Disease

9 Comments Posted on August 6, 2017August 6, 2017 18th Century, 19th Century, Disease, France, Georgian Britain, Guest Posts, Persons of Interest, The Enlightenment, The Regency

Fanny Burney and Her Mastectomy

Fanny Burney

In 1811, before anesthesia was invented, Frances Burney d’Arblay had a mastectomy aided by nothing more than a wine cordial. She wrote such a gripping narrative about her illness and operation afterwards readers today still find it riveting and informative.

Fanny came from a large family and was the third child of six. From an early age, she began composing letters and stories, and she became a phenomenal diarist, novelist, and playwright in adulthood. Certainly, her skillful writing was a primary reason her mastectomy narrative had such appeal.

In her narrative, Fanny provides “psychological and anatomical consequences of cancer … [and] while its wealth of detail makes it a significant document in the history of surgical techniques, its intimate confessions and elaborately fictive staging, persona-building, and framing make it likewise a powerful and courageous work of literature in which the imagination confronts and translates the body.” Prior to her surgery, she had written similar works about “physical and mental pain to satirize the cruelty of social behavioral strictures, especially for women.”

Samuel_Johnson_by_Joshua_Reynolds-wikipedia

Dr. Samuel Johnson

Fanny grew up in England and had been embraced by the best of London society. She had served in George III and Queen Charlotte’s court as Second Keeper of the Royal Robes. Moreover, she was admired by such literary figures as Hester Thrale, David Garrick, and Edmund Burke. Fanny also befriended Dr. Samuel Johnson, the English writer who made significant contributions to English literature as a poet, essayist, moralist, literary critic, biographer, editor and lexicographer. In fact, some of Fanny’s best revelations are about Johnson, how he teased her, and the fondness that he held for her.

In 1793, Fanny married Louis XVI Alexandre-Jean-Baptiste Piochard d’Arblay and became Madame d’Arblay. D’Arblay was an artillery officer who served as adjutant-general to the famous hero of the American Revolution, Gilbert du Motier, Marquis de Lafayette. D’Arblay had fled France for England during the Revolution just as had many other Frenchmen. However, in 1801, d’Arblay was offered a position in Napoleon Bonaparte’s government. He and Fanny relocated to France in 1802 and moved to Passy (the same spot where Benjamin Franklin and the princesse de Lamballe had lived), and they remained in France for about ten years.

Baron Dominique-Jean Larrey (left) and Antoine Dubois (right)

While living in France, Fanny suffered breast inflammation in her right breast in 1804 and 1806. She initially dismissed the problem but then in 1811 the pain became severe enough that it affected her ability to use her right arm. Her husband became concerned and arranged for her to visit Baron Dominique-Jean Larrey, First Surgeon to the Imperial Guard, as well as the leading French obstetrician, surgeon, and anatomist, Antoine Dubois.

The French doctors treated Fanny palliatively but as there was no response to the treatment, it was determined surgery was necessary. Fanny’s surgery occurred on 11 September 1811. At the time, surgery was still in its infancy and anesthesia unavailable. Cocaine was later isolated, determined to be an effective local anesthetic, and used for the first time in 1859 by Karl Koller. So, it must have been horrific for Fanny to experience the pain of a mastectomy with nothing more than a wine cordial that may have contained some laudanum. Fanny was traumatized by the surgery and it took months before she wrote about the surgery details to her sister Esther exclaiming:

“I knew not, positively, then, the immediate danger, but every thing convinced me danger was hovering about me, & that this experiment could alone save from its jaws. I mounted, therefore, unbidden, the Bed stead – & M. Dubois placed upon the Mattress, & spread a cambric handkerchief upon my face. It was transparent, however, & I saw through it, that the Bed stead was instantly surrounded by the 7 men & my nurse. I refused to be held; but when, Bright through the cambric, I saw the glitter of polished Steel – I closed my Eyes. I would not trust to convulsive fear the sight of the terrible incision. A silence the most profound ensued, which lasted for some minutes, during which, I imagine, they took their orders by signs, & made their examination – Oh what a horrible suspension! … The pause, at length, was broken by Dr. Larry [sic], who in a voice of solemn melancholy, said ‘Qui me tiendra ce sein?”

Fanny went on to describe “torturing pain” and her inability to restrain her cries as the doctors cut “though veins – arteries – flesh – nerves.” Moreover, she noted:

“I began a scream that lasted unintermittingly during the whole time of the incision – & I almost marvel that it rings not in my Ears still! so excruciating was the agony. When the wound was made, & the instrument was withdrawn, the pain seemed undiminished, for the air that suddenly rushed into those delicate parts felt like a mass of minute but sharp & forked poniards, that were tearing the edges of the wound. … I attempted no more to open my Eyes, – they felt as if hermetically shut, and so firmly closed, that the Eyelids seemed indented into my Cheeks. The instrument this second time withdrawn, I concluded the operation over – Oh no! presently the terrible cutting was renewed – and worse than ever … I then felt the Knife rackling against the breast bone – scraping it! – This performed, while I yet remained in utterly speechless torture. “

Despite the excruciating pain, Fanny lived through the operation, and her surgery was deemed a success. Larrey produced a medical report about his brave patient stating that he removed her right breast at 3:45pm and that Fanny showed “un Grand courage.” Courageous as she was, there was no way for doctors to determine if Fanny’s tumor was malignant or if she suffered from mastopathy.

Fanny’s Commemorate Plaque. Courtesy of Bath-heritage.co.uk

Fanny’s healing took a long time, and while still recuperating, she and husband returned to England in 1812. Six years later, in 1818, her husband died from cancer, and she died twenty-two years later, at the age of eighty-seven, on 6 January 1840 in Lower Grosvenor-street in London. As Fanny had requested, a private funeral was held in Bath, England, and attended by a few relatives and some close friends. She was laid to rest in Walcot Cemetery, next to her beloved husband and her only son Alexander, who had died three years earlier. Their bodies were then moved during redevelopment of the Walcot Cemetery to the Haycombe Cemetery in Bath and are buried beneath the Rockery Garden.

