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Health, Medicine and Pharmaceuticals

Aging     Dentistry    Diet & Nutrition     Diseases, infectious   Exercise    Homeopathy   La Grippe    Mental health, nervousness, RUM, drinking & opiates     Mortality    Pregnancy ,childbirth miscarriages  Babies   Public health    Sarah Bernhardt's cold prevention recipe     Tonics     Tuberculosis

19th century medicine bore little relationship to what we know and experience today. 

Drugs consisted primarily of quinine, morphine, opium. belladonna, paregoric and castor oil,  with some arsenic, mercury and strychnine thrown in. (While arsenic and strychnine have no recognized medical uses today, they were sold as medicinal ingredients in the 19th century. Mercury was prescribed for syphilis until the first effective treatment Salvarsan (arsphenaminne) was marketed in 1910.)  DePew' s One hundred years of American Commerce
  has a chapter on The Drug Trade which notes that morphine was discovered in 1804 and strychnine and quinine some years later "of vast importance to the physician and pharmacist, furnishing as they did the active ingredients of valuable remedial agents...One of the most important  alkaloidal discoveries of recent years was cocaine ... very extensively  and successfully used as a local anesthetic .... laughing gas, chloroform, ether ... have played an important part since their discovery as alleviators of the sufferings of humanity."  Average importation of opium from 1869-71 was 90,000 pounds and morphine 1,912 ounces, increasing to an average of 552,516 pounds of opium  and 30,000 ounces of morphine in 1892-94  Chauncey DePew, One hundred years of American Commerce 1795- 1895, published 1895 http://www.archive.org/stream/onehundredyears00depeuoft/onehundredyears00depeuoft_djvu.txt

Natural products such as jalap and ipecac also were used with varying success.  Oil of peppermint was used for flavoring, fragrance and also medicinally. Camphor can be a natural product or produced synthetically.  Paregoric id an opium/camphor tincture. "Sassafras was widely used as a home remedy in the 19th century – taken in sufficient doses it induces sweating, which some people thought had health benefits. Sarsaparilla apparently made its debut as a patent medicine, an easy-to-take form of sassafras, much as Coca-Cola was first marketed in 1885 as a remedy for hangovers, headaches and morphine addiction.[4] Besides the effects of the ingredients, sodas were popular in the United States at the time, due to the belief that carbonated water had health benefits.[5] " Wikipedia accessed 2018 Sept 8 https://en.wikipedia.org/wiki/Sarsaparilla_(soft_drink)#History

These letters have endless references to diseases, much concern about 'nervousness' and inquiries after various people's health, but very little to say about medical treatment (except the occasional 'tonic') and limited discussion about preventive health measures. Aspirin wasn't even on the market for most of the time covered, and first marketed under that name in  1899  http://en.wikipedia.org/wiki/History_of_aspirin .  

Here is how [Dr. Oliver Wendell] Holmes summarized the value of medical pharmacology in 1860:
   We frequently hear the remark ‘that on the whole more harm than good is done by medication'. Excluding opium ‘which the Creator himself seems to prescribe', wine which is a food, and the vapors which produce the miracle of anesthesia and I firmly believe that if the whole material medica, as now used, could be sunk to the bottom of the sea, it would be all the better for mankind—and all the worse for the fishes.” ... As for the benefits of no treatment, Holmes said he learned when he cared for patients in the depths of poverty that “there was no help for the utter want of wholesome conditions and if anybody got well under my care, it must have been in virtue of the rough and tumble constitution which emerges from the struggle for life in the street gutters, rather than the aid of my prescriptions”.  Quality and Safety in Healthcare,  2006 August 

The 1906 Pure Food and Drug Act] and the 1938 Food, Drug, and Cosmetic Act came after these letters, and we can see why they were needed.  As a pharmaceutical librarian I have been fascinated to see how relatively new the industry is, and how much progress has been made in the past century or so.  As much as I enjoy the 19th century I have no desire to have lived then -- particularly without the advantages of 20th and 21st century medicine which I've been the beneficiary of.  Matthew Herper, What's Pharma done for you lately? A Lot, Forbes blog June 16 2011 http://blogs.forbes.com/matthewherper/2011/06/16/whats-pharma-done-for-you-lately-a-lot/  
The 1906 Pure Food and Drug Act  took 27 years to pass and was limited to food and drugs involved with interstate commerce

Physicians and Medical Education
Medical education in the 19th century was of highly variable quality. The 1910 Flexner report  resulted in many reforms and changes. "
When Flexner researched his report, many American medical schools were small "proprietary" trade schools owned by one or more doctors, unaffiliated with a college or university, and run to make a profit. A degree was typically awarded after only two years of study. Laboratory work and dissection were not necessarily required. Many of the instructors were local doctors teaching part-time, whose own training left something to be desired. The regulation of the medical profession by state governments was minimal or nonexistent. American doctors varied enormously in their scientific understanding of human physiology, and the word "quack" flourished.

Flexner believed that admission to a medical school should require, at minimum, a high school diploma and at least two years of college or university study, primarily devoted to basic science. When Flexner researched his report, only 16 out of 155 medical schools in the United States and Canada required applicants to have completed two or more years of university education.[10] By 1920, 92 percent of U.S. medical schools required this of applicants.[11]Flexner also argued that the length of medical education should be four years, and its content should be what the CME agreed to in 1905. Flexner recommended that the proprietary medical schools should either close or be incorporated into existing universities. Medical schools should be part of a larger university, because a proper stand-alone medical school would have to charge too much in order to break even financially.

Flexner sought to reduce the number of medical schools in the U.S. to 31, and to cut the annual number of medical graduates from 4,400 to 2,000.[11] A majority of American institutions granting MD or  DO degrees as of the date of the Report (1910) closed within two to three decades. (In Canada, only the medical school at Western University was deemed inadequate, but none were closed or merged subsequent to the Report.) In 1904, there were 160 M.D. granting institutions with more than 28,000 students. By 1920, there were only 85 M.D. granting institutions, educating only 13,800 students. By 1935, there were only 66 medical schools operating in the USA. Between 1910 and 1935, more than half of all American medical schools merged or closed. 

When Flexner researched his report, "modern" medicine faced vigorous competition from several quarters, including osteopathic medicine, chiropractic medicine, electrotherapy, eclectic medicine, naturopathy and homeopathy.[16] Flexner clearly doubted the scientific validity of all forms of medicine other than that based on scientific research, deeming any approach to medicine that did not advocate the use of treatments such as vaccines to prevent and cure illness as tantamount to quackery and charlatanism. Medical schools that offered training in various disciplines including electromagnetic field therapy, phototherapy, eclectic medicine, physiomedicalism, naturopathy, and homeopathy, were told either to drop these courses from their curriculum or lose their accreditation and underwriting support. A few schools resisted for a time, but eventually all either complied with the Report or shut their doors.[17]  https://en.wikipedia.org/wiki/Flexner_Report   accessed 2018 Sept 8

Reforms were obviously needed, but the results were not without critics or significant trade-offs.

