Nathan Smith and Joseph Smith

 

Nathan Smith, a Vermont farmer’s son, became a doctor and started his medical practice in Cornish, New Hampshire, marrying Elizabeth Chase, Jonathan Chase’s daughter.  When Elizabeth died, Nathan married her sister Sally.  Unsatisified with the apprenticeship system of training doctors, Nathan applied to the Trustees of Dartmouth College for approval of a medical school and after a year or so delay, the Dartmouth Medical School was established.  Although not especially lucrative for a doctor who had a steadily growing family, both Nathan and the medical school thrived, until a court case involving grave robbery.

                Nathan felt that Dartmouth College was not doing enough to help him procure the specimens necessary to conduct the dissections he felt were so important a part of a medical student’s education. He also thought the college should have been more generous in giving the medical school money for the textbooks and equipment he needed to conduct his classes. Nathan was a big believer in hands-on experience in medical training, in an era when most medical instruction consisted of just lectures.  We know that Dartmouth College was strapped for cash during its first years, but it may also have been that the trustees felt that Nathan’s methods were ridiculous.  Then, there is the inescapable fact that dissection of cadavers was illegal.

When school was not in session, Nathan traveled amazing distances treating patients and performing surgery.  It is understandable that Sally would not want to move households to follow her husband in his endeavors, since he was all over the place anyway.  His granddaughter-in-law Emily Smith, in her book “The Life and Letters of Dr. Nathan Smith”, includes a letter dated April 20, 1811. Nathan wrote to his friend and former student George Shattuck. Nathan starts out, “I intended to spend this winter in Boston, but in reviewing my affairs found them such as required my presence at home.”  Really?  Possibly because his wife was raising eight children there by herself?  For all the times Mrs. Smith remarks on his tenderness toward his children and his family, it does not seem very tender to leave them in Hanover and spend the winter in Boston. In several of his letters to Mr. Shattuck, he describes journeys to Bath, Coos, Weathersfield, Charlestown, Boston, Merrimack, Concord, and Exeter.

Apparently George was a bill collector for Nathan, or maybe just his emissary in Boston.  In any case, much of Nathan’s correspondence to George consisted of asking – actually, more accurately, commanding – him to collect one note or another.  He also used George as a social secretary as well, asking him to ask other people if they are coming to visit him, giving dates when he is going to be home (not many), and offering alternate sites for visits in Concord or Boston. Many of these proposed social visits appeared to involve the collection of money owed – a “bring me my money and stay for dinner” kind of arrangement. Certainly it was fair that Nathan collect the money he was owed, especially with a family of eight children. The arresting thing about these letters is that their tone is so imperious, and you wonder if Nathan was giving Mr. Shattuck any money for being his emissary in Boston and southern New Hampshire.  My guess is that he did not.

Ill feelings still lingered in Nathan regarding the court case, and the general difficulties in getting dissection specimens in rural New Hampshire. The political situation in New Hampshire was not encouraging to the funding of education. It is interesting to note that Dartmouth College was petitioning the New Hampshire legislature for funds.  This is why Nathan went to Concord.  He often attended sessions of legislature to lobby for funding for the medical school. Yale College in New Haven, Connecticut had been putting out feelers to Nathan, recruiting him to teach at their newly established medical school and Nathan began leaning in that direction.  He sent both Ryno and Solon to Yale to medical school, and, in 1812, Yale offered him a position on the faculty at the medical school. 

Before he could leave for Yale, the Upper Valley was hit by an epidemic of Typhoid Fever, and Nathan, who had treated patients successfully in many previous outbreaks of typhoid, felt compelled to stay in Hanover, especially when his wife and three of his children came down with it.

In West Lebanon, a ten year old boy was suffering from a bone infection in his leg that he had gotten as a result of having typhoid. He was in excruciating pain and when his mother called in their family doctor, the doctor said his leg would have to be amputated. This type of bone infection is called osteomyelitis in 2014, and is treated with antibiotics.  My nephew had it, and was hospitalized for two days, then discharged with a fanny pack of IV antibiotics that he had to wear 24/7 for at least a week.

Nathan had been treating this type of bone infection for at least two years, by excising the dead bone and draining the infection from the area. The boy went to school with several of Nathan’s kids, and his mother, Lucy Smith, (no relation) contacted Nathan and asked him if he could come and take a look at her son, and hopefully save his leg. It is unclear whether or not she knew that Nathan was an expert at this kind of bone infection.  It is  more likely that she knew he was a very accomplished physician and surgeon and possibly more able to help her son than the local doctor who had prescribed amputation.