References

DeMaria, Jr., Robert, British Literature 1640-1789, 2016
“Died,” in Northampton Mercury, 18 January 1840
Epstein, Julia L., “Writing the Unspeakable: Fanny Burney’s Mastectomy and the Fictive Body,” in Representations, No. 16 (Autumn, 1986), pp. 131-166
Madame D’Arblay, in Evening Mail, 20 January 1840
Madame D’Arblay’s Diary, in Evening Mail, 18 May 1842
“The Journals and Letters of Fanny Burney (Madame D’Arblay), Volume VI, France 1803-1812,” in Cambridge Journals

Geri Walton has long been interested in history and fascinated by the stories of people from the 1700 and 1800s. This led her to get a degree in History and resulted in her website, geriwalton.com which offers unique history stories from the 1700 and 1800s. Her first book, Marie Antoinette’s Confidante: The Rise and Fall of the Princesse de Lamballe, discusses the French Revolution and looks at the relationship between Marie Antoinette and the Princesse de Lamballe.
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A Field Guide to Historical Poisons

[From the archives]

The Long Way Home takes place in the court of Louis XIV during the Affair of the Poisons. During this period, many people from all walks of life were employing poison to dispatch with rivals and even family members to improve their fortunes or standing in court. As you can imagine, poison plays a large part in the plot of The Long Way Home. Here are three that are featured in the book along with symptoms so you’ll be first to know if your enemies have dosed your wine.

You know, just in case.

Arsenic (also known as Inheritance Powder)

Arsenic was the most commonly used poison at this time, and was used alone or to add extra toxicity to other lethal concoctions. It was the primary ingredient in Inheritance Powder, so called because of the frequency with which it was against relatives and spouses for the sake of inheritance.

Tasteless as it was potent, arsenic usually went undetected in wine or food, although it was also added to soap and even sprinkled into flowers. It could easily kill someone quickly, but was more commonly distributed over a long period of time to make it appear that the victim was suffering from a long illness. The symptoms begin with headaches, drowsiness, and gastrointestinal problems, and as it develops, worsen into convulsions, muscle cramps, hair loss, organ failure, coma, and death.

Unusually for a poison apart from lead, arsenic has had many other common uses throughout history. It was used as a cosmetic as early as the Elizabethan period. Combined with vinegar and white chalk, it was applied to whiten the complexion as a precursor to the lead-based ceruse popular in later centuries.

Ad for Arsenic Wafers, 1896. Arsenic was a common complexion treatment until the early 20th century.

By the Victorian period, arsenic was taken as a supplement to correct the complexion from within, resulting in blueish, translucent skin. Victorian and Edwardian doctors prescribed it for asthma, typhus, malaria, period pain, syphilis, neuralgia, and as a nonspecific pick-me-up. It was also used in pigments such as Paris Green, Scheele’s Green, and London Purple, all of them extremely toxic when ingested or inhaled. A distinctive yellow-green, Scheele’s Green was a popular dye in the nineteenth century for furnishings, candles, fabric, and even children’s toys, but it gave off a toxic gas. It may have even played a part in Napoleon’s death. While it took nearly a century to discover the dangers of the pigment, it was later put to use as an insecticide.

A Glass of Wine With Caesar Borgia. John Collier, 1893. From left to right: Cesare, Lucrezia, their father, Pope Alexander VI, and a young man with an empty glass. The implication is that the man doesn’t know if it will be poisoned.

Cantharides (also known as Cantarella or Spanish Fly)

Cantarella was a poison that was rumored to have been used by the Borgias (among others). Although it appeared in literature as something that could mimic death, cantarella was probably made from arsenic, like most of the common poisons of the era, or of canthariden powder made from blister beetles, and was highly toxic. Cantharides are now more commonly known as Spanish Fly.

Although it was only rumored to have been used by the Borgias, it was definitely 8fda6-cantharides associated with the Medicis. Aqua Toffana, or Aquetta di Napoli, was a potent mixture of both arsenic and cantharides allegedly created by an Italian countess, Giulia Tofana (d. 1659). Colorless and odorless, it was undetectable even in water and as little as four drops could cause death within a few hours. It could also be mixed with lead or belladonna for a little extra f*** you.

In case you’re wondering how one would catch enough blister beetles to do away with one’s enemies, cantharides were surprisingly easy to come across. They were also used as an aphrodisiac. In small quantities, they engorge the genitals, so it must have seemed like a good idea at the time. In larger quantities, however, they raise blisters, cause inflammation, nervous agitation, burning of the mouth, dysphagia, nausea, hematemesis, hematuria, and dysuria.

Oh, and death.

The powder was brownish in color and smelled bad, but mostly went unnoticed with food or wine. More than one character in The Long Way Home has come in contact with it, and it even plays a part in the story.

Ad for Pennyroyal Pills, 1905.

Pennyroyal

Pennyroyal was not often used to intentionally poison anyone, but I’m including it in this guide because of its toxic effects. Usually drunk as tea, is was used as a digestive aid and to cause miscarriage. Is was also used in baths to kill fleas or to treat venomous bites.

Although this is the least toxic of the bunch, the side effects are much more worrying. Taken in any quantity, it may not only result in contraction of the uterus, but also serious damage to the liver, kidneys, and nervous system. It’s a neurotoxin that can cause auditory and visual hallucinations, delirium, unconsciousness, hearing problems, brain damage, and death.

Along with Inheritance Powder and Cantarella, Pennyroyal also appears in The Long Way Home and causes some interesting complications for a few of our characters.

All of these poisons were common and easily obtainable in much of Europe during the time this book takes place and as you can see, continued to be commonly used for a variety of purposes until very recently. The use of Inheritance Powder in particular is very well-documented and it played a huge part in the Affair of the Poisons as well as commanding a central position in The Long Way Home.

Don’t say I didn’t warn you.