The Flexner Report was embraced as the definition of the academic model that was to characterize American medical education up to the present. Its success was importantly assured by the huge financial gifts of the Rockefeller and Carnegie Foundations ― this single model of medical education required large sums to support the scientific focus at its core. The powerful stimulus of philanthropy money also affected the fashion in which medical faculty would live their lives in academic medicine; this was the important introduction of the full-time system in medical schools. Medical professors were to be freed from any major responsibilities for patient care and could dedicate their lives to research and teaching. ..But the full-time system was not without its serious critics. The most vocal challenger and naysayer was William Osler, who was subsequently seconded by Harvey Cushing. Osler believed that the focus of such physicians would be too narrow, they would live lives apart with other thoughts and other ways []. He was apprehensive that a generation of clinical prigs would be created, individuals who were removed from the realities and messy details of their patients’ lives....  His [Osler's] mentee, Harvey Cushing, voiced the same sentiments, basing his reservations on his background of several generations of practicing physicians. Their voices were hushed by the irresistible seduction of large sums of money tied to implementation of the full-time system. ...There was maldevelopment in the structure of medical education in America in the aftermath of the Flexner Report. The profession’s infatuation with the hyper-rational world of German medicine created an excellence in science that was not balanced by a comparable excellence in clinical caring. Flexner’s corpus was all nerves without the life blood of caring. Osler’s warning that the ideals of medicine would change as “teacher and student chased each other down the fascinating road of research, forgetful of those wider interests to which a hospital must minister” [] has proven prescient and wise. Duffy TP. The Flexner Report ― 100 Years Later. The Yale Journal of Biology and Medicine. 2011;84(3):269-276. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3178858/

Paul Starr's The Social Transformation of American Medicine 1982 notes that physicians' incomes were only an average of between $750 and $1500 in 1900. "A magazine article in 1903 commented that doctors earned less than "an ordinary mechanic".  

While EJ Philips mentioned consulting various physicians, the one she seemed to know best was Dr. Nagle, who also ran boardinghouses, presumably to supplement his income as a public health doctor (though his 1919 New York Times obituary reported an estate of  more than $250,000).  Nagle worked for the Health Dept of the City of New York  Bureau of Vital Statistics, No. 301 Mott St, and published mortality statistics I found in the Library of Congress collection.

Mortality and life expectancies 
"Model Shows How Medical Changes Let Population Surge" Simple advances in hygiene had the greatest impact, Gina Kolata, New York Times Jan. 7, 1997
"At the turn of the century, life expectancy at birth was 47.3 years. In 1994, it was 75.7 years.... In 1900, fewer than 60 percent of women lived to the age of 50, while 95 percent of women can now expect to live to be at least 50. ...Most of the health advances and resulting declines in mortality rates occurred in the first few decades of the 20th century.  This means, Dr. Preston said, that they were due to simple changes in hygiene and public health, not to sophisticated medical treatment. ... The declining mortality rates in the first half of the century benefited children, for the most part. ... Asked what changed the death rates in the first half of the century, Dr. Preston said he thought it was the ascendance of the germ theory of disease.  This resulted, he said , in profound changes in personal and public health practices, like cleaner water, the sterilization of food, keeping flies away from food, washing hands and isolating sick patients... After the advent of small pox vaccinations, in the 18th century, and vaccinations against diphtheria in the 1890's, there was no major medical advance until the late 1930's, [Preston] said, when sulfa drugs were introduced to fight bacteria, and in the late 1940's, when penicillin was introduced." Demographic study by Dr. Samuel. H. Preston, and graduate student Kevin M. White, University of Pennsylvania

Public Health  Dr. Nagle and Jacob Riis  Dr. Nagle's statistics on abortion  infant mortality and suicides.

Of course people were less likely then to die of cancer or dementia when they were dying so young of other causes. 

Germ Theory of Disease
The germ theory of disease is the currently accepted scientific theory of disease. It states that many diseases are caused by microorganisms. These small organisms, too small to see without magnification, invade humans, animals, and other living hosts. Their growth and reproduction within their hosts can cause a disease. "Germ" may refer to not just a bacterium but to any type of  microorganism, especially one which causes disease, such as protists, fungi, viruses, prions, or viroids.[1] Microorganisms that cause disease are called pathogens, and the diseases they cause are called infectious diseases. Even when a pathogen is the principal cause of a disease, environmental and hereditary factors often influence the severity of the disease, and whether a potential host individual becomes infected when exposed to the pathogen. ...A transitional period began in the late 1850s with the work of Louis Pasteur. This work was later extended by Robert Koch in the 1880s. By the end of the 1880s the miasma theory was struggling to compete with the germ theory of disease. Eventually, a "golden era" of bacteriology ensued, during which the theory quickly led to the identification of the actual organisms that cause many diseases.[3][4] Viruses were discovered in the 1890s.   Wikipedia accessed Sept 8 2018   https://en.wikipedia.org/wiki/Germ_theory_of_disease 

It now seems incredible that it took so long for the ideas of Louis Pasteur, Robert Koch, Ignace Semmelweis, Joseph Lister  and others to be accepted.

Home remedies
New York, Jany 16th, 1887  Sorry you have had so bad a cold.  We have been indulging in the same. Hattie's throat has been sore for several days, but by keeping indoors and applying Pond's Extract she is much better.

New York, Jany 31st 1887 Uncle was feeling better. A porous plaster had relieved the pain in his back.

Chicago, July 4, 1887  "Sorry you have had to feel the effect of combining cherries, soda water & lemonade.  Hope you are all right by this time.  If at any time you are taken with cramps, get some gum camphor"  

Boston Sept  28 1887 A tallow candle is a very old remedy for a "cold in the head" 

Sarah Bernhardt's cold prevention recipe 1892

Tonics and patent medicines
Pepsin Tutti-Frutti for dyspepsia killing ad in 1896 theatre program Blood purifier for rheumatism, gout, dyspepsia, malaria, neuralgia, paralysis constipation & stubborn blood diseases 1895 program

Boston, Sept. 7, 1887  I find one good in attending the [baseball] games.  It keeps me in the fresh air and I think that does me more good than medicine. I do not get as strong as I wish to be.  A little exertion fatigues me.  I was in hopes the bracing air of Boston would do me good, but the heat is too much. 

Boston, May 14th 1888 Poor child.  You have my sympathy in your suffering.  But that will not cure you.  I imagine the extra strain upon your system in those long walks has done the mischief. For sometime before leaving New York Alice wanted me to use a new remedy but I was afraid to try it - but at last did so, and used one bottle before leaving New York, and got another bottle here.  It is a Spanish mineral water called Rubinat Cordial.  I imagine it is doing me a great deal of good.  It does not pain or gripe.  I have taken the label off the bottle, and will enclose it so that if your druggist has not got it he will know where to send for it.  It is recommended by the high school doctors in New York.  I take about a wine glass full in the morning before breakfast, but only on alternate days.  So far it has been a decided success with me.  In New York I paid 35 cents for it. Here they charged me 50 cents. 