Nathan came and performed surgery on Lucy’s son, bringing ten medical students to observe the operation.  Often, patients were brought to the medical school to have operations at the medical school, on a table in the lecture hall.  Probably due to his age and the amount of pain he was in, Nathan operated at his home.  Lucy’s mother described the operation. “ The surgeons commenced operating by boring into the bone of his leg, first on the one side where it was affected, then on the other side, after which they broke it off with a pair of forceps or pincers. Thus they took away large pieces of bone.” Keep in mind that this whole procedure was accomplished on a ten year old without anesthesia.

Accounts of Nathan’s operation on Lucy Smith’s son, in West Lebanon, New Hampshire in 1813 can readily be found online by googling “Dr. Nathan Smith and Joseph Smith”.  The ten year old was Joseph Smith, future founder of the Mormon religion.  The Mormons consider it very significant that Nathan was the only surgeon in the country who was performing this procedure, almost one hundred years before it became standard practice in World War I. They believe that it was God’s divine intervention that put Joseph in school with Nathan’s children during that Typhoid Fever epidemic, and thus gave him access to the only doctor who could save his leg.

After the Typhoid Fever had passed, Nathan joined his sons at Yale Medical School and began his career at Yale, again leaving Sally and the rest of the children behind while he established himself there. A letter from Nathan to Sally, reprinted in its entirety in Emily Smith’s book, has Nathan yet again missing Sally and the children, promising never to leave them again. “I fear my absence has been severely felt by you and the children.  For my own part, I have had a dreary winter of it. You may rest assured that I will never leave you and the children for so long a time again during my lifetime. I think I will be able to get home by the middle of April.” In that same letter, he describes a situation between Solon and a cook in the kitchen.  “We have been having some difficulty in the school between the cooks and the scholars. A cook abused one of the scholars in the kitchen and the scholars put him under the pump and pumped him, as it is called. I think, however, it will be settled without difficulty. Solon is one who helped to pump the cook, but so many assisted in the thing that the blame will be light on individuals.  No doubt the fact that Solon was Nathan’s son also helped with the “light blame”.

 Notwithstanding all the legal difficulties surrounding dissection, Dartmouth College was loathe to let Nathan go.  Oliver Hayward, in his biography of Nathan, “Improve, Perfect  and Perpetuate”, states that students were drawn to the medical school by the reputation of Dr. Smith.  Most of them hated Hanover because it was way out in the middle of nowhere, and the weather was miserable – cold in the winter and hot, humid and buggy in the summer. Dartmouth College was concerned that the Medical School would not survive the defection of its founder.

Three years later, Sally and the kids still had not moved to Connecticut.  Nathan had to return home in 1815 when his daughter Sally died. This was the first death in the family, and by all accounts it hit Nathan hard. Regardless, he left Sally in Hanover and returned to New Haven for another year.  In 1816 he went back and gave a series of well-attended lectures at Dartmouth.  This was the last time he taught in Hanover.  Sally and the kids finally joined Nathan in New Haven in 1817, and Sally gave birth to her last child, a girl, Sally, born in 1819.  Interestingly enough, although they lived in New Haven at the time, all records at Ancestry.com show that Sally was born in Cornish, as were all of her siblings but one, who was born in Hanover.  Sally must have returned to Cornish to have the baby.  Since both of her parents were dead by then, she must have had the baby at a siblings’ house.

Nathan established two more medical schools, one in Maine and one at the University of Vermont. Although Sally visited both Maine and Vermont, the move from Hanover to New Haven was the last one she made. Nathan died in New Haven in 1829 at age 66, of what appears to have been a stroke. Sally died in Springfield, Massachusetts twenty years later and was buried in New Haven.  She may have been living with her next youngest son James, at the time, because he is listed as living in Springfield, Massachusetts in 1850. 

None of Nathan’s children lived in the Upper Valley as adults.  The boys became doctors, the girls all married and had children.  Every one of them gave one of their children “Chase” as a middle name, and most of them had a daughter named “Sally”.