5 Comments Posted on April 20, 2017 18th Century, 19th Century, Death, Disease, Georgian Britain, Guest Posts, Victorian

Bones, Blood, Barbers, and Butchers: Surgeons in the 18th Century

In the eighteenth century, the record for the fastest amputation at the thigh was nine seconds, start to finish, including sawing through the bone. Are you impressed yet? Even the average, thirty seconds, was pretty damned fast.

And speed was of the essence. Let’s face it. If you needed surgery in the eighteenth century or the first half of the nineteenth, you’d better be strong and brave, because it wasn’t a doddle. Not for the surgeon, and not at all for the patient.

Patients faced three major killers

They’d solved one of the major issues that killed people who needed surgery, reinventing ligatures to tie off blood vessels so the patient didn’t bleed out on the table. Before the sixteenth century, they’d used cautery—burning—to seal any gushers, vastly adding to the pain. And, of course, closing up the wound as fast as possible helped.

And pain was the second issue. No effective anesthetics. Not until the mid-nineteenth century. The patient was awake for the entire operation, which was the main reason why speed (and some strong helpers to hold the patient down) mattered.

The biggest killer was factor number three. Germs.

Not that they knew that, of course. The prevailing opinion was that wound infections were caused by air, though how nobody quite knew. They had no way of knowing that the surgeon’s hands and clothes, the bed sheets, the surgical instruments, the dressings, and a myriad of other surfaces that would come into contact with the patient were covered with organisms too tiny to see, but that would infect the wound. Most people sickened. More than half died.

Keep out the air to keep out the contagion

Some hospitals did pretty well. Their theory was that the infective element was carried in noxious fumes; that is, if it smelled like bad air, it would be bad for their patient. Alexander Monro (Primus and Secundus), a father and son team who headed the Royal Infirmary in Edinburgh, must have run a clean operation. They managed to get the death rate for amputations down to eight percent. Given that other hospitals of the time managed rates of 45 to 65 percent, that’s truly impressive.

Most surgeons relied on speed to limit the amount of time the wound was exposed to the air, thus—they hoped—cutting down on the damage the air did to the tissues.

More butchery than medicine

So a fast surgeon was far more likely to be a successful surgeon for three reasons: less blood flow, a shorter time of acute agony, and (they thought) less contagion. No wonder that, to the rest of the human race, surgery seemed more a matter of butchery than medicine.

Naturally, as they thought at the time, physicians did not perform surgery. Physicians had, since medieval times, been university trained. They were gentlemen’s sons with a medical doctorate, highly educated and knowledgeable about the humours of the body and the appropriate ways to balance them. In theory, their superior knowledge made them the only proper people to practice medicine and oversee surgery. They did not involve themselves in physical labour, but expected rather to command those who distilled the medicines they prescribed (apothecaries) or who carried out operations they deemed necessary.

Surgeons, barber surgeons and apothecary surgeons

Specialist surgeons learned their craft on the job, working as a surgeon’s mate in the navy or the army, or as the apprentice to a barber surgeon or an apothecary surgeon.

Barbers were good men with a blade, so an obvious choice for removing some part that shouldn’t be there or performing a beneficial bloodletting. The familiar red and white barber’s pole dates from the time of the barber surgeon, representing the rod the patient held tightly during the operation and the bloodied and clean bandages used. When washed and hung to dry, they would twist together in the wind, forming the spiral we see today.

Apothecary surgeons had won a landmark case in the first decade of the eighteenth century, when an apothecary was taken to court by the Guild of Physicians for compounding and administering medicines without the benefit of a physician’s advice. The Physicians won, but the Society of Apothecaries appealed to the House of Lords, who were unimpressed with the argument that allowing apothecaries to care for the sick would:

“Deprive the gentry of one of the processions by which their younger sons might honourably subsist and be a great detriment to the Universities.”

The Lords reversed the judgement.

The rise of a profession

By the eighteenth century, surgeons were giving physicians a run for their money, some attending university as well as learning their craft by apprenticeship. However, they seldom had any formal qualifications before the Royal College of Surgeons was founded in London in 1800. They were ‘Mister’ compared to the physician’s more prestigious ‘Doctor’, though the brilliant work of a plethora of eighteenth century surgeons raised their status and the work of medical teaching hospitals such as the Royal Infirmary mentioned above raised their knowledge.

By the time Victoria ascended the throne, the confidence of surgeons, and the income they could command, had risen to the point that the cheeky surgeons made the former insulting honorific into a badge of honour. In the UK, Eire and New Zealand to this day, surgeons are called ‘Mister’ rather than ‘Doctor’.

Jude Knight’s writing goal is to transport readers to another time, another place, where they can enjoy adventure and romance, thrill to trials and challenges, uncover secrets and solve mysteries, delight in a happy ending, and return from their virtual holiday refreshed and ready for anything.

She writes historical novels, novellas, and short stories, mostly set in the early 19th Century. She writes strong determined heroines, heroes who can appreciate a clever capable woman, villains you’ll love to loathe, and all with a leavening of humour.

A Raging Madness is out May 9th. Stop by our sister blog today to see surgery in action in a new excerpt and enter two giveaways!

Leave a comment Posted on April 14, 2017 16th Century, 17th Century, 18th Century, 19th Century, Disease, English Civil War, Georgian Britain, Literature, London, Medieval History, The Restoration, The Southwark Saga

On The Famous Voyage: Finding London’s Lost River

The Fleet River. Samuel Scott, 1750.

London’s major river is, of course, the Thames but, as the capital’s antiquarians will tell you, there are more than a dozen ancient tributaries hidden beneath the surface of the modern metropolis. The largest of these smaller rivers is the River Fleet, which flows from the largest stretch of common green in London, at Hampstead Heath, to Blackfriars Bridge, where it enters the Thames. This is a journey, not just from North London to the River, but also through the history of the City from Ancient to Modern times, marking some colourful characters and encompassing some bewildering changes along the way.

Cities are typically built along rivers to provide drinking water, transport, defense, and sewage removal. The Fleet has served all of these functions over London’s long history. As place-names along its banks (Brideswell, Clerkenwell) suggest, many wells were built along the Fleet in Roman and Saxon times, although, as we shall see, the purity of its waters were not set to be a defining feature as London grew.