Washington DC, April 25, 1891 I have not been feeling very well for the past few days, have dyspepsia. We had very hot weather coming over on the cars, and I drank a very cold apollonian lemonade which I think checked up my digesting apparatus, and I ate some canned chicken which added to my misery, and on Monday & Tuesday I felt very wretched. I have not told Hattie anything about it, for she has enough to worry her in her present condition, without worrying about me.  I had some mixture from the drugstore which helped me very much and I feel better. 

Pittsburgh, May 4, 1891  I am now taking "Scotts Emulsion of Cod Liver Oil" and I think it is helping me.  I was very weak, sick and nervous in Washington but feel a good deal better now, thanks to the Emulsion. 

Cod Liver Oil, National Museum of American History http://blog.americanhistory.si.edu/osaycanyousee/2009/10/cod-liver-oil-and-pink-peignoirs.html

Chicago, Feby 1st 1895  I am sorry to hear Mrs. Smith continues so weak.  I wonder if they have tried "Valentine's Meat Juice"?  It will stay "down" when nothing else will and is very strengthening and worth trying.  It would make her stomach feel good anyway and give her rice water to drink. 

Boil the rice to a pulp and strain the water off, and let her drink that either warm or cold as she feels like drinking it.  I hope soon to hear the has found some remedy to relieve her  - she must suffer dreadfully. 

Cambridge Mar 23,1895  I am very sorry to hear your [Neppie's] Mama is in poor health -- she should have a tonic. I have a new one I am taking.  Although it has been thirty years on the market -- I never heard of it until a week ago.  It is called "Fellows Compound of Hypophosphites".  I have taken a very few doses and feel that it is building me up.  I had begun to have "that tired feeling" -- and was afraid I was sinking back into the old condition. When we become weak, that is the time disease catches hold of us -- so do get your Mama to take something.  Get it for her -- don't let her get down sick -- for then it will be harder to build her up.  And it would be a good Spring medicine for you -- the doses are very small.  One teaspoonful in a wine glass of water, with your meals. 

Chicago, June 3, 1896  Your Mama has fallen into the same state I have been suffering from for the last three years.  She needs a tonic.  She is in a nervous condition and doesn't know what ails her.  Do not wait for her to get something for herself but get it for her.  She is at a very critical age now, and wants looking after.   Do not tell her I have said so, but I think you had better have her doctor see her.  I am sure he will tell you she is "run down" and nervous.

I found Mrs. Holmes, my friend here, in the same condition.  I bought a bottle of Lydia Pinkham's vegetable compound.  She had been taking it a week when I again called and found her much better.  Says the compound did her a great deal of good.  I do not suggest this for your Mama, although I believe it would do her good, but she certainly needs something.  And it's part of her complaint not to do anything for herself.  She must have it done for her.  I am sorry she is feeling so.  I know what it is & sympathize with her. http://en.wikipedia.org/wiki/Lydia_Pinkham   National Library of Medicine http://www.nlm.nih.gov/exhibition/ephemera/women.html 

Diseases, infectious and otherwise
Boston May 4, 1886  Hattie seems to like it [room and board in Boston] and I hope she will soon reap some benefit to her health from it.  I think she has a little malaria in her system, which I hope the change of air may eradicate.   

Chicago, June 9, 1886 Fever and Ague I guess are a part of the trials you may be exposed to -- but there is always something to battle with, and perhaps it is not so bad in that part of the State. 
Albert was talking about moving to Texas.

New York Mar 17, 1887  Hattie is somewhat better. Has been taking Kusline, a new form of quinine, and it seems to have done her good. 

Seattle, June 26, 1890 Well I am in Seattle! at the above hotel which stands on a high hill overlooking Puget Sound -- the "Mediterranean of America".  The view from my window is indeed very beautiful.  The City, like Tacoma, is built on a succession of hills, but I think the site is prettier than Tacoma.  And I should think healthier.  There is more swampland lying around Tacoma but the water is salt in the Sound so may not be aquish [malarial].

New York, Feb. 5, 1892     Have you had Edward vaccinated?  Smallpox is said to be on the "increase".  Jack [Dolman, aged 4] is all right but I do not think  Elizabeth [8 months] has yet been vaccinated.  It is perhaps better to be ready for it. 

New York, Oct 15 1892 I hope Diphtheria will soon be checked. 

New York, Mar. 24, 1893  Very sorry you have such a cold and hope the remedies employed have broken it up. If not go to a doctor.  Do no funny business with it for Pneumonia is on the "rampage

New York, Mar. 27, 1893   I went over to see Mrs. Nagle last Evening and learned that Baby Lily Marigold is down with the measles.  Was quite sick when I was there on Thursday, but going about the house.  They thought it was only a cold but on Friday the measles put in an appearance.  Now you must use your judgment about coming with Ted.  It will not be necessary to you to go to 47 [East 21st. St.], but Lily taking the disease may show it is in the neighborhood.  I asked Dr. Nagle if it was very plentiful in the City and he said, "not more so than usual at this time of year".  

Of course I want to see my "bit of Sunshine" [grandson Ted] but I do not want him to catch the measles.  As far as I know there is only one child in the house, and she is about the size of Lily, but has more care taken of her, and seems to be well & healthy looking. Let me know your decision about coming as soon as you can.  One thing is certain.  Children get the measles without being exposed to it, so that if you put them in a glass case they may get it and not be anywhere near a child who has them. 

Philadelphia 1893 Augus How did the lady who was ill get along?  If it was pneumonia, she must either be dead or better by this time.  I heartily hope she got well, and will be spared to her sons for many years to come. 

Philadelphia Jan. 4, 1894 Thanks for the recipe for whooping cough.  I will tell Nellie [Dolman Law] about it. 

Hattie to Neppie, Philadelphia, Mar. 22,1897  I had quite a cold last week. Doctor said I had follicular tonsillitis.  I told him I was glad he gave it such a high-sounding name.

Philadelphia, Jan. 1898  When the doctor came on New Years Eve to see him [Jack Dolman] he could not decide what ailed him but said it was either measles or Typhoid. And he hoped it might be measles, so on New Years Morning, sure enough the measles were fully developed and we were all made happy for Typhoid is so long and tedious and one never knows when it will take its departure.  I hope he will not take it, but he may for there are a great many suffering from it in this locality.  And in Nellie's neighborhood measles are epidemic. Glad Ted has had them he will not have to suffer again.

Portland, Oregon July 5, 1895 The change of weather the past two days has given us all a little shaking up in the way of "Summer Complaint".  I was quite queer yesterday and had two performances, but I am better today.  The first taken was Miss [Ada] Dyas on Monday night.  Fortunately she did not have to appear on Tuesday night, and was able to doctor herself up -- she was really very ill -- the worst case amongst us, but she is quite well now. 