Ezekiel Cushing. You can read “Improve, Perfect and Perpetuate” at the Howe library in Hanover. Emily Smith’s biography of her grandfather-in-law, “The Life and Letters of Nathan Smith”, is available online, as is Nathan’s “Medical and Surgical Memoir. http://books.google.com/books?id=QaoaAAAAYAAJ&printsec=frontcover&source=gbs_ge_summary_r&cad=0#v=onepage&q&f=false (Life and Letters)

 

 

http://books.google.com/books?id=Kps-AAAAYAAJ&pg=PA2&lpg=PA2&dq=Nathan+Smith+Medical+and+surgical+memoir&source=bl&ots=vMDd-UKy-w&sig=IZyzwFttkRMQjjmZhp85khdgi0k&hl=en&sa=X&ei=BThyVK6dMsfmsATjyoLYCw&ved=0CC8Q6AEwAg#v=onepage&q=Nathan%20Smith%20Medical%20and%20surgical%20memoir&f=false (Memoirs)

Ezekiel Cushing, the medical student arrested and charged with grave robbing, went on to become a doctor in Plymouth, Massachusetts.  He did die young, at age 38.

Nathan may very well be related to Simeon Ide (see Simeon’s story in my posts of late fall 2012/ early winter 2013). Nathan’s mother’s maiden name was Ide, originally from Rehoboth, Massachusetts, as was Simeon’s family (and mine as well). Simeon and Nathan came from the same area of Vermont.

The founder of Gifford Hospital in Randolph had his own experiences with grave robbing.  You can read about it here: http://dartmed.dartmouth.edu/winter03/pdf/Grave_Robber_Good_Doc.pdf

 

Teaching Medicine at Dartmouth

                The founder of the Dartmouth Medical School, Nathan Smith, started his medical practice in Cornish.  His wife was the daughter of Jonathan Chase, Revolutionary War Colonel and founder of the Cornish-Windsor bridge.  Doctors were not plentiful in the North Country at the time, and as Nathan’s reputation as an excellent doctor and surgeon grew, he found that he often had several apprentices working with him.  Nathan had studied at Harvard, and considered the apprenticeship system to be vastly inferior to a high quality formal medical education.  He approached the trustees of Dartmouth College with a proposal to establish a medical school there, and after a couple of years of waiting, during which time Nathan went to Scotland and London adding to his own medical education, the trustees approved the Medical School.

                Nathan had an attitude toward the practice of medicine that differed from that of other learned doctors of his day.  He taught his students to carefully examine their patients and pay particular attention to what they were experiencing. He believed that good nursing care was very important in the treatment of a sick person, and that the wise physician takes advantage of every avenue of treatment while being careful to watch for side effects.  During this time, medical knowledge was rudimentary at best, and there were many treatments commonly used on patients that were useless, and some that even harmed them and made them less likely to recover.  Nathan believed that “watchful waiting” was often the best course of action.  Other doctors commonly practiced “heroic measures” like bleeding and purging.  Before the medical school was established, Nathan had dealt with an outbreak of Typhus at Dartmouth College without losing a single one of his patients by opening the windows of the patients’ rooms, wrapping them in wet sheets and giving them lots of fluids.  In his biography of Nathan, Oliver Hayward, in his book “Improve, Perfect and Perpetuate” states that he believes that Nathan’s isolation on the frontier may have saved him from engaging some of the practices popular with more established doctors elsewhere.  Harvard Medical School had more than one doctor on the faculty, and these doctors had been established as medical eminences for a long time. They hesitated to stray from the accepted teachings and medical beliefs.  Nathan was younger, in charge pretty much in a vacuum, and had been practicing medicine in the howling wilderness where necessity was often the mother of invention.

                While Nathan was in Europe, he attended many classes and lectures that featured dissection of bodies.  These experiences made him committed to dissection of real human subjects and laboratory chemistry experiments as part of the education at Dartmouth Medical School.  The problem was, that dissection of human bodies was illegal in America at this time, and because of this, bodies were hard to come by.  It was especially difficult to obtain cadavers in rural New Hampshire and Vermont. In cities, medical schools often used the unclaimed bodies of paupers, or prisoners who had died in jail. There were more cemeteries in cities, and the cemeteries were much bigger, and a disturbed grave would not be noticed as quickly than it would be in the rural Upper Valley, where everyone noticed everything.  If a body was dug up in Hanover, everyone in the whole town would know about it immediately. 

                If a person was caught and convicted of graverobbing, they would receive a $2000 fine, 2 years in prison and 50 lashes.  There are multiple indications that graverobbing was rampant in the Upper Valley at this time.  Norwich cemetaries were a prime spot for grave robbers, and in the early town reports in Cornish there is documentation of the “problem of grave robbing” being discussed at town meeting, and stern warnings given by town officials toward potential grave robbers. Of course one wonders if Nathan Smith was behind the grave robberies in Cornish and whether or not his Chase relatives knew.