The Fleet (‘tidal inlet’ in Anglo-Saxon) initially provided a waterway which served London from the North and, in a later incarnation as the New Canal, was part of the network which brought coal from the North of England to fuel the rapidly industrializing London of the seventeenth and eighteenth centuries. Even after the canals were superseded by road and rail and entirely covered over in the later eighteenth and early nineteenth centuries, the valley carved by the Fleet continued to form the basis for some of London’s modern arteries, such as Farringdon Road and the Metropolitan Railway line (although it resisted having an underground railway line–that which would become the Jubilee Line–lain beneath it by repeatedly flooding tunnels).

Defensively, the Fleet has a rather inglorious history. It is unclear how the Fleet was utilized by the Romans and it seems rarely to have been called upon subsequently. A second century boat carrying ragstone (possibly intended for building the city wall) was discovered in 1962, sunk at the mouth of the river.

Much later, the Fleet’s banks were built up into earthworks during the Civil War, when London was very much a Parliamentarian (‘Roundhead’) stronghold. The Royalist armies, however, never threatened the capital, with Charles II’s return to the City being by invitation rather than by conquest. During one of the great crises of the restored king’s reign in 1666, desperate Londoners were hopeful that the Fleet would provide an effective break against the Great Fire as it reached its third day. Here the Fleet proved as ineffective as the civic defenses and the Fire jumped the Fleet ditch, ultimately allowing it to claim St Paul’s Cathedral.

Of course, the most serious modern military threat to London came from the air in the form of the Luftwaffe. The old river beneath Fleet Street could offer no protection when Serjeant’s Inn, one of the oldest legal precincts in England, was destroyed during the Blitz.

It is with the removal of sewage and other waste, or at least with its failure to do so effectively, with which the Fleet is most famously associated. As London grew, the Fleet increasingly became a repository for whatever the city’s inhabitants wanted to get rid of. The medieval meat markets which grew up to feed the expanding population soon became problematic and in 1290 the Carmelite monks complained that the offal deposited in the river by butchers at a nearby market (the delightfully-named Shambles, at Newgate) was constantly blocking what was, at this point, a stream.

The southern end of the Fleet, 1550s.

Although all manner of industries poured waste into the Fleet, it was the offal and dead animals in various forms which seemed to catch the imagination of early modern satirists of the capital. Ben Jonson’s (c. 1612) mock-epic poem which lends its title to this article was a litany of classical references intertwined with toilet humour and social satire and described the diverse pollutants of the river with considerable gusto:

Your Fleet Lane Furies; and hot cooks do dwell,
That, with still-scalding steams, make the place hell.
The sinks ran grease, and hair of measled hogs,
The heads, houghs, entrails, and the hides of dogs:
For, to say truth, what scullion is so nasty,
To put the skins, and offal in a pasty?
Cats there lay divers had been flayed and roasted,
And, after mouldy grown, again were toasted,
Then, selling not, a dish was ta’en to mince them,
But still, it seemed, the rankness did convince them.
For, here they were thrown in with the melted pewter,
Yet drowned they not. They had five lives in future.

Jonson’s influence and the continued assault of the Fleet upon the senses continued into the eighteenth century: Jonathan Swift’s “Drown’d Puppies” and “Dead Cats” of 1710’s A Description of a City Shower, floating amongst the offal and turnip-tops, were echoed by Alexander Pope’s “large tribute of dead dogs to the Thames” in 1728’s Dunciad.

The enthusiasm of these men for describing the sewage, of which the Fleet’s waters seemed largely comprised, was hardly less. Jonson’s ‘voyage’ was taken down a river where “Arses were heard to croak, instead of frogs”. His Fleet contained the contents of every ‘night-tub’ from an overcrowded metropolis, where “each privy’s seat/ Is filled with buttock” and the very “walls do sweat Urine”. This state of affairs is compounded by the diet of a city where “every clerk eats artichokes, and peason, Laxative lettuce, and such windy meat”. In 1700, Thomas Brown has his narrator, an ‘Indian’ revealing the strange “Manners, Customs, and Religions” practiced by the various “Nations” of London to his readers, shove an impudent rag-seller into the kennel [1] in the centre of the street with the words:

Tho’ I want nothing out of your Shops, methinks you all want good Manners and Civility, that are ready to tear a New Sute (suit) from my Back, under pretence of selling me an Olde one; Avant Vermin, your Cloaths smell as rankly of Newgate and Tyburn, as the bedding to be sold at the Ditch-side near Fleet-Bridge, smells of Bawdy-House and Brandy.

Brown’s tone is lighthearted and playful, but some of the associations he makes are telling. The visceral nature of these accounts certainly reflected a literal reality but they also had a metaphorical dimension in which it was the excesses and vices of London itself which were clogging up its abused waterways. The writers were playing, not just on the Fleet’s role in waste disposal, but also on the reputation of those who occupied its banks. In Jonathan Swift’s A Description of a City Shower, in particular, a storm washing through London links the different areas and strata of the city together through its flow.

The Fleet flowed past Bridewell and the Fleet prisons and through areas such as Clerkenwell, notorious for sheltering heretics, thieves, and prostitutes from the arms of the law. Here the bodies floating downstream alongside the unfortunate cats and dogs might be human. The industries around the river were messy and disease was known to cling to its slums. The Dunciad plays on the Fleet’s use as an open sewer by having the hack-writers, who are one of the principal subjects of Pope’s ire, swim in it. The implication was as clear as Pope’s Fleet was ‘muddy’. Much later, Charles Dickens’ child-warping pick-pocket, Fagin, would have his den alongside the Fleet.