Summer Complaint seems to be gastrointestinal, judging by a Boston Globe ad of Sept 1887, saying that "Cholera Morbus, Cramps, Colic, Diarrhoea, Summer Complaints and Dysentery all cured by a teaspoonful of Perry Davis Pain Killer.   

      1889 ad "Microbe Killers"

Philadelphia Dec. 29, 1902  the [Philadelphia] Bulletin tells us this Evening that Typhoid fever is now pretty bad in West Philadelphia, and though smallpox is on the decrease it is not yet over there -- so what comes next we cannot tell, can only hope for the best. 

Many of the routine inquiries as to health have been edited out of the letters, but I can see why EJ Phillips did not take good health for granted. Diseases readily treated today could be quickly fatal without antibiotics.  Baby Elizabeth Ellen Dolman's illness and death is poignantly described in letters of 1892.  Dr. Nagle collected statistics on infant mortality in New York and the numbers (approaching 50%) are astonishing.  I've always been aware of just how many tiny gravestones are found in old cemeteries. What came as a surprise in these letters was the number of teenagers and young adults who died, primarily of Tuberculosis, including half of the Dolman siblings.

I was startled to realize that Dolmans Sr. lost four of their eight children as teenagers or young adults.   This became clearer when I received genealogy charts from various Dolmans,  and could see how deaths mentioned in the letters were related to characters I knew. Dolman Family tree   The cause(s) of death are not clear from letters I've seen, but would seem likely to be from tuberculosis.  Charlie Dolman wrote Albert from Florida, where he'd been taken to the milder climate in (unsuccessful) hopes of recovery.  John Dolman Sr. died of consumption in 1895     

History of  Tuberculosis http://en.wikipedia.org/wiki/History_of_tuberculosis#Nineteenth_century

New York, Mar 8, 1891 Very sorry your sick Auntie is suffering so much -- a bad month for consumptives

Cleveland, Ohio March 7th 1895

My dear Son, 

Mr. Dolman is very ill.  Dr. says it is consumption.  He has had hemorrhages and he said to the Dr. on Monday night, "Dr., this is the beginning of the end".  I have wondered for some time how he got about.  And I do not think he will last very long.  And no one to take his place in that big family.  This in haste from your loving Mother

La Grippe
Odell's Annals of the New York Stage notes that 1890 was the year of the "grippe scourge"

New York, Jan 3, 1890   Very sorry to hear Penelope has been so ill.  Glad she was improving and hope she will soon be well again.  Of course every complaint is called La Grippe Now. When Nellie [Dolman Law] was first taken sick the doctor said it was malaria & bilious attack. After a week had passed he said she had Typhoid fever in mild form.  Now that she is about again he says she had "La Grippe" with Typhoid symptoms.  Guess I had it in Wissinoming [at Hattie's] on your wedding trip.  I know I was very sick.

Be sure and write to me to let me know how Penelope is. Do not let her go out in damp weather. The death rate is very high. Dr. [Nagle] told me at lunch time that 222 deaths had been reported at the [public health] office in 24 hours. Of course not all from "La Grippe". Pneumonia is the greatest gleaner at present. 

Give my love and sympathy to my daughter [in law]. I hope catching cold from her trip will not prevent her coming again to see me.  I guess she might have had it if she had been at home. My love and Kisses to you both dear children from your loving Mother.

New York, Jan 6, 1890  I am pleased to hear that Neppie is improving, although so slowly. It will be best for her to remain in the house until her cough is better.  Our old remedy of squills, honey & paregoric is very good for the cough.  I hope she has no fever or chills. 

On Saturday I got to Aunty's  [Zavistowskis] about  2:15 PM.  She was up but was taken quite sick about 4 PM and at 5 I put her into bed.  She continued to get worse, the fever being very high.  So at eight o'clock Uncle went for the doctor who got there a little after ten.  He said she has La Grippe.  Gave her medicine and called again yesterday morning, when he found her better but told her to keep in bed.  She is a sick woman. 

Uncle [Zavistowski] is now fancying he is sick because the doctor said to him, jokingly, that he "would have it next".  About an hour after, he thought he had a sore throat and began gargling with vinegar.  I do not think anything is the matter with him except fright.  But I suppose that will be enough to give him La Grippe, Influenza & Pneumonia all at the same time.   

New York, Feb. 3, 1891  Mrs. Kirby just the same, poor sufferer.  Never out of pain but she has her mind bright as ever and her voice is not weak.  She seemed delighted to see me.  Asked after everybody and told me to be sure and give her love to all.  Said she didn't want to forget anyone and wanted all to know she thought of them.  Said she couldn't understand why she was left to suffer.  She was no use to anyone, and was ready and willing to go.  She is very thin. Mrs. Kirby just the same, poor sufferer.  Never out of pain but she has her mind bright as ever and her voice is not weak.  She seemed delighted to see me.  Asked after everybody and told me to be sure and give her love to all.  Said she didn't want to forget anyone and wanted all to know she thought of them.  Said she couldn't understand why she was left to suffer.  She was no use to anyone, and was ready and willing to go.  She is very thin.

Is this cancer?

Hattie to Neppie, Philadelphia, Oct. 10, 1893  I found Mama looking thinner & more haggard than when she went away & from all accounts she had had a pretty close call from a thorough break-down.  The Doctor had been to see her the day before & made an examination of her.  She thought she had a cancer or that her heart was diseased, both of which he denied.  Said there was a slight irritation of the heart from the nervous strain & her system run down. Said her lungs were as sound as a drum.  Told her she fretted too much. 

1896 Gay Parisians program ad Sozodont for the teeth and breath  Painless extracting 1896 Gay Parisians
New York, Mar. 16, 1886 I have a nice visit to pay this afternoon to the dentist who is going to cut off the tops of my two lower centre teeth, they having grown so long are forcing the upper teeth to project outward.  I am not nervous - oh! dear no! 

New York, Oct. 21, 1887 I hope you will call on Dr. Walker or someone as good, and keep your teeth in good condition.  Wish I had found a dentist as good when I had that tooth extracted in Cincinnati.  The loss of that tooth has injured all the others, as far as they are injured.  

I am fortunate enough to have better teeth than many people of my age, but had I taken as good care of them years ago, as I have the last ten years, there would be very little change noticeable. Take care of your teeth if you want to be a good looking old gentleman.

New York , Apr. 17, 1890 I have been quite busy last week and this, trying to pack, sew and have had so many other calls upon my time that I have not succeeded in getting much accomplished.  I have had to go to Photographers two days to sit for pictures for our travels.  Been twice to Dentist and have to go again tomorrow. 

Philadelphia, May 12, 1892 Elizabeth is very ill indeed.  Got through the measles seemingly very well, but it is supposed her teeth are causing some brain trouble, and it is quite uncertain whether she will be able to pull through or not.

