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!

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Lies, Spies, and Unsung Heroes: Espionage and the British Empire

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Engraving of Elizabeth I with William Cecil (left) and Francis Walsingham (right)

We’ve loved our spy fiction for over 100 years. The early years of the twentieth century saw the start of the genre, with Kim, by Rudyard Kipling, several books by Joseph Conrad, The Scarlet Pimpernel, by Baroness Orczy, even some of the Sherlock Holmes stories by Sir Arthur Conan Doyle.

Sexy heroes, thrilling encounters, mysterious beautiful women, and ghastly villains. Spy novels had it all. How things have changed.

Disreputable and dishonest

In the past, spying was a murky hidden business, and spies despised as liars who sold their honour. The British Secret Service was not founded until the twentieth century, and before that spies were seen as dishonest and disreputable. Yet without them, the history of England would be very different.

Henry VIII and Elizabeth I both had spymasters whose extensive spy networks helped keep their royal majesties on their throne.

Sir Anthony Standen—torn between loyalties

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Standen’s alias: Pompeo Pellegrini

One of those spies was a Catholic refugee from Protestant England, whose reports on the Spanish Armada allowed the English to attack the Spanish Fleet at Cadiz. Sir Francis Drake fired ships and sunk galleys, putting the invasion off for years.

Poor Sir Anthony Standen. His love for England and his love for his faith conflicted, and — although he eventually returned to his home country — he was not welcomed by a grateful nation. Indeed, though he was sent on further spying missions, he was also imprisoned for a time in the Tower of London.

It is an interesting juxtaposition: his sterling work for the Crown did not (in the eyes of some) prove his patriotism, but rather his lack of moral fibre. He spied, therefore he could not be trusted.

Spying at home as well as abroad

Walsingham and his successors were as likely to spy on Englishmen as on enemies from abroad. William Pitt the Younger, in more than tripling the amount spent by the government on spying and infiltration of potentially rebellious organisations, was walking in well-trodden footsteps. The budget passed through the hands of a few civil servants at home, and ambassadors and military commanders abroad, with no more accounting than this oath.

I A.B. do swear, That the Money paid to me for Foreign Secret Service, or for Secret Service in detecting, preventing, or defeating, treasonable, or other dangerous Conspiracies against the State…, has been bona fide, applied to the said Purpose or Purposes, and to no other: and that it hath not appeared to me convenient to the State that the same should be paid Abroad. So help me GOD.

A secret part of the Post Office opened, read, and copied mail, especially mail from foreign governments. And both amateur and professional informers reported on their neighbours.

Systematic spying

Napoleon employed a network of spies, under the Minister of Police, Joseph Fouche, who had survived the two previous regimes and would survive the Empire to serve the restored monarchy.

The English system was much more ad hoc. Spies, yes, and many of them, but probably no central co-ordination, though William Savage makes a good argument for the central role of The Alien Office.

Overseas, diplomats and military commanders took the fore. We know the names of some of the diplomatic spymasters who plotted against Napoleon: William Wickham in Switzerland, Francis Drake* in Munich and later Italy.

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Colquhoun Grant by George Jones (1815-1820), National Portrait Gallery. Grant was a British army soldier and intelligence officer during the Napoleonic Wars.

Noble spies

Wellington had ‘exploring officers’, who would have challenged you to a duel had you dared to call them spies. They were officers and gentlemen, and if they did creep behind enemy lines to collect information, they wore their uniforms to do so. Wearing a disguise or other forms of deception would be beneath their code of civilised behaviour.

But Wellington (and other military leaders) also had other intelligence gatherers who were less particular. Did some of them include members of the great aristocratic families of England? If so, we would not expect to find out from the records. Such a secret would reflect badly on those families, and would never be disclosed.

Spies of romance

So we are free to imagine that the romantic heroes and heroines of our modern stories might represent some, at least, of the spies whose reports on Napoleon’s troops, movements, and intentions saved England from invasion. Or who uncovered plots at home.

Prudence Virtue, heroine of my book Revealed in Mist, is a spy in the service of the mysterious Tolliver. Recruited after a love affair turned sour, she infiltrates the houses of the ton to uncover secrets and help defend the State. Or so Tolliver claims.

Jude Knight

15057987_707784779371091_490009922_nJude 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.

Since publishing Candle’s Christmas Chair in December 2014, Jude’s name has seldom been off Amazon bestseller lists for one or more books. She is a member of Romance Writers of New Zealand, and of the Beau Monde chapter of Romance Writers of America. You can visit her at http://www.judeknightauthor.com

Revealed in Mist is out December 13, 2016.

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References
Ioffe, Alexander: Espionage During the Napoleonic Wars. The Dear Surprise.
Rice, Patricia: Spies in Regency England. Word Wenches
Savage, William: The C18th British Secret Service under Pitt. Pen and Pension.
Secrets and Spies, National Archives Exhibition.

*The diplomat, not to be confused with Sir Francis Drake. -Ed.

 

The Rakehell in Fact and Fiction

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A Rake’s Progress, Hogarth (1732-33). This progress was a series of eight paintings by William Hogarth showing the decline and fall of a man who wastes his money on luxurious living, sex, and gambling.

In modern historical romantic fiction, the hero is often described as a rake. Frequently, he has the reputation but not the behaviour. He is either misunderstood, or he is deliberately hiding his true nature under a mask, perhaps for reasons of state.

Even the genuine player is not what they would have called a rakehell back in the day. He cats around, sleeping with multiple lovers (either sequentially or concurrently) or keeping a series of mistresses, or both. But when he falls in love with the heroine he puts all of that behind him, and—after undergoing various trials—becomes a faithful husband and devoted family man.

Yesterday’s rakehell was a sexual predator

johnwilmot

John Wilmot, 2nd Earl of Rochester was part of the Merry Gang, the original Restoration rakes who surrounded Charles II. He is known for his lovers, his poetry, his profligate behavior, and an unending stream of scandal. He is said to have been constantly drunk for five years, and died at only 33 years of age.

The Georgian and Regency rakehell was a far less benign figure. Back then, a rakehell was defined as a person who was lewd, debauched, and womanising. Rakes gambled, partied and drank hard, and they pursued their pleasures with cold calculation. To earn the name of rake or rakehell meant doing something outrageous—seducing innocents, conducting orgies in public, waving a public flag of corrupt behaviour under the noses of the keepers of moral outrage. For example, two of those who defined the term back in Restoration England simulated sex with one another while preaching naked to the crowd from an alehouse balcony.

Then, as now, rakes were self-centred narcissists who acknowledged no moral code, and no external restraint either. Their position in Society and their wealth meant they could ignore the law, and they didn’t care about public opinion. What they wanted, they took. A French tourist, writing towards the end of the 19th century said:

“What a character! How very English! . . . Unyielding pride, the desire to subjugate others, the provocative love of battle, the need for ascendency, these are his predominant features. Sensuality is but of secondary importance. . . In France libertines were frivolous fellows, whereas here they were mean brutes. . .”

Most aristocrats in the 18th century would not have called themselves rakes

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Francis Dashwood, 11th Baron le Despencer, fount time between his political duties and his promiscuous sexual activities to found and run the Hellfire Club, whose members included some of the most powerful men of the day. They gathered to share their interests: sex, drink, food, dressing up, politics, blasphemy, and the occult.

Historians have commented that we see the long Georgian century through the lens of the Victorian era, and our impressions about moral behaviour are coloured by Victorian attitudes. The Georgians expected men to be sexually active, and