From the early attempts by the Carmelites to keep the river unblocked to the late seventeenth and early eighteenth century attempt to make it serve as a canal, the smell and the constant need for dredging could not be overcome. So impossible was it to contain the flood of effluent that, even after the river was paved over during the later part of the eighteenth and early part of the nineteenth centuries, the build-up of trapped gas exploded near Blackfriars in 1846, taking out three posthouses and a steamboat in the process. It must have seemed as though the truth would not be hidden beneath the streets. Eventually, however, the Great Stink of 1858 preceded a concerted effort to enclose the city’s sewers and a London more familiar to us today emerged.

Dr. J.V.P. Jenkins is a historian and freelance editor from London. He earned his BA, Master’s, and Doctorate at Swansea University. He is the new co-editor of Dirty, Sexy History and sometimes tweets @JVPolsomJenkins.

Sources

Brown, Thomas. Amusements serious and comical, calculated for the meridian of London (1700)
Dickens, Charles. Oliver Twist (1839)
Jonson, Ben. On The Famous Voyage (c.1612)
Pope, Alexander. Dunciad (1728)
Swift, Jonathan. A Description of a City Shower (1710)
Ackroyd, Peter. London: The Biography (Anchor; New York, 2003)
Brown, Laura. Fables of Modernity: Literature and Culture in the English Eighteenth Century (Cornell U.P., 2003)
Gray, Robert. A History of London (Taplinger; New York, 1979)

[1] An open gutter, running down the middle of the street. The 1671 Sewage and Paving Act had prescribed moving the kennel from the center of the street to an open side drain set off by a raised pavement. The main thoroughfares were also to be cambered (built up in middle for drainage and paved) but these measures were not instantly applied to all streets.

5 Comments Posted on March 30, 2017March 29, 2017 18th Century, 19th Century, Death, Disease, France, Georgian Britain, Guest Posts, Law, London, Religion, The Regency

Smallpox vs Edward Jenner: How One Doctor Invented Vaccination and Cured the World

1808_cruikshank-vaccinia

The deadly disease smallpox had been feared by man for thousands of years by the 1800s, and rightly so. It was highly contagious, incurable, and killed a third of those unlucky enough to catch it.

Those who survived it were rarely left unscathed. Aside from the inevitable permanent scarring, it could leave victims blind and doomed to spend the rest of their days battling lung or joint problems. The disease also did not discriminate between the rich or poor.

Several royals and world leaders contracted it. Queen Elizabeth I, George Washington and Joseph Stalin all had pock-marked faces which they took great pains to disguise. The 18th century fashion for wearing patches stemmed from the desire to hide the damage smallpox had done to aristocratic skin. Smallpox killed both King Louis XV of France and Queen Mary II of England, monarchs who could well afford the best physicians to try to save them, so the merest threat of it was enough to send the population into a panic.

Of course, it didn’t help matters that medical scientists had no idea how the disease was spread and had no way of treating it. The concept of bacteria and viruses would not begin to enter into medicine until 1861, so physicians were clueless. Theories abounded over time, blaming God, the alignment of the planets, and eventually evil miasmas (bad air) as the root cause of an epidemic. Treatments were equally as primitive. Prayer, smelling sweet nosegays, and bonfires were the only weapons the Western World had for centuries. As a result, outbreaks could kill thousands in a very short space of time with terrifying speed, especially children or the old. The only thing they did know, was once you had caught it, you couldn’t catch it again.

In the East where medicine was traditionally more advanced and largely unencumbered by religious interference, physicians expanded upon this idea. Using the healing scabs of a recovering smallpox victim, which they scratched into the skin of healthy people, they protected them. Although they did not realise it at the time, what they were doing was building up the body’s antibodies using a weakened dose of smallpox and thereby rendering the body resistant to any stronger. It’s still a common practice nowadays with certain diseases. Polio is a classic example. Variolation (or inoculation as we now know it) was brought to Britain in 1715 by Lady Wortley Montague, an ambassador’s wife who had suffered smallpox as a child and lost a brother to it.

Whilst inoculation did work in a great majority of cases, it was not without serious risk. By exposing people directly to smallpox, albeit a significantly weaker version of the disease, at least ten percent of those inoculated contracted full-blown smallpox in the process, often with fatal consequences. King George III lost his son Prince Frederick after he had the boy inoculated. When even the king could not guarantee its safety, a great many preferred not to take the risk. Inoculation was also very expensive, which put even more off it, so smallpox remained a devastating killer throughout the eighteenth century.

In 1784, after extensive study of smallpox victims during an epidemic in his hometown of Chester, Dr John Haygarth became convinced smallpox was transferred by human contact. He recommended quarantining anyone with smallpox and gave sound advice as to how anyone coming into contact with a victim should stop the infection spreading:

“During and after the distemper, no person, clothes, food, furniture, cat, dog, money, medicines or any other thing that is known or suspected to be bedaubed with matter, spittle, or other infectious discharges of the patient should go out of the house until they have been washed…When a patient dies of smallpox, particular care should be taken that nothing infectious be taken out of the house so as to do mischief.”

Haygarth’s methods were soon widely adopted. Wherever possible, smallpox victims were isolated away from the rest of the community. Every item of clothing and bedding used was burned to avoid contaminating others. Sometimes, this occurred using quarantine ships. These were hardly floating hospitals as there was little doctors could do other than let the disease run its course, however, moving sufferers offshore was fairly successful in containing the disease if they caught it quickly enough.

cowpox The big breakthrough came thanks to a country doctor called Edward Jenner. He decided to test the validity of an old wives’ tale which claimed all those who worked with cows were immune to smallpox. Over the course of many years, he discovered that those new to working with cattle–such as milk maids–often caught a relatively harmless disease from them. Cowpox caused a mild fever and an irritating skin rash in humans which quickly cleared up of its own accord. Jenner began to suspect cowpox was the key to the immunity from smallpox. However, to test his theory he would need to infect a human with cowpox who had never come into any contact with cows before.

In 1796 he paid the parents of James Phipps, and then injected the pus from a cowpox pustule into the boy. A few weeks later, he exposed the boy to smallpox and when nothing happened declared it a resounding success. He called his new treatment vaccination as the word vacca is Latin for cow and was convinced it was the only thing capable of defeating the ‘speckled monster’. However, the Royal Society did not welcome his research with open arms. They declared it too revolutionary and asked for more proof. It took until 1798, and several more experiments with cowpox including one on his own baby son, before they published his findings.