Philadelphia Nov. 8, 1897 I hope [Neppie's sisters] Jessie's rheumatism is not troubling her and that Miss Grace's toothache has been relieved -- best remedy I know is Listerine. 

Chicago, June 1887  "Try and find a good doctor to treat your catarrh trouble.  I prefer Homeopathy"  

New York Clipper, Feb. 16, 1889 "Homeopathy is again triumphant A cure for Jim jams has been discovered. In accordance with the law of Hahnemann similius simulatur  curantur , patients are instructed to swallow snakes instead of whiskey" Puck 

Boston May 9, 1890 Homeopathic "Nux vomica" would relieve her [Neppie, of morning sickness] 

Philadelphia has always been the center of US homeopathy.  But Middletown NY had both a State Homeopathic Hospital -- and  a State Hospital Dramatic Co. A program of "Townsend's Thrilling Western Drama The Mountain Waif. A Realistic Drama of the California Gold Regions  (Nov. 29, 1895) featured Scenery by Voegtlin, Madison Square Theatre

Mental Health Blues and nervousness  RUM and drinking and opiates

Oscar Hammerstein's Opera House programme for Camille (week commencing Jan. 14, 1895) has an ad for Morphine, Opium, Laudanum and similar habits, speed permanent cure, no suffering; not a reduction cure, so easy is the cure that patients can retain in their possession during treatment the drug to which they have been addicted and at no time will they feel uncomfortable enough to yield to the temptation of resorting to it.  National Health Co. 125 West 34th St. NY
Morphine, Opium, Laudanum and similar habits cured

Before it became a popular recreational drug, heroin was used in medicine until its addictive properties became known. In the 1890s, German pharmaceutical company Bayer marketed heroin as a morphine substitute and cough suppressant. Bayer promoted heroin for use in children suffering from coughs and colds.  Partly as a result of these medical treatments, by the early 1900's, heroin addiction in the United States and western Europe had skyrocketed.  Heroin Morphine & Opiates https://www.history.com/topics/history-of-heroin-morphine-and-opiates

Mrs. James O'Neill, mother of playwright Eugene, was a morphine addict for many years. http://www.nytheatre-wire.com/sb06093t.htm

Coca-Cola, introduced in 1886 originally contained cocaine. "Confederate Colonel John Pemberton, who was wounded in the American Civil War and became addicted to morphine, began a quest to find a substitute for the problematic drug.[5] The prototype Coca-Cola recipe was formulated at Pemberton's Eagle Drug and Chemical House,[6] a drugstore in Columbus, Georgia, originally as a coca wine.[7][8] ... Pemberton claimed Coca-Cola cured many diseases, including morphine addiction, indigestion, nerve disorders, headaches, and impotence.  Pemberton called for five ounces of coca leaf per gallon of syrup (approximately 37 g/L), a significant dose; in 1891, Candler claimed his formula (altered extensively from Pemberton's original) contained only a tenth of this amount. Coca-Cola once contained an estimated nine milligrams of cocaine per glass. (For comparison, a typical dose or "line" of cocaine is 50–75 mg.[64]) In 1903, it was removed.[65] Wikipedia accessed 2018 Sept 24 https://en.wikipedia.org/wiki/Coca-Cola#Coca_%E2%80%93_cocaine

Limited mental health treatment was available in the 19th century. See Wikipedia Neurasthenia https://en.wikipedia.org/wiki/Neurasthenia accessed 2018 Sept 24 would become a major diagnosis in North America during the late nineteenth and early twentieth centuries after neurologist George Miller Beard reintroduced the concept in 1869. ...Americans were said to be particularly prone to neurasthenia, which resulted in the nickname "Americanitis"[3] (popularized by William James[4]) ...From 1869, neurasthenia became a "popular" diagnosis, expanding to include such symptoms as weaknessdizziness and fainting, and a common treatment was the rest cure, especially for women, who were the gender primarily diagnosed with this condition at that time.   Virginia Woolf was known to have been forced to have rest cures, which she describes in her book On Being IllCharlotte Perkins Gilman's protagonist in The Yellow Wallpaper also suffers under the auspices of rest cure doctors, much as Gilman herself did. Marcel Proust was said to suffer from neurasthenia. To capitalize on this epidemic, the Rexall drug company introduced a medication called 'Americanitis Elixir' which claimed to be a soother for any bouts related to Neurasthenia.

San Francisco, Aug. 9, 1886  My experience in the past days of volunteer fire  departments warrants me in saying I never knew any man who reaped any benefit from them - but I have known them to be the cause of breaking up many happy homes. ...I hope you are in good health.  Give all your attention to keeping so.  No happiness with poor health.  

Neurasthenia a term that was first used at least as early as 1829 to label a mechanical weakness of the nerves and would become a major diagnosis in North America during the late nineteenth and early twentieth centuries Wikipedia accessed 2018 Sept 8 https://en.wikipedia.org/wiki/Neurasthenia  EJ Phillips often talks about "blues" and being "nervous"

San Francisco, Aug. 14, 1886 Hope your wedding cards job was an omen of good luck and that other work follows to keep you employed and to dispel the "blues".  

New York, Jan. 9, 1887 All my life, I have never spent money for display or pleasure that I knew I could not afford and I advise you now to follow the same course -- you will be happier and better off in the long run. See how you are placed to-day by listening to Seymour and there are 19 out of 20 men you may meet, who would do just as he did.  And you would still listen to the 19 men instead of the 20th or your Mother. 

New York, Mar 16, 1887  I hope you are energetic in trying to find a house for Mrs. G[arretson]. Ha ha! ha! That is the best yet!!  I think it is a good place to select; the asylum is near!  She is just as far gone as ever the Dudley woman was.  

Boston, Oct. 1, 1887 We could keep on playing Jim [the Penman] here for another four weeks to big business.  The business seems to increase with every week.  The musicians had to give up their seats last night and go under the stage.  Some are prognosticating that it will run again all this season at Mad[ison] Sq'[uar]e [Theatre]. If so we shall all be ready in the Spring to join Bartley Campbell in your big town house.  

Bartley Campbell (1843-1888) was one of the first American dramatists to make playwriting his profession.  However he died insane [in Middletown NY]. (Oxford Concise Comp Theatre).  "From 1876 until his mental breakdown in 1885 he was America's most popular melodramatist. 

Philadelphia, July 1, 1888  [I would have to] wear myself out before starting for the long journey to California, and all for the benefit and convenience of A.M. P[almer].   So I may as well remain where I am.  If he can do without me, perhaps someone else will take me in the Fall. I have been his Jack at a pinch long enough.  It has made me ill and nervous, and I cannot allow him to impose upon me any longer.  

New York, Jan. 22, 1889  I was sorry to hear you were in a fit of "the blues" or that affairs were not progressing as smoothly with you, as you and I would have them. But perhaps it is not as bad as you think. B. may have a disagreeable manner when he is thinking, but I guess he appreciates your work even if he does not gush over it.  You know I have often been accused of being cross, when I have been in the happiest of moods. And it may be the same with him. 