                In 1804, the Dartmouth Trustees voted to give Nathan a raise, on the condition that he would move to Hanover permanently, and bring his family with him.  Before this, Nathan had been maintaining two households.  He rented a couple of rooms in Hanover, but Sally and his sons remained behind in Cornish.  One assumes that the Trustees thought that Nathan was spread too thin, and he would do a better job if he could live with his family at Dartmouth.  The question is, was it financial considerations that kept the family in Cornish, or Sally’s disinclination to move to Hanover?  The family was living right across the road from her parents, in a house that her father owned.  With Nathan being so busy teaching medical school and carrying on his medical practice, she probably preferred to stay by her parents and siblings.  After Jonathan died in 1801, she may have been more amenable to a move to Hanover that she would have been before he died.  By all accounts, Jonathan was very close to his children and his grandchildren, in a way that Nathan may very well not have been.

Nathan Smith and Smallpox Inoculation

Nathan Smith was an important doctor in the Upper Valley in the late 1700’s, if not the only doctor.  He married Sally Chase, Jonathan Chase’s daughter, and they lived right across the road from Colonel Chase in Cornish.  Emily Smith wrote a biography of her grandfather-in-law, The Life and Letters of Nathan Smith. In her book, she said that Nathan’s practice encompassed an hour fifty miles in diameter..

            Nathan gained the credentials he needed to begin a medical practice by serving as an apprentice for a well-respected, established doctor in Southern Vermont. After he had been in practice for a few years, he decided he needed formal medical training and became the 5^th student to receive a Bachelor’s in Medicine degree from Harvard. 

            Nathan took medical education seriously, and often had a medical student or two living with him and helping with his practice as apprentices. We get an idea of how he ran his household from a comment in one of his student’s diaries regarding a visit to Nathan’s home prior to his apprenticeship.  The student says, “I am not likely to be burdened with compliments, for, all the time I was there, Smith had not introduced us to the ladies of the family, and three were sitting silently engaged in needlework.” The student seemed to assume that Nathan’s lack of courtesy toward the female members of his family would likely extend to the newest and perhaps lowliest newcomer.

            This interesting tidbit notwithstanding, we can assume that Sally was called upon to assist with some of her husband’s medical endeavors.  The 1790 Cornish town report documents that Dr Nathan Smith “shall have the liberty to erect a pesthouse and inoculate for the small-pox.  A pest house was a sort of hospital, a building where the town constables and doctors would quarantine people who were sick with a communicable disease, usually smallpox, but sometimes other diseases as well.  These people would be confined to the pesthouse until they either died or got well. One wonders whether Sally helped with these inoculations or whether the apprentices did. The fact that Nathan himself was given the liberty to erect the pesthouse seems to indicate that he also had responsibility for the patients within them.

            When Nathan was at Harvard, one of the three medical school professors there was Benjamin Waterhouse, the first doctor in America to practice inoculation for smallpox.  Smallpox inoculations at that time involved making a scratch in a person’s skin and introducing matter from cowpox pustules into the scratch.  Cowpox was a non-lethal illness similar to smallpox.  People who had gotten cowpox were immune to smallpox. Edwin Jenner had developed the smallpox vaccine in England.  Waterhouse introduced it to America by inoculating his own children.  Then he inoculated a servant boy and sent him to a pesthouse, where he did not contract the disease.  Nathan studied under Waterhouse and came home to Cornish believing in smallpox inoculation.  The fact that the Cornish town report mentions a pesthouse and inoculation in the same entry probably means that anyone who was inoculated had to be quarantined in the pesthouse for a period of time, just in case they came down with smallpox. Inoculation was a brand-new procedure, and many people thought that it was unsafe and probably wouldn’t work. 

            Smallpox and cowpox were originally European diseases.  Waterhouse made a lot of enemies by insisting that doctors throughout America doing inoculations buy the inoculant from him only, thus insuring that he had a monopoly on the vaccine.  Without a doubt any vaccine used in Cornish or anywhere in the Upper Valley came from Waterhouse. The vaccine consisted of some pus or serum scraped onto a piece of cotton string from a cowpox lesion on a patient in England and shipped to America.  Since there were no refrigerated compartments on ships, and the voyage was not quick, some of the cowpox samples were dried out and dead by the time they were used, so effectiveness was not guaranteed.  Still, the inoculations done in this primitive way were remarkably powerful in reducing smallpox cases.