Although conclusive, the people were less enthusiastic to this new miracle prevention. There was an enormous backlash against Jenner’s vaccination accompanied by an extensive propaganda campaign. Aside from the fact the new prevention was more expensive than the old-fashioned inoculation, the widespread resistance came because of two things:

Firstly, and perhaps most importantly, vaccination was seen as ungodly. The very religious masses listened to the anti-vaccination sermons preached from pulpits the length and breadth of the British Isles. After all, in Corinthians is stated quite clearly: “All flesh is not the same flesh: but there is one kind of flesh of men, another flesh of beasts”. Mixing the two things was grossly unacceptable according to the scriptures.

James Gillray, The Cow Pock. An anti-vaccination cartoon from 1802.

Secondly, although Jenner was able to prove vaccination did work with none of the risks caused by inoculation, he had no earthly idea why. Even the educated struggled to justify agreeing to vaccination without knowing the science behind it. Perhaps it was possible they would begin to sprout horns and udders in the future? Nobody could say for certain this wouldn’t happen.

Others were less resistant. Napoleon honoured Jenner with a medal after the Frenchman vaccinated his troops. Before that, more of his army were killed by smallpox than by battle. Another fan was President Thomas Jefferson who, in 1806, wrote a gushing letter of thanks to Edward Jenner:

“I avail myself of this occasion of rendering you a portion of the tribute of gratitude due to you from the whole human family. Medicine has never before produced any single improvement of such utility… Future nations will know by history only that the loathsome small-pox has existed and by you has been extirpated.”

While history proved Jefferson’s prediction correct, such accolades from Britain’s then enemies did not really do Edward Jenner any favours at home. Vaccination remained hugely unpopular with the masses and some dyed-in-the-wool physicians despite overwhelming evidence of its success and continued to be during Edward’s lifetime and beyond. He died in 1823 with his vaccination still as controversial then as it had been in 1796.

Things came to a bit of a head in the UK when the government stepped in. In 1840 they declared the old inoculation illegal, thus eliminating the choice. Then, the 1853 Vaccination Act made it compulsory in law for all babies to be vaccinated before they were three months old. Failure to do so resulted in a one pound fine and potentially the risk of prison. People argued they were now denied the right to decide what they could put into their own bodies and many took to the streets to protest. Compulsory vaccination was so unpopular, the government had to back down and stopped prosecuting those who refused.

It was only once the brilliant French scientist Louis Pasteur began to do more experiments on vaccination in the late 19th century, and was finally able to explain why it worked, that public objection lessened. Smallpox vaccination became widespread and the catastrophic and destructive epidemics died out. The last known recorded case of smallpox was in Somalia in 1977 and in 1980 the World Health Organization declared the disease eradicated save the few samples kept secure in laboratories. And all thanks an old wives’ tale and a tenacious, mild-mannered country doctor from Gloucestershire who never wanted to be famous.
virginia heath cover
Virginia Heath writes witty Regency romantic comedies for Harlequin Mills & Boon. The first book in her ‘Wild Warriners’ series, A Warriner to Protect Her, will be released in April 2017.

2 Comments Posted on February 16, 2017February 15, 2017 19th Century, America, Death, Disease, Guest Posts, Violence

Civil War Hospitals Were Enough to Make You Sick

A nurse and the wounded outside a hospital in Fredericksburg

When people find out that I wrote the non-fiction companion to Mercy Street, the PBS series set in a Union hospital during the American Civil War, they almost always ask me whether the show gets the historical details right. Particularly whether the medicine is accurate. I tell them that the series does a great job with historical accuracy with one exception: the television version of Mansion House Hospital isn’t dirty enough.

Today we think of hospitals as bastions of sanitation. But in the mid-19th century hospitals were dangerous, dirty, smelly places that many people rightly regarded as death traps. Add in the chaos of war and you had breeding grounds for contagious diseases, including smallpox, measles, pneumonia, influenza, tuberculosis, typhoid and yellow fever.

At the beginning of the war, the Union Army had a few hospitals attached to forts in the west, but none along the eastern seaboard. In order to cope with the crisis of illness and injury that began before the first battle was fought, the Army’s Medical Bureau requisitioned buildings for use as general hospitals throughout Washington DC and surrounding towns, primarily hotels and schools. Many of them were run down and most suffered from inadequate ventilation and poorly designed toilet facilities, which aggravated the problems of disease.

The largest of the Washington hospitals was the Union Hotel, where Louisa May Alcott served as a nurse for a little over a month. The hospital opened on May 25, 1861, and was soon infamous for its poor condition and worse smells. A report on its condition, made shortly after the first Battle of Bull Run in July 1861, stated that

…the building is old, out of repair, and cut up into a number of small rooms, with windows too small and few in number to afford good ventilation. Its halls and passages are narrow, tortuous and abrupt…There are no provisions for bathing, the water-closets and sinks are insufficient and defective and there is no dead-house [a room or structure where dead bodies could be stored before burial or transportation—a grim necessity in a Civil War hospital.] The wards are many of them overcrowded and destitute of arrangements for artificial ventilation. The cellars…are damp and undrained and much of the wood is actively decaying. (1)

Alcott was more blunt. In a letter home, she complained “a more perfect, pestilence-box than this house I never saw,–cold, damp, dirty, full of vile odors from wounds, kitchens, wash-rooms, and stables.”

Nurses, supported by convalescent soldiers, occasional chambermaids, and an army of laundresses, fought to keep hospitals clean in the face of a seemingly endless stream of mud, blood, and diarrhea—a common element of Civil War military life seldom mentioned in letters and memoirs of the period. (An average of 78 percent of the Union Army suffered from what they called the “Tennessee quick-step” at some point each year.) It was a monumental task, even by standards of cleanliness that required patients’ undergarments to be changed once a week and saw nothing wrong with reusing lightly soiled bandages.

