Family Medicine: ‘Practical Family Doctor’ a window into health care before modern medicine

Life expectancy in 2020 was 77, down almost two years from 2019, the biggest decline since World War II, according to a recently released report from the U.S. Centers for Disease Control and Prevention.

COVID-19 and drug overdoses are mostly to blame, causes of death that didn’t register a century ago. Lately, I’ve been thinking about the forgotten afflictions that killed people back then as I flip through the 1908 edition of “The Practical Family Doctor,” passed down from my grandparents.

The 1,000-plus-page book was the WebMD of its day. From A to Z, the “The Practical Family Doctor” covered every affliction, every condition and injury along with every treatment and remedy known to medical science of the day. My grandparents, Ellis Crabtree and Mabel Morgan, purchased the household medical guide when they married and set up housekeeping in Kemmerer, Wyo., in October of 1908. The book has traveled from Wyoming to Idaho to rural north Clark County, where I live, as it was handed down through the family.

Medical history

At the dawn of the 20th century in 1908, tuberculosis, the dreadful bacterial infection of the lungs, was killing more Americans than any other disease. Pneumonia and heart disease ranked second and third. Average life expectancy for American men that year was 49. For women, 53.

For Americans in 1908, death was part of life and could take a family member of any age. Those dying from TB were typically in their 30s. Those succumbing to typhoid fever, in their 20s. Cancer was little understood and underreported as a cause of death. People faded away at home from illnesses that had not yet been defined. For every 1,000 women who gave birth in those years, as many as nine would die from complications.

Newborn babies were particularly vulnerable because of unsafe drinking water, unpasteurized milk and stomach infections. One-fifth of all deaths in the United States in 1908 were infants under a year old. When deaths of children age 5 and younger were included, the percentage jumped to 27 percent of all deaths, the American Council of Science & Health reports.

This was a time when most sick people were cared for at home by family members who relied on a medical guide such as “The Practical Family Doctor,” and occasional house calls from a general practice doctor. Doctors set broken bones, helped women give birth, dispensed medicines and speculated on what might be making someone ill.

Infectious diseases such as measles, acute bronchitis, whooping cough, diphtheria, croup and scarlet fever often were fatal to children. Polio, the disease that causes spine and respiratory paralysis, was on the rise.

Doctors had few tools to save their patients. Penicillin wouldn’t be invented until 1928. The use of insulin to treat diabetics wouldn’t be discovered until 1922. Vaccines had not yet been invented to prevent deadly diseases such as measles, mumps or diphtheria in children. While X-ray technology had been discovered, it was not yet in general use. Only in the prior 20 years had scientists begun to understand germs. In 1877, Louis Pasteur proposed the germ theory of disease that prompted doctors to start washing their hands in between visits with patients.

Fatal illness was a common visitor to families rich and poor. Both the wife and the mother of Theodore Roosevelt, elected president of the United States in 1908, died within hours of each other — his mother of typhoid, his wife from Bright’s Disease, an inflammatory kidney ailment. Both deaths in 1884 were sudden and devastating to the future president.

Celebrated American author, Mark Twain (Clemens) and his wife, Olivia, lost their daughter, Susy, to spinal meningitis at age 24. Olivia Clemens died at 58 from heart failure in 1904. Twain also was devastated.

Family losses

Soon after marrying in 1908, my grandparents, the Crabtrees, were urgently summoned east to Kansas where my grandmother’s younger sister, Rose, was dying of TB. Traveling by rail, they did not reach the bedside in time. Rose was dead at age 19, a lasting tragedy for the family.

The year before his marriage to my grandmother, Ellis Crabtree lost his first wife, Nellie Ruth Lyon, 29, to an undisclosed lingering illness.

After moving their household several times, Ellis and Mabel settled in Twin Falls, Idaho, where according to the 1930 U.S. Census, he was operating a pickle business — raising cucumbers, pickling them, then packing and selling them throughout South Idaho.

My grandmother, meanwhile, ran a boarding house that offered overnight and long-term lodging. My mother remembered her mother wearing a cloth headband to suppress her headache pain as she labored from dawn to dark doing laundry and cooking meals for boarders.

By age 30, Mabel had delivered three healthy children. Born in 1915, my mother was the youngest. A family photo portrait circa 1920s presents the image of a successful, healthy family.

Ellis (better known as E.E.) and Mabel lived through the 1918 flu epidemic, World War I, the Great Depression, World War II and survived comfortably into their 90s. He died in 1967 at age 93, she in 1983 at 98.

