this i$ seldom the case, especially in towns where much coal is burnt.
  • Asthmatic persons who are obliged to be in town all day, ought at least to sleep out of it. Even this will often prove of great service
  • Those who can afford it ought to travel into a warmer climate. Many asthmatic persons who cannot live in Britain, enjoy very good health in the south of France, Portugal, Spain, or Italy.
  • Exercise is likewise of very great importance in the asthma, as it promotes the digestion, preparation of the blood and etc. The blood of asthmatic persons is seldom duly prepared, owing to the proper action of the lungs being impeded. For this reason such people ought daily to take as much exercise, either on foot, horseback, or in a carriage, as they can bear.
Buchan recommends medicine when the asthmatic is "seized with a violent fit. This indeed requires the greatest expedition,:as the disease often proves suddenly fatal."  

Upon reading the word "fatal," she felt a palpation in her chest.  She read the next words fast, yearning to fix up this remedy.  (4, pages 408-409)
In the paroxysm or fit, the body is generally bound; a purging clyster, with a solution of afafeetida, ought therefore to be administered, and if there be occasion, it may be repeated two or three times. The patient's feet and legs ought to be immersed in warm water, and afterwards rubbed with a warm hand, or dry cloth. Bleeding, unless extreme weakness or old age should forbid it, is highly proper. If there be a violent spasm about the bread or stomach, warm fomentations, or bladders filled with warm milk and water, may be applied to the part affected, and warm cataplasms to the soles of the feet. The patient must drink freely of diluting liquors, and may take a tea-spoonful of the tincture of castor and of saffron mixed together, in a cup of valerian tea, twice or thrice a-day. Sometimes a vomit has a very good effect, and snatches the patient, as it were, from the jaws of death. This however will be more safe after other evacuations have been premised. A very strong infusion of roasted coffee is said to give ease in an asthmatic paroxysm. (4, pages 408-409)
He then describes two types of asthma: moist and convulsive/ nervous.  Moist asthma was a common term for asthma that presents with chronic cough and excessive sputum production, and it may actually be what we refer to as chronic bronchitis.  For this type of asthma the author writes: (4)
Such things as promote expectoration or spitting ought to be used; as the syrup of squills, gum ammoniac, and such like. A common spoonful of the syrup, or oxymel of squills, mixed with an equal quantity of cinnamon-water, may be taken three or four times through the day, and four or five pills, made of equal parts of afafœtida and gum-ammoniac, at bed-time*. (4, page 409)
This certainly did not describe her son's asthma.

The author then explained convulsive or nervous asthma as a type of asthma whereby some exciting cause incites the nervous system to send signals to the lungs to cause the muscles wrapping around the air passages to spasm.

Obviously neither Buchan nor Smellie wouldn't have known about bronchial muscles, although they were well aware that air passages of the lungs spasm during a fit.  He explained that spasms generally left no lesions, and therefore were often regarded as a neurosis.  For this type of asthma they said: (4)
For the convulsive or nervous asthma, antispasmodics and bracers are the most proper medicines. The patient may take a tea-spoonful of the paregoric elixir twice a-day. The Peruvian bark is sometimes found to be of use in this cafe. It may be taken in substance, or infused in wine. In short, every thing that braces the nerves, or takes off spasm, may be of use in a nervous asthma. It is often relieved by the use of asses milk; I have likewise known cows milk drank warm in the morning have a very good effect in this case. (4, pages 409-410)
They add:  
In every species of asthma, setons and issues have a good effect; they may either be set in the back or fide, and should never be allowed to dry up. We shall here, once for all, observe, that not only in the asthma, but in most chronic diseases, issues are extremely proper. They are both a safe and efficacious remedy; and though they do not always cure the disease, yet they will often prolong the patient's life. (4, page 410)
So this is what you would learn about asthma upon referencing his book.  As noted above, it was among the few medical self help book prior to the 20th century.  Most other books regarding diseases and medicine were written for physicians.  As noted by Buchan in his 11th edition: (4, page vi)
Although the Domestic Medicine was never intended to supersede the use of a physician, but to supply his place in situations where medical assistance could not easily be obtained, yet the Author is sorry to observe, that the jealousies and fears of the Faculty have prompted many of them to treat this Work in a manner altogether unbecoming the professors of a liberal science: notwithstanding their injurious treatment, he is determined to persist in his plan, being fully convinced of its utility;nor shall interest or prejudice ever deter him from exerting his best endeavours to render the Medical Art more extensively beneficial to Mankind. 
While such self-help wisdom benefited our house wife, and was generally accepted by the populace, the medical community did not accept it so well.  In fact, physicians resented such information from getting out.  They wanted such wisdom to remain esoteric to only medical students and physicians, mainly because they feared that if people learned how to do what they were trained to do, they would no longer be needed.

Although, as we know today, that is hardly ever the case -- physicians were, are, and always will be necessary.  Yet if someone could treat basic problems in the home, it would be beneficial to the patient, but also to the pocket books of the patient and the patient's family.

It was nothing new for the medical community to look with antipathy toward such a "self-help" book.  In 1768, Dr. Phillip Sterns published a self-help book that was flat out rejected by the medical profession. Although, unlike Stern's book, Buchan's was a major success.

In fact, Buchan's book was so successful it was often plagiarized, as noted by Buchan himself in his 11th edition:  (4, page vi)
But this illiberal treatment of the Faculty is not the only thing of which the Author has cause to complain. By some of them his Book has been served up mangled and mutilated, and its title, type, size, &c. so closely imitated, that purchasers are misled, and frequently buy these spurious productions instead of the real one. That a needy Author, incapable himself of producing an original work, should prey upon another, and that a mercenary Bookseller should vend such productions, knowing them to be stolen, are things not at all to be wondered at: but that all this can be done with impunity, shews that the laws of this country respecting literary property, are still in a very imperfect state, and stand much in need of amendment.
Steeling other people's ideas, and making them available for free, continues to be a problem that plagues mankind to this day.  Both Hollywood and the music industry loses millions, if not billions, of dollars annually because pirated versions of their songs and movies are available for free on the Internet.

Regardless, there were many people in Europe and the United States who benefited from the wisdom available in the book of Buchan and Smellie.  The fact that this was a nice humanitarian effort, one that netted a nice profit I bet, made it worthwhile for Dr. Buchanan to risk his reputation to put is name on the cover.

  1. Nulan, Sherwin B, "The mysteries within: a surgeon explores myth, medicine and the human body," a good starting place is 216 where Nulan describes van Helmont's archeus and 
  2. Maryland, Hilary, "Medicine and Society in Wakefield and Huddersville: 1780-1870," 1987, Cambridge University Press, page 447 (this information is available too many references to name, and therefore is generally considered to be public knowledge.  I reference Maryland here mainly due to the quality of her reference).
  3. Jackson, Mark, "Asthma: The Biography," 2009, New York, Oxford University Press
  4. Buchan, William, "Domestic Medicine, or a treaties on the prevention and cure of diseases," 11th Ed., London, 1790, pages 406-410
  5. Lawrence, C.J, "William Buchan: Medicine Laid Open," Medical History, 1975, volume 19, pages 20-35. 
  6. Buchan, William, "Domestic Medicine: or, a Treaties on the Prevention and Cure of Disease by Regimen and Simple Medicines," 5th edition, 1776, London, pages 406-410
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