Keeping a supply of clean shirts, clean underwear, clean sheets, and clean bandages required a heroic effort—especially when a given patient might require three clean bandages and a fresh shirt daily, all of which would need to be thrown away because they were so stained with blood and pus. The newly constructed general hospital at Portsmouth Grove, Rhode Island, reported boasted a new-fangled steam washing machine that could wash and mangle four thousand pieces of laundry a day. It was an innovation that hospitals improvised from hotels and schools could only dream of with envy. Most hospitals had to make do with wooden washtubs, soap-sized kettle for heating water, and elbow grease. Washable clothing, bed linens, bandages and rags were washed in hot water using soft soap and a scrub board, boiled to kill lice and insects, rinsed several times in hot water, allowed to cool, and then rinsed again in cool water. Water had to be carried by hand from water sources that varied in degree of inconvenience. Once acquired, water was heated in large kettles on wood- or coal-burning stoves and carried from kitchen to washtub. It was not unusual for a general hospital laundry to process two or three thousand pieces of laundry in one day.

Even the best efforts to keep hospitals clean did not deal with the root causes of contagion. A bacterial theory of disease was some decades in the future. The prevailing medical theory of the period focused on clean air rather than clean water because doctors believed that diseases were spread through the poisoned atmosphere of “miasmas.” Doctors interested in hospital sanitation were concerned with eradicating foul smells. New hospitals were built with an eye toward providing fresh air. Hospital designers would have been well advised to focus on handling human waste instead.

The sanitary arrangements in Civil War hospitals made it easy for diseases linked to contaminated water, like typhoid and dysentery, to spread. Many latrines and indoor water closets had to be flushed by hand, carried by hand from a water source some distance away. As a result, they were not flushed out as frequently as required to keep them sanitary. Worse, in some hospitals, latrines were located too close to the kitchens. Even when there was an adequate distance between the two, flies carried bacteria on their feet as they flew between latrines, kitchens and patients’ dinner trays.

It’s no wonder that disease was responsible for two-thirds of all Civil War deaths.

(1) Quoted in Hannah Ropes. Civil War Nurse: The Diary and Letters of Hannah Ropes, ed. John R. Brumgardt. (Knoxville: University of Tennessee Press, 1980) p. 40.

(2) Quoted in Ropes, p. 40

Further Reading

Humphreys, Margaret. Marrow of Tragedy: The Health Crisis of the American Civil War. Baltimore: Johns Hopkins University Press. 2013

Rutkow, Ira. M. Bleeding Blue and Gray: Civil War Surgery and the Evolution of American Medicine. New York: Random House. 2005.

Schultz, Jane E. Women at the Front: Hospital Workers in Civil War America. Chapel Hill and toler_heroinesofmercystreet London: University of North Carolina Press. 2004.

Pamela D. Toler is a freelance writer with a PhD in history and a large bump of curiosity. She is the author of Heroines of Mercy Street: The Real Nurses of the Civil War and is currently writing a global history of women warriors, with the imaginative working title of Women Warriors. She blogs about history, writing, and writing about history at History in the Margins.

5 Comments Posted on February 2, 2017 19th Century, Death, Disease, France, Georgian Britain, Guest Posts, Politics, The Regency, Uncategorized

“A Second St Domingo”: Sickness during the Walcheren Expedition of 1809

Terrain of the Walcheren campaign, from France Militaire: histoire des Armees Francaises de terre de mer de 1792 a 1833…by A. Hugo, 1837.

In 1809, the British government sent an amphibious force of 40,000 men and 600 naval vessels to the Scheldt to destroy the French fleet and dockyards at Antwerp and Flushing. It was Britain’s biggest expeditionary undertaking since the beginning of the wars with France in 1793, part of the War of the Fifth Coalition and a diversion to assist the Austrians against Napoleon in central Europe.

The expedition, under the military command of John Pitt, 2nd Earl of Chatham, was a complete failure. The Austrian allies were defeated before the expedition left; although the British captured the island of Walcheren, they advanced too slowly across the neighbouring island of South Beveland, allowing the French to reinforce Antwerp. The expedition was finally withdrawn after a catastrophic outbreak of ‘Walcheren fever’, a combination of several diseases, including malaria.

The impact of this sickness can best be gauged through dry statistics. Of the 39,219 rank and file sent to Walcheren, 11,296 of them were on the sick lists by February 1810. By this time 3,960 were dead. A further 106 had died in battle, but those numbers were swallowed up in the sheer scale of the tragedy.

‘Walcheren fever’ struck the troops suddenly and savagely. One source, the anonymous Letters from Flushing, recorded fatalities from sickness as early as 12 August 1809, but on 8 August the British Chief of Staff reported ‘We have as yet no sick,’ and on 11 August the commander-in-chief Lord Chatham thought ‘the Troops upon ye whole continue healthy.’[1]

By 20 August, however, things had changed. The official Proceedings of the Army recorded on 22 August: ‘Sickness began to show itself among the Troops in South Beveland. On the 20th the number of Sick was 1564, and within the two following days it increased very considerably.’ The next day, the 23rd, the Proceedings recorded ‘Sickness increased very much within the last 24 hours.’ By the 24th the sickness had spread to Walcheren.[2]

At first the officers were not too worried. One of the aides-de-camp to Sir Eyre Coote (Chatham’s second-in-command) recorded in his diary on 24 August: ‘5000 French Troops are said to have fallen a victim to the climate last year, but I consider this as a very exaggerated statement, and at any rate, the constitutions of our men & their habits of life, are much better adapted to this moist atmosphere.’[3]

But by the 27th there were 3467 sick. The following day the officer compiling the official returns could not restrain his concern: ‘The sickness increased to an alarming Proportion, some of the General, and many other Officers were seized with fever, and the Number of Men on the Sick List was nearly 4000.’[4]

The evacuation of South Beveland, August 1809

The sickness was described by Lieutenant William Keep of the 81st:

