Knowlton Biography, Chapter 3
Three: Onanist
When about 17 years of age I began to be troubled with gonorrhea dormientium, which alarmed me exceedingly…I do not think I ever met with one so mentally wretched as I was. I think that onanism had much to do in causing this disease…I had the advice, and took of the prescriptions, of ten different physicians…My wan countenance, debility, nervousness, gloom and despondency, were all regarded as being caused solely by the disease, or by the grief to which it gave rise. Under this impression my physicians prescribed bark, wine, tincture of cantharides, various preparations of iron, balsams, opium, nitrate of silver in pills, alum, various vegetable astringents, blisters, in short almost all sorts of things that are calculated either to derange the digestive organs or to irritate the genital; and I now say, as might be expected, without producing any permanent benefit. I had several ill turns…for I took some kind of medicine daily for three years!
Around 1817, when Charles Knowlton was dividing his time between attending the village school and shaving pine shingles, he developed what his doctors told him was a serious—possibly fatal—illness called gonorrhea dormientium. The condition Charles suffered from is now known by the much less alarming name of wet dreams, and it’s no longer considered life-threatening. But its nineteenth-century Latin name easily evoked images in Charles’s mind of a deadly venereal disease, and his doctors compounded his fears.
American medicine in the first half of the nineteenth century was just beginning a long, slow struggle to shake off superstition and transform itself into a scientific profession. Charles’s experiences, as a patient and later as a physician, provide an unusually clear view of that transformation. But the story of American medicine is about more than just how doctors acquired new, scientific knowledge. It’s also about the battle between authority and free inquiry—so it’s no surprise that Charles Knowlton would be right in the middle of the fight.
In all his years as a doctor, Charles later said, he never met with a patient “so mentally wretched as I was.” Even if his claim was exaggerated, the fact Knowlton never met a patient as miserable as he’d been probably had a lot to do with the way Charles treated his patients. Charles was not so lucky. He saw ten different physicians over a three-year period, and followed each of their contradictory diagnoses and prescriptions until the medicines had completely ruined his health. As each new doctor failed to cure his “disease,” Charles or his parents found another to consult. Most of these doctors had been trained in what’s now remembered as the “heroic” school of early medicine. This made them infinitely more dangerous to Charles than the condition they were trying to cure.
Heroic medicine was based on the idea that health depended on the balance of four humors—blood, phlegm, black and yellow bile—which lined up with the four elements of the ancient world—air, water, earth, and fire. Originally developed in Mesopotamia and Egypt, the system was introduced to Europeans by Hippocrates in the second century of the common era. Over the centuries, the theory became so elaborate that by Knowlton’s time it explained everything from illness to temperament and personality.
To treat disease, physicians tried to determine which humor was out of balance and then correct the problem and rebalance the patient. Treatment was called heroic because the idea was to give the patient something else to fight, which would—somehow—cause the body to forget whatever had been bothering it. At this time, of course, physicians hadn’t yet discovered bacteria and viruses, and had no concept of germs. Heroic treatment usually involved bloodletting, cupping, and purging. Leeches were sometimes used to remove blood, but usually the physician opened his patient’s vein with a lancet. Blood was allowed to flow into a bowl until the humors balanced, which was often determined by the patient passing out. Doctor Benjamin Rush of Philadelphia was a leading proponent of bleeding, and his prestige gave authority to his medical opinions. Ironically, this prestige came not from Rush’s skills as a doctor, but from his patriotic credentials as a Revolutionary War hero, signer of the Declaration of Independence, and friend of the founding fathers. William Cobbett, a contemporary critic of Rush, called his heroic technique “one of those great discoveries which have contributed to the depopulation of the earth.” Dr. Rush sued Cobbett for libel and won, rescuing his reputation. One consequence of Rush’s continued popularity was that in 1799 George Washington, suffering from a throat infection, was relieved of 126 ounces of blood over a ten-hour period. Washington died a few hours later.