            There is some confusion between the words inoculation and vaccination. They are almost interchangeable. Inoculation refers to the practice of giving people a disease, under controlled conditions, causing them to contract the disease in a less virulent form, thus developing immunity to the disease but not dying from it.  Vaccination refers to giving a person dead or weakened pathogens so that the person develops immunity to the disease without getting the disease itself, or by getting a very mild case.  Some inoculations done in America were done by taking the serum from actual smallpox pustules and infecting healthy people with it. For some reason, people who contracted smallpox in this way became much less sick than from natural smallpox. This was done if an area couldn’t get any of Waterhouse’s inoculant, or if there was an outbreak of smallpox nearby and people were scared enough to take the risk.  I believe Nathan’s method of inoculation used Waterhouse’s cowpox inoculant.  We do not  have any evidence of a smallpox outbreak near Cornish, and Nathan would have had personal ties to Waterhouse and thus would have had access to his inoculant.  That being said, the mention of a pesthouse confuses the matter.  Why would they need a pesthouse if there had not been some cases of smallpox, unless they thought they were about to have some?  I stand by my original thought that they wanted to isolate the people who were inoculated, but it is a question.

           

           

Nathan and Sarah's wedding - Cornish, 1794

Nathan Smith, a doctor and surgeon in Cornish in the late 1700's, married Jonathan Chase's daughter Elizabeth in 1791. Elizabeth was 26 and Nathan was 29. They had only been married for two years when Elizabeth died. After Elizabeth died, Nathan married her younger sister Sarah, who was called Sally. At the time of their marriage, Sally was 18 and Nathan was 32.

Many of the rules of American society changed after the Revolution, and the customs of courtship and marriage were no exception. Although marriages had ceased to be an economic negotiation between the fathers of two families, families still viewed marriage as a way to align the leading families of a town or county. It was common for sisters to marry brothers, and it was not uncommon for second cousins to marry. If a mother or father remarried after their original spouse had died, often the children would marry into the stepfather or stepmother's family. Prudence Chase married married a man named Nathaniel Hall, who was almost certainly related to her stepmother, whose maiden name was Hall.

The Chase's were the leading family in Cornish, and would have been happy to have their daughter marry a doctor. Although Nathan was a doctor, he was the son of a farmer from Chester, Vermont, and gained considerable social status by marrying a Chase. Fifty years earlier, the marriage would have been negotiated between the parents of bride and groom, or between the groom and the bride's parents, with little input from the bride. By the late 1700's, the bride had much more voice in the decisions surrounding her marriage, although exactly how much voice she had depended on the family.

Regardless, it wasn't a matter of falling in love with a boy and presenting him to her father as the man she wanted to marry. Girls saw boys at school or at church or at other social events, usually weddings or funerals. Girls and boys didn't “date” like they do now. There was very little privacy in small houses where there were lots of siblings and often an unmarried aunt or grandparent. Sometimes if a couple were interested in maybe getting married, the family would let them “bundle”. “Bundling” was a custom invented to give a couple some privacy in order to get to know each other better. Each young person was tied or sewn into their clothes, and maybe tied or bundled into sheets and blankets, and put into a bed together, then left alone in order to be able to visit in privacy. Sometimes the parents would put lay a board up on its side between them – called a bundling board.

We often imagine the families of young unmarried guys and girls during this era being very strict, not letting them out of the house unsupervised and guarding the morals of their young people very closely. Actually, in the late 18^th century, one girl in three was pregnant when she was married, and the theory is that bundling had a lot to do with it. As long as girls were married by the time the baby came along, a premarital pregnancy wasn't the calamity it would be later in American history.

Obviously we don't know if Jonathan and Sally Chase allowed Elizabeth to “bundle” with Nathan Smith. We do know that neither Elizabeth nor Sarah was pregnant when they were married, although Sarah and Nathan's first child, a son, was born almost exactly nine months from their wedding day.

There is a story about Sarah and Nathan, that I have found in multiple sources. Apparently at Nathan's and Elizabeth's wedding, Sarah managed to get in between Elizabeth and Nathan for a few moments during the ceremony. One account portrays Sarah as a little girl, so I envisioned a four year old who had a crush on her future brother-in-law. No, Sarah was sixteen at Elizabeth and Nathan's wedding, so she may have had an eye on Nathan from the beginning. Keep in mind that wedding ceremonies were much simpler in those days. The bride and groom were married in the bride's parents' best room – the parlor if they had one, with close family members from both sides of the family in attendance. All attendees wore their best clothes, but not anything different from what they wore to church on Sunday. Afterward, there may or may not have been a big meal. Probably in Elizabeth and Nathan's case, there was, and probably there was a big meal for Sarah's wedding as well, although we don't know.