The disease comes on with a cold shivering, so great that the patient feels no benefit from the clothes piled upon him in bed, but continues to shiver still, as if enclosed in ice, the teeth chattering and cheeks blanched. This lasts some time and is followed by the opposite extremes of heat, so that the pulse rises to 100 in a small space. The face is then flushed and eyes dilated, but with little thirst. It subsides and then is succeeded by another paroxysm, and so on until the patient’s strength is quite reduced and he sinks into the arms of death.[5]

The British army had been sent to Walcheren with medical supplies for only 30,000 men. It was caught completely off-guard by the scale of the sickness. Things were not helped by the fact that the British had bombarded one of Walcheren’s largest merchant towns, Vlissingen (Flushing), in mid-August, which restricted the accommodation available to the British troops. By 30 August there were nearly 900 sick in Flushing alone, ‘all of them laying [sic] on the bare boards without Paillasses & many without Blankets.’ Two days later Coote’s aide concluded in despair: ‘This island is a mere Hospital and an Inspector of Hospitals will shortly be a more useful officer than the General Commanding.’[6]

Flushing Harbour. Photograph by Jacqueline Reiter

All these circumstances contributed to an atmosphere of near-panic. Nobody knew who would be next, and no rank was exempt. ‘A considerable degree of apprehension of Climate and Disease has prevail’d too generally, and there has been much anxiety shewn to get away from this Island as if it had been a second St Domingo,’ the Chief of Staff reported disapprovingly, but by this time several generals (including General Mackenzie-Fraser, who later died) were dropping like flies.[7] By mid-September the Adjutant-General of the army was sending in daily (rather than weekly) sick reports, and Chatham decided to start sending the sick home ahead of official orders from the War Office.

According to one account, one doctor ‘and his assistant [had] nearly five hundred patients prostrate at the same moment … the whole concern was completely floored’. [8] By 23 September the army had almost completely run out of bark (now quinine, used to treat malaria) and the medical corps were of course also losing staff to sickness. Sir Eyre Coote (who took over from Chatham, who was recalled) reported to the Secretary of State for War: ‘I can assure Your Lordship, without any Fear of Exaggeration … that the Situation of the Troops in this Island is deplorable … The Sick are so crowded, as to lay Two in one Bed in several Places, and have no Circulation of Air.’ In Flushing, by contrast, many of these places had rather too much air circulation, owing to ‘the damaged State of the Roofs, never repaired since the Siege.’[9]

Totally overburdened, the medical corps became desperate in their attempts to stem the disease. They had no idea what was causing it: they knew it wasn’t contagious, but thought it was due to ‘local or endemic Causes, viz. the Miasmata or Exhalations from the Soil.’ They did, however, notice that the sailors on board the British ships remained healthy, with the exception of the ones who had gone ashore to help with the siege of Flushing (naturally, as mosquitoes do not breed around salt water). One proposed treatment therefore was to pack the British sick into ships and sail them around the islands, in the hope that the sea air and a change of scene would restore them to health. Unsurprisingly, this did not work.[10]

The impact of Walcheren fever on the British army was significant and long-lasting. The soldiers who had served on the campaign continued to relapse periodically for years after. In March 1812 Lord Wellington, in the midst of fighting in the Spanish Peninsula, lamented the fact that his troops had been ‘so much shaken by Walcheren.’ [11] The careers of the commander-in-chief of the Army, Lord Chatham, and the naval commander, Sir Richard Strachan, were destroyed by the disaster.

The British government that had planned the expedition under the Duke of Portland fell, and its successor nearly foundered during the ensuing parliamentary inquiry into the debacle. Two government ministers, Lord Castlereagh and George Canning, ended up fighting a duel. None of this, of course, was especially comforting to the four thousand men who had died from ‘Walcheren fever’.

References
[1] Letters from Flushing … by an Officer of the Eighty-First Regiment (London, 1809), p. 120; Sir Robert Brownrigg to Colonel Gordon, 8 August 1809, BL Add MSS 49505, f. 9; Chatham to Castlereagh, 11 August 1809, PRONI D3030/3220; John Webb to the Surgeon General, 27 August 1809, A Collection of Papers relating to the Expedition to the Scheldt (London, 1809), pp. 588-90.
[2] The National Archives WO 190, 22-4 August 1809.
[3] University of Michigan Coote MSS, Box 29/3, Diary of the Walcheren Expedition, 24 August 1809.
[4] The National Archives WO 190, 27-8 August 1809.
[5] Quoted by Martin Howard, Walcheren 1809, Barnsley, 2011, p. 161.
[6] University of Michigan Coote MSS, Box 29/3, Diary of the Walcheren Expedition, 30 August, 1 September 1809.
[7] Sir Robert Brownrigg to Colonel Gordon, 8 September 1809, BL Add MSS 49505 f. 69.
[8] Rifleman Harris, quoted by Howard, Walcheren 1809, p. 172.
[9] Sir Eyre Coote to Castlereagh, 17 September 1809, A Collection of Papers, pp. 137-40.
[10] Memorandum dated 25 September 1809, A Collection of Papers, pp. 623-5; Sir Eyre Coote to Lord Liverpool, 23 October 1809, A Collection of Papers, pp.177-8.
[11] Howard, Walcheren 1809. p. 215.

Further reading
Gordon Bond, The Grand Expedition (Athens, GA, 1971)
Martin R. Howard, Walcheren 1809 (Barnsley, 2011)
John Lynch, ‘The Lessons of Walcheren Fever, 1809’, Military Medicine 174(3) 2009, pp. 315-19
T.H. McGuffie, ‘The Walcheren Expedition and the Walcheren Fever’, English Historical Review 62(243) 1947, pp. 191-202

Jacqueline Reiter has a PhD in late 18th century political history from the University of Cambridge. A professional librarian, she lives in Cambridge with her husband and two children. She blogs at www.thelatelord.com and you can follow her on Facebook or Twitter. Her first book, The Late Lord: the life of John Pitt, 2nd Earl of Chatham, was published by Pen & Sword Books in January 2017.

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