Pittsburgh, May 4, 1891 I was very weak, sick and nervous in Washington.

New York, Sept. 18, 1893  I have had considerable trouble and annoyance over the matter [contract with Charles Frohman for the 1893-1894 season], and consequently am very nervous and not at all well. 

New York, Sept. 29, 1893  I have no real pain, but great nervousness.  If I can only get through Monday night all right, I hope then to improve.  The "part" would have been nothing to me in the past and I am very near perfect, but I am so afraid that I shall not get through, that it makes me fear to go through the ordeal.  ...  I have not told Hattie that I have been to Dr. Smith as I had been getting medicine from Dr. Guernsey, but I was not getting any better and thought it best to get another Dr. to brace me up.  

Hattie to Neppie, Philadelphia, Oct. 10, 1893  On the evening after the first production of Lady Windermere's Fan I had a letter from Maud Harrison who had, I knew, been going with Mama to select her dresses & helping her in many little ways.  She wrote to tell me that Mama had got through the first performance very nicely, looked lovely, &c, & then went on to tell me how sick Mama had been, what a terribly nervous state she was in, how every little thing exhausted her & all about it.  

So to New York I went Saturday morning leaving Jack in the care of his Grandma Dolman.  I found Mama looking thinner & more haggard than when she went away & from all accounts she had had a pretty close call from a thorough break- down.  The Doctor had been to see her the day before & made an examination of her.  She thought she had a cancer or that her heart was diseased, both of which he denied.  Said there was a slight irritation of the heart from the nervous strain & her system run down. Said her lungs were as sound as a drum.  Told her she fretted too much. 

She denied it, but she does & always has when she is away from her children.  She worries how they may be getting on & when she is home she worries because her salary isn't coming in.  Summer vacations have never done her any good for that reason.  It is among my earliest recollections.  She is not weak in any way & doesn't feel weak.  I think it has all come from mental worriment.  

Philadelphia, Mar 24, 1894  I am as usual beginning to feel a little "blue" that my occupation is ended.  I am rested and want to go to work again -- but I shall have to wait for a long time before I shall be wanted I am afraid. 

Philadelphia, Aug. 12, 1894 I have not made any arrangements for next season, and do not as yet see any prospect of my getting anything to do. Of course, you can understand that makes me rather "blue".  It was later than this when I got the "Duchess" last year and perhaps something may yet turn up. 

Hattie to Neppie, Philadelphia, Aug 27, 1894  Mama has nothing in prospect and that makes her nervous & blue at times.  She is never perfectly happy when idle.

Philadelphia, Sept. 18, 1894  I feel "right down in the dumps".  I am still a member of the great army of the un-employed, do not think anything will be given me before Novr, if then. 

St. Louis, Oct. 16, 1894  I am not as strong as I would like to be, but if in an engagement I think I should feel better.

Hattie to Neppie, Philadelphia, Oct. 31, 1894  It was well that I could go [to New York], for she [EJP] had a wretched time of it.  Long rehearsals, running to dressmakers &c & the part was altered just enough to make it confusing & more troublesome than a new one.  And she was ill in the bargain.  The day before I arrived she had nothing to eat between 9 AM & 6 PM.  She began to feel so worn out & miserable by Saturday that she went to see Dr. Smith who thought the trouble came from nervousness.

Sunday night there was a rehearsal, which was not over until 1:30 Monday morning.  Mon morning she saw the Doctor again & he then said her liver was congested.  She was a little better when I left her yesterday. 

Detroit, May 15, 1896  I am glad to hear Ted enjoyed his visit to New York.  I feel it was not a very enjoyable time for any of you for I was tired, nervous & fidgety, and did not know what to do to make it pleasant for you.  It made me very happy to have you all there and in my own happiness I fear I did not do all I might have done to make the rest of you comfortable.  The rooms were all so small.  We were crowded, yet I took the best they had.  I thank you all for coming to see me

Philadelphia Dec. 10, 1896  Since my arrival I have slept every Morning until after 10 and the rest of the day soon passes.  Yesterday left here at 12:30 and returned at 11:30 so did not get time to write.  This Morning I feel more like myself than I have since my arrival.  The nerves are more rested.  ... Mrs. Dolman is now able to come out here but looks as if she didn't have any red blood in her.  She is excessively pale. 

One ad in a Spring 1885 Sealed Instructions program was for Brain and Nerve Good Crosby's Vitalized Phosphites.  It claimed to "strengthen the intellect, restore lost functions, build up worn out nerves, promote good digestion, improve the mental and bodily growth of children, develop sound teeth, clear skin, glossy hair and handsome nails and to have been used with benefit by Bismarck, Gladstone, Emily Faithful and thousands of the hard brain-workers of the world. 

At least three members of Palmer's company committed suicide in the 1890s 
Frederick A Lovecraft in 1893, May Brookyn in San Francisco in 1894 and Will Palmer in St. Louis in 1895.  

Suicide? Recalled from retirement March 15th 1898    Dr. Nagle's statistics on suicides

New York, Feb. 14, 1886 after climbing up two long stairs and finding the money order office, I discovered I had no eye glasses with me and could not see to fill the blanks properly, so in disgust I left the office and took the 4th Avenue cars home. 

Boston, May 30, 1886  Mr. [Louis] Massen just called to know if there was anything he could do for me.  I told him "no".  Kind of him though, wasn't it?  Said he and his wife would see me to the Depot which is only one block away, but I feel the kindness for very seldom so you find actors so thoughtful of an old lady. 

San Francisco Aug 9, 1886  I am getting old - my health will not stand the wear and tear it did 

Boston, May 27, 1888  I am awfully nervous all the time, but I suppose that is the result of my increased age. 

Philadelphia June 5, 1891 Excuse this letter Neppie dear.  I am very sleepy, and my eye glasses make my eyes ache.

Cincinnati Jan 20, 1893 I have seen a few old acquaintances here, but more that knew me than those I knew.  Have not heard from the Egans or Mrs. Bass -- all my other friends have died or gone away.  It makes me feel sad. 

New York, Sept. 29, 1893 I have come to the conclusion that a woman has no right to be on the stage after she is 50 [EJP was 63].  It has cost me $290 to dress the part, without counting my expenses of board & and all I had was $400.  So you see I am bankrupt, and if my health fails, I do not know what is to become of all of us. 

Providence, Rhode Island, Feb. 1894  You have waited and I pray trust, you are now rewarded.  It will be a great consolation to me, I assure you, for I do not see much prospect before me of bettering my condition.  Managers are looking for the young and beautiful and I shall have to take a back seat.  

Philadelphia, Feb., 22, 1898  I have been idle for a year and so have many others in my profession, even those younger than I.  Whether I shall be able to appear again is doubtful, though I am not in bad health, but the accumulation of years has me tied down and I cannot do as I have done.  I did hope to be able to pull through for another five years at least, but it is vanity for me to think it.  "All is beauty." 