Cupping and purging were equally dangerous for the patient. Cupping was believed to pull excess bile out through the skin. The same effect was often produced by applying chemical irritants to “blister” the skin. Purging cleared the intestines using mercury, which is now known to be highly toxic. Some doctors preferred “puking” their patients, using another toxic metal, antimony. All these remedies had centuries of tradition behind them and the authority of the greatest writers on medicine, including ancient Greeks such as Hippocrates and Galen, and Renaissance alchemists like Paracelsus.
Charles Knowlton doesn’t say he was bled, possibly because the practice was so universal he didn’t bother to mention it. The remedies he does mention were all extremely dangerous. “Bark” refers to cinchona, a South American tree containing an alkaloid called quinine that is effective against malaria. In large doses cinchona is toxic, and severe vomiting and digestive problems were common side effects. Cantharides come from a green beetle sometimes incorrectly called Spanish Fly. Toxins from crushed beetles cause painful blisters, which were especially unpleasant in Charles’s case because the medication was applied to the genitals. Cantharides are now recognized to be among the most violent poisons known. Iron and silver nitrate are both toxic, and of course opium is an addictive narcotic. All these medicines were legal and widely used in the early nineteenth century. Many were key components of the Materia medica, the physician’s ancient list of drugs and their uses.
Suffering through one treatment after another, taking “some kind of medicine daily for three years,” Charles became personally familiar with many of the medicines he’d later learn about in medical school. This personal experience probably gave Charles a different perspective on the drugs than most of the other students had, attending lectures on the Materia medica. The ineffectiveness, pain, and toxicity of all the treatments he tried while under the care of ten physicians had a lasting effect on Knowlton’s understanding of medicine and on his attitude toward medical authority.
But physicians weren’t the only authorities Charles had to contend with. Although the doctors confused him with their competing theories and ruined his health with their contradictory treatments, only some of them blamed him for his condition. Charles’s frustration over his continuing illness can be credited to the doctors who had undoubtedly caused many of the symptoms they were trying to treat. But his misery, despondency, and feelings of guilt came mostly from the other authorities Charles listened to: ministers and moralists.
“I think that onanism had much to do with causing this disease,” Knowlton said in an article he wrote nearly twenty years later. Onanism is a nineteenth-century word for masturbation. It refers to an Old Testament story in which a young man named Onan “spills his seed on the ground” and is cursed and later killed by God for his wickedness. Although it may seem absurd today, masturbation was a serious sin in early America. Countless sermons, pamphlets, and books described the dangers of self-abuse, and the life of debauchery that began when young people touched themselves.
Although it originated in a Biblical story, onanism was never really considered a problem requiring public attention until the age of revolutions. A growing desire for personal freedom in the eighteenth and nineteenth centuries caused a backlash by the groups people sought freedom from. Traditional authorities such as churches and governments feared an outbreak of infidelity—which literally means unfaithfulness to their teachings and rules. They strove to control people’s thinking and private behavior like never before. And what better way to get control of people’s consciences than by regulating the most personal activities of all, the ones that happened behind closed doors?
Ironically, the same technology that had sparked revolutions by empowering people to challenge authority gave the authorities a way to fight back—and gave opportunists a way to cash in. Cheap printing presses had allowed Thomas Paine and his allies to get Common Sense into the hands of half a million American colonists. Presses also allowed moralists intent on telling people how to behave to get their propaganda into countless homes. Sermons, lectures, and commentaries on the evils of secular society such as Jonathan Edwards’s Sinners in the Hands of an Angry God were read by thousands of people. And because nineteenth-century medicine was still very close to superstition in many ways, health and “hygiene” were fair game for preachers and moralists. In many cases, the doctors and the preachers were the same people.
The first book to blame personal and social disorder on masturbation was published in 1723. Titled Onania, or the Heinous Sin of Self-Pollution, and All Its Frightful Consequences, in Both Sexes, Considered: With Spiritual and Physical Advice to Those Who Have Already Injured Themselves by This Abominable Practice, the book claimed masturbation led to coughing, paralysis, impotence, back pain, blindness, paleness, pimples, loss of memory, madness, idiocy, epilepsy, fever, and suicide. By 1760, thirty-eight thousand copies of Onania had been sold, in nineteen English editions. And like nearly all subsequent books on the subject, Onania offered readers a cure they could buy mail-order for twelve shillings a bag, and testimonials from satisfied customers.