Their medical bible, “The Practical Family Doctor,” written by physicians Lyman, Fenger and Bellfield, apparently was well used. When handed on to me 45 years ago, the book’s spine was already missing, the cover faded.

Many ailments described in its pages today are no longer mentioned or deemed serious: dropsy (swelling and puffiness), lockjaw (tetanus), pox (sexually transmitted diseases), flux (internal bleeding), yellow fever, smallpox, cholera, croup, whooping cough and scarlet fever. Even writer’s cramp, a once serious affliction for bank employees, accountants and store clerks, would soon be on the wane as typewriters began appearing in offices.

Color illustrations and potential uses of medicinal plants appear in the book’s later chapters. An ounce of goldenrod, for instance, could be added to a pint of water to create an infusion that might relieve colic in babies. Mustard used as a powder could promote vomiting (if needed), or put in a plaster or poultice to relieve pain and promote circulation.

First published in 1883, then revised several times until 1908, “The Practical Family Doctor” was an encyclopedic tome meant to provide the “Most Approved Methods of Treatment, with Plain Instructions for the Care of the Sick.” Owning the book must have provided some sense of security for a family unsure of what illnesses they might encounter.

Curiously, a dictionary of drugs is listed in both Latin and English with names such as Acetum Opii or Vinegar of Opium, Spiritus Frumenti (the Latin label for whiskey) and Morphina, obviously morphine. The medical book mentions “drugs” that we now would find at an alternative health or herbal medicine store: star anise, flaxseed, arrowroot, cod liver oil and belladonna leaves. Recommended treatments called for natural remedies found in kitchen pantries such as bicarbonate of soda or at the local pharmacy where a druggist could mix up a solution of vinegar and opium.

Life expectancies

By 1908, the nation’s population had reached 87 million, 40 times greater than 100 years earlier. But life could be short, death unexpected.

According to CDC research, tuberculosis was killing hundreds of Americans daily at the beginning of the 20th Century. There was no hope of a cure. Sometimes it killed quickly. Often it was a lingering death that slowly damaged the lungs making it difficult to breathe with the victim drowning from the inside. The afflicted were sent to sanatoriums for rest and “cures.”

And since most Americans worked on farms or labored in mines, mills and factories, accidents were claiming more than 135,000 lives a year. Workplace reform was only beginning to take hold.

A great uncle of mine, Evan Kyle, died in 1927 when a team of mules hitched to a farm wagon lurched forward, tossing him off the back of the wagon. He struck his head on a rock in the fall and died.

Today, average life expectancy for men is 74, women, nearly 80. The decline in American mortality over the past 120 years can be credited to incredible advances in American living standards related to clean water, better housing and safer food, to landmark achievements in medical science and technology that brought us antibiotics and vaccines, diagnostic tools such as the X-ray machine and laboratory diagnostics.

Children no longer die soon after birth because of prematurity, complications of childbirth or birth defects.

“Children who previously would have perished from an array of childhood infections today live healthy and long lives thanks to sanitation improvement, vaccines and antibiotics,” reports the National Library of Medicine.

Today, women rarely die in childbirth as they once did in 1908, a year when an estimated six to nine women out of every 1,000 births died in the process. In 2021, a total of 861 women died in childbirth in the U.S. out of 3.97 million live births, according to the CDC.

In 1908, the nation’s doctors, researchers and government health administrators were well positioned to make spectacular advances in health care on behalf of the American people and the world. The nation’s first county health departments were set up that year. Congress passed the Pure Food and Drugs Act in 1906 to prevent the sale of misbranded foods, drugs and drinks.

In 1914, vaccines were licensed for rabies and typhoid. Progress continued with the development of penicillin and other antibiotics as well as more vaccines for devastating diseases such as polio, measles, mumps, and diphtheria. Scanning technology and X-rays now are routine. Blood pressure and cholesterol medicines extend lives.

With U.S. population now at 332.4 million, the leading killer of Americans is no longer tuberculosis but heart disease, claiming 696,962 lives in 2020. Cancer ranks second with 602,350 deaths. The leading cause of death in children is now accidents.

As my grandparents, Ellis and Mabel, opened the pages of “The Practical Family Doctor,” in 1908 they must have been encouraged by the volume of research and medical advice at their fingertips. They went on to live through an amazing era of health care advances that eliminated childhood diseases, extended peoples’ lives by 30 years and made retirement a new phase of life.

Years ago, internet research replaced home-based guides such as “The Practical Family Doctor.” But you can buy a vintage copy in good condition on eBay for $86.

Julia Anderson retired as The Columbian’s business editor in 2010.