EJ Phillips and stroke   Death of EJ Phillips

Promise and Challenge of Aging Research, US President's Council on Bioethics, 2002 http://bioethics.georgetown.edu/pcbe/background/agingresearch.html  There have also always been efforts to slow or reverse the process of aging, if not to beat back death itself. In the last hundred years, this project appears at first glance to have been more successful than ever. At the turn of the twentieth century, life expectancy in the United States was, on average, about 45 years. At the turn of the twenty-first century, it was 78 years.

Public Health  Dr. Nagle and Jacob Riis  
Dr. John T. Nagle worked at the Health Dept. of the City of New York,  Bureau of Vital Statistics, No. 301 Mott St. He had been an Acting Assistant Surgeon, US Army during the Civil War.  EJ Phillips was friends with him (and Mrs. Dr. Nagle) not just from staying at their boardinghouse on East 21st. Street.  Dr. Nagle was an amateur photographer and Jacob Riis writes of how essential flash photography was to his expose of the New York slums in How the Other Half Lives, and how Dr. Nagle helped with his early expeditions into tenements (when the flash powder was set off with a revolver). 

I'd love to know more about Dr. Nagle's civil war medical/surgical experience. 

New York, Nov 1890, I  was much troubled on Saturday so thought I had better keep quiet on Sunday.  Therefore I did not get up until 4 PM.  The looseness is still troubling me and I begin to think it must be New York's new water. 

New York's waster came from the Croton watershed in upper Westchester county, carried to the city by a system of aqueducts, tunnels, and holding reservoirs implemented as a results of the great fire of 1835.....on fifth Avenue between Fortieth and Forty-second Streets, the twenty-million gallon, Egyptian-inspired batter-walled distributing reservoir, possibly designed by James Renwick Jr [was] in place by July 4, 1842, when the water was turned on. ...The exceptional development of the city after the [Civil] war outstripped the croton system's capacity, and after considerable public agitation, a special act of the state legislature in 1883 called for a new supply system that, when it opened in July 1890, carried water in from the Croton Dam down the West Side to Central Park, vastly expanding the flow of water.... the fate of the reservoir would not be resolved until 1899, when it was torn down to make way for the New York Public Library.  New York's water supply, though overtaxed, was otherwise exemplary, its sewers, however were a scandal. Stern, Robert, Thomas Mellins and David Fishman, New York 1880: Architecture and Urbanism in the Gilded Age, New York: Monacelli Press, 1999

Building New York's Sewers, Joanne Abel Goldman, Purdue University Press  1997 http://books.google.com/books/about/Building_New_York_s_sewers.html?id=2ofTUQ49ARMC
History of Sanitary Sewers: New York http://www.sewerhistory.org/photosgraphics/new-york/

Philadelphia was not only the first city to provide water as a public utility, but also pioneered new technologies - such as distributing its water supply through a centralized system, using hydropower for pumps, and installing disinfection systems - that fueled the revolution of water and sanitation services in the United States.  Philadelphia also faced challenges in creating effective institutions to manage water resources. Public demand for better health was often at odds with city leaders’ short term goals. But Philadelphia made notable institutional achievements through its foresight in planning and merging water and sanitation systems. Philadelphia’s geography (Figure 1) is like many other older big cities: it sits at the confluence of two rivers, the Schuylkill and Delaware, whose waters are the source for drinking water and the destination for wastewater.  ...Outbreaks of typhoid - which had been an unfortunate annual occurrence since the 1860s - dramatically worsened; the water-borne disease caused at least 600 deaths a year in the 1880s. Though several hundred typhoid deaths were expected in warm weather months, as unprecedented amounts of waste tainted the drinking water supplies, the death rate climbed. By the 1890s, citizen groups desperately petitioned the city to clean the drinking water supply [3]. Not until 1902, nearly two decades after drinking water treatment was proposed, did filtration begin, followed a decade later by chlorination.  The history of Philadelphia's water supply and sanitation system, Niva Kramek and Lydia Loh, University of Pennsylvania 2007 https://www.scribd.com/document/94148334/The-History-of-Philadelphia-s-Water-Supply-and-Sanitation-System

Croton Reservoir Forgotten NY http://forgotten-ny.com/2002/01/theres-no-stoppin-the-croton-from-hoppin-remnants-of-the-croton-aqueduct-old-and-new/  

Elizabeth Ellen Dolman (1891-1892)  death of granddaughter Elizabeth Ellen Dolman 1892

3219 Clifford Street  
Phila Pa
May 25th 1892

My dear Son, 

I arrived here on Monday 10:15 PM.  Was pretty tired having been on the road since  2 PM on Tuesday.  I found John, Hattie & Jack very well but Elizabeth is very ill indeed.  Got through the measles seemingly very well, but it is supposed her teeth are causing some brain trouble, and it is quite uncertain whether she will be able to pull through or not.  The doctor has just been and told Hattie she was preparing for the 4th of July celebration again.  Spoke of your being sent for &c.  Hattie is very tired from taking care of her.  My time in Chicago was short and not very pleasant as it rained every day while I was there.  Baby has been vomiting so I am going down to the doctor.   Love and Kisses to my dear children Albert, Neppie & Edward  from their loving Mother 

3297 Clifford St
 Phila Pa
May 27th 1892 

My dear Son, 

Elizabeth continues very ill, but the doctor said at 12 when he called that he doesn't give her up yet - he is to call again at 6 this evening.  Mrs. Dolman has been here all morning & taken Jack home with her to keep him all night, the doctor ordering everything kept very quiet to let baby have as much rest as possible.  She is a very sick baby, but may pull through.  Her temperature when the doctor took it at 12 was 102.6.  Said it was higher than he expected to find it.  Of course the trouble is from her teeth - but I think the doctor now has the congestion under control and will be able to bring her through, unless other complications arise - with these little mortals one never knows what will come next. 

Hattie is keeping up pretty well - but looks very anxious and tired.  I am sorry to write you such sad news - but am very glad I was able to come here for my presence seems a great comfort to Hattie.  John has come home early, looking as if he expected to find all over with his little daughter - for he went to the doctor this morning to tell him how the baby was, and sent the doctor back with a change of medicine - which seemed to have the desired effect - for she is better than when John went away this morning - but it is still bad enough. 

