Health and Mortality Lessons from Mark Twain

One of the hot-selling items this holiday season is the newly released Autobiography of Mark Twain. He had carefully instructed that it could not be published in its entirety until 100 years after his death (which occurred in 1910). Twain was born as Samuel Clemens in 1835 and grew up in Hannibal, Missouri, and suffered through his father's death from pneumonia when only 11 (although his mother lived into her 90s). This was a time before the confirmation of the germ theory--before modern public health and medical revolutions--and life expectancy in the United States generally was in the 40s, about the same as the poorest countries today in sub-Saharan Africa. Twain recounts the "health care system" that existed in his town:

The doctor worked by the year— $25 for the whole family. I remember two of the  Florida doctors, Chowning and Meredith . They not only tended an entire family for $25  a year, but furnished the medicines themselves. Good measure, too. Only the largest persons could hold a whole dose.  Castor oil  was the principal beverage. The dose was half a  dipperful, with  half a dipperful of New Orleans molasses  added  to help it down and make it taste good, which it never did. The next  stand-by was calomel; the next, rhubarb; and the next,  jalap. Then they bled the patient, and put  mustard plasters  on him. It was a dreadful system, and yet the death-rate was not heavy. The calomel was nearly sure to salivate the patient and cost him some of his teeth. There were no dentists. When teeth became touched with decay or were otherwise ailing, the doctor knew of but one thing to do: he fetched his tongs and dragged them out. If the jaw remained, it was not his fault.

Doctors  were not called in cases of ordinary illness; the  family’s  grandmother attended to those. Every old woman was a doctor, and gathered her own medicines in the woods, and knew how to compound doses that would stir the vitals of a cast-iron dog.

He might be able to say that "the death-rate was not heavy" but that was only because he didn't know what was ahead in the world in terms of keeping death at bay. Still, Mark Twain's writing seems remarkably modern, which reminds us that a low death rate is a gift of the modern world, not the thing that created it.