Not everybody was so easily convinced onanism was about to destroy society and morals. Jonathan Swift, a well-known British satirist, began the first chapter of his 1727 classic Gulliver’s Travels with several references to “my good Master Bates,” a doctor the narrator served as an apprentice. Unfortunately, unlike Gulliver’s Travels, Onania and the books that followed it were written by physicians and endorsed by ministers. The most influential of these, Tissot’s Treatise on the Diseases Produced By Onanism, was even endorsed by American medical societies well into the middle of the nineteenth century. Tissot’s Treatise included a chapter on “Nocturnal Pollutions,” that quoted extensively—in Latin—from the Roman poet Horace and the Greek physician Galen.
Charles Knowlton’s problem was, his doctors’ ideas about wet dreams and masturbation came from the authority of a classical tradition thousands of years old, not from examining his actual condition. Medicine in 1817 was a very insecure profession. The elite colleges didn’t really teach it. Schools like Harvard, Yale, and Dartmouth catered to affluent families who expected a certain degree of decorum, even if their sons weren’t training to be ministers. The inevitable controversies over dissection at the new medical schools were bad enough. But everyone knew, as the Latin proverb said, Ubi tres medici, duo athei—where there are three doctors, there are two atheists. So the Harvard medical school where Charles Adams of Keene had taught wasn’t really part of Harvard. It was a separate entity associated with the prestigious college but held very much at arm’s length. Distrust and suspicion of infidelity and illegal dissection resulted in similar separations at Yale, Dartmouth, and Williams College. Upper-class young men who went to these colleges trained for professions: law and the ministry. Very few of them went into medicine.
Throughout the first half of the nineteenth century, physicians complained that they were not respected like the professional men of their towns. They wanted to be treated like ministers and lawyers, not like mechanics and barbers. The push to build medical schools and phase out the old “preceptor” system, where students worked with a practicing physician as apprentices, was an attempt to make medicine more like a profession and less like a trade. So it’s not surprising that doctors tried to turn medicine into something that operated just like religion and law. They built organizations to license doctors and schools to train them. Their goals were limiting the number of physicians and identifying who could be a doctor and who could not. And at a time when medical knowledge was in its infancy, this meant specifying what was acceptable “medicine” and what was “quackery.” Like minsters and lawyers, the doctors did this by identifying a set of canonical, sacred texts.
The texts that most physicians accepted as authorities were classics from the ancient world. Many of these books were in Greek and Latin, most of the more recent ones were French or German. Educated men who could read foreign—or dead—languages suddenly had the advantage over women and self-trained healers from competing, alternative traditions. Midwifery, bone-setting, herbalism, and a wide variety of techniques that disagreed with the books of the canon were tossed aside. Since the authority of ancient texts was the test of professionalism, the books became more important for many doctors than the evidence of experience. An ironic result was that “legitimate” doctors began to call their competitors “empirics,” ridiculing the ignorance of those who believed what they saw more than what they read.
Gonorrhea dormientium and onanism were clearly identified in old texts, and so were the remedies. It’s not surprising, when his doctors obeyed these traditions and ignored their patient’s actual condition, that Charles Knowlton’s “disease” persisted in spite of all the heroic measures he tried. But his strength and health were slowly eroded by three years of toxic medication. Charles was able to continue working until the fall of 1818. He then “kept school and took medicine” in Alstead, the hometown of herbalist Samuel Thompson, before the effort became too much for him. When Charles “learned a little Latin” from Dr. Adams in 1819, he was living with Adams as a patient. But by the spring of 1820, three years of heroic treatments had destroyed his health. In the “fall and winter of 1820-21,” Charles recalled, “I did nothing but take medicine [and] mope about, mourning over my sad condition.” He stayed at home, rarely leaving the safety of his warm room. Charles got so weak he could barely “stand erect for ten or fifteen minutes.” Now and then he was able to pull himself together and work on “some hard question in algebra,” but he was usually too depressed. There was nothing abnormal, unhealthy, or immoral about Knowlton’s “disease.” But it was 1820. “I knew no better,” Charles recalled. “My physicians told me no better.”