I think it is too bad that Neppie has gone to so much trouble for me.  The small room was large enough for me - and I should not feel at all comfortable in the large one, while you & she occupied the small one.  So if you wish to make me comfortable - please return to first principles - and let me have the small room.  I cannot leave Hattie while baby is sick.  Should she pass away - I may take Hattie to see you, for under the circumstances I think a change would be the best thing for her.  Of course I have not mentioned such a thing to her - but I have thought it.  Will send you word at once if anything fatal takes place.  Love and Kisses to my dear children Albert, Edward and Neppie from their loving  Mother 

3207 Clifford Street
Phila Pa
May 30th 1892

My dear daughter Neppie, 

Hattie asks me to write and thank you for her for the pretty presents rec'd from you this Morning for Jack & Elizabeth.  She is too full of care and anxiety to write.  Her little daughter still lingers with us, but very little hope exists that it will be for long.  The Doctor almost gave up hope yesterday.  He has not yet been this Morning but we are looking for him every moment.  I will keep this open to give you his opinion when he comes.  Hattie is behaving very bravely but the strain she is under is making her look very thin and I am afraid she will break down if the little one is to be taken from her. 

I do not feel like letter writing today, dear, so please excuse this if it is not very lucid or satisfactory.  Mrs. Dolman is here and Mrs. Robinson has sat up with us for the past two nights helping us to watch the little sufferer.  She is holding her now and will not give her up and I am sure the poor woman must feel dreadfully tired, but she will not give up until the little one comes out of a sleep she is taking, as she thinks it will be the turning point, for better or worse.  I hope I shall have better news to tell you in my next.  Now I can only thank you for your loving kindness to Hattie and the babies and send you John's thanks.  Our love to all with love and Kisses to Albert, Edward and Neppie from their loving Mother 

4:30 PM 
Doctor did not find much change to encourage us.   Temperature was rather lower but not enough.  Will come again this Evening.  Your loving  Mother 

3207 Clifford Street 
Philadelphia Pa
Monday June 6th 1892

My dear daughter Neppie, 

We thank you for your prayers and good wishes to our little darling who is still with us, but we cannot be sure whether she will remain with us or not.  Sometimes we feel that she has improved and again a change comes that makes us fear the worst.  She does not give any indication of knowing us, and at times rolls her eyes up so that one can scarcely see anything of her eyes but the white.  She has been, and is a very sick baby and we are all very tired, for we cannot leave her alone for a moment for fear spasms will come. 

No one would think such a little creature would require so much constant attention.  Hattie has grown very thin, but is keeping up surprisingly.  Mrs. Dolman was here yesterday and is here today helping us to take care of Jack.  The latter is very good under the existing state of affairs.  You know it is hard for him to keep quiet.  He is growing fast -- quite a big boy now.  I wish Edward could come and play with him. I hope that Edward is still a lovable little bit of Sunshine.  I should like so much to see him.  Kiss him for us all.  Hattie would like you to come see her this Summer.  She will not be likely to go anywhere unless her little girl passes away. 

Had got this far when I heard Hattie calling me to assist with Elizabeth who had a sick turn and vomited quite a quantity of thick phlegm.  An hour previously her bowels had moved more freely than usual.  Now I think we shall soon know how it is to be.  The doctor is expected in a few moments.  I will wait and send you his opinion before closing this.  Perhaps she may yet live to wear the pretty little wrapper Aunt Neppie sent for her birthday. 

Monday  5 PM

The doctor has just gone.  Was surprised to find Elizabeth had been vomiting but also said if she can retain anything on her stomach after this it may be for the best, but I think he is very doubtful of her recovery.  Poor Hattie & John.  They have worked so hard to save her.  Well, dears, will now close with love and Kisses to you, Albert and darling bit of Sunshine, my dear children from their loving Mother

June 10 92

My dear sister, 

I don't know that I can collect my thoughts enough for a letter but will try, for I know you would like to hear from Baby.  I wish I could send better news.  The dear little sufferer's life still trembles in the balance.  Sometimes we feel hopeful & again it does not seen possible for her to keep up the struggle longer. Every one marvels at the wonderful vitality she has shown.  Last evening I was quite despondent, for she had scarcely slept for 48 hours.  I don't think she had more than 3 hours sleep in that time & that only in little snatches.  To-day she has been more drowsy & has taken a number of little "cat-naps". 

The Doctor lanced her gums to-day.  He is unable to determine whether the brain trouble is the result of the measles having struck in or from delayed dentition.  He has worked very faithfully with her & declines to give her up yet.  He says her breathing has been so good through all the long trouble.  Four weeks next Monday since he began to visit her & he has been every day & sometimes twice a day.  John goes down every morning to him to report & every evening.  For more than two weeks Baby has not known us & part of the time can't see us.  She is so changed & unlike herself & looks so helpless & pitiful.  It seems months since I have seen Elizabeth.  If she could only tell us how she feels we would feel better able to relieve her.  Everybody has been very good & kind & sympathetic. 

Little Jack has been at his Grandma Dolman's a great deal.  I hate to have him away but yesterday the Doctor was so anxious for Baby to sleep his Grandma took him home & he is there now.   And how are you all?  And dear little Sunshine.  Don't let him run the slightest risk of measles if you can help.  I laughed at measles & treated the matter lightly when Elizabeth first showed that she had them, although I was careful not to let her take cold, but now I have a horror of them I can assure you.  This is the first letter I have written since Mama came home.  Love to Buddie & "Ted".  Your loving sister  Hattie  9:50 PM

3207 Clifford Street 
Phila Pa
June 12th 1892

My dear Son,  

Your little niece passed away at 8:30 this Evening.  Your dear sister is keenly feeling her first trouble but is bearing up bravely.  Sends love to you all.  I am writing a number of these so excuse brevity this time.  God bless and keep you all in health.  Love & Kisses from your loving Mother & sister to you all.   Mother  Funeral will be on Wednesday AM. 

Address of the Committee to Promote the Passage of a Metropolitan Health Bill microform : New-York, December, 1865. New York : J.W. Amerman, printer, 1865. Boston Public Library, Microtext 
Bordley, James and A. McGehee Harvey, Two Centuries of American Medicine 1776-1976, Philadelphia: WB Saunders Co., 1976.
Cowen, David L, and Alan B. Segelman, Merck, Sharp & Dohme, Antibiotics in Historical Perspective, 1981  Thanks to Sara Day for this gift.
Leavitt, Judith Walzer and Ronald L. Numbers, Sickness and Health in America: Readings in the History of Medicine and Public Health, Third edition, 1997
Martin, Justin, Genius of Place: The Life of Frederick Law Olmstead: Abolitionist, Conservationist and Designer of Central Park, Cambridge, Da Capo Books, 2011     Useful information on Civil War Medicine given Olmstead's work on the US Sanitary Commission. https://www.amazon.com/Genius-Place-Frederick-Olmsted-Lawrence/dp/0306821486
Sontag, Susan, Illness as Metaphor, New York, Farrar, Strauss and Giroux, 1978.
Starr, Paul, The Social Transformation of American Medicine, New York: Basic Books, 1982.
Stern, Robert, Thomas Mellins and David Fishman, New York 1880: Architecture and Urbanism in the Gilded Age, New York: Monacelli Press, 1999

Popular Medicine 1896, Vassar College http://projects.vassar.edu/1896/medicine.html

Last updated Dec. 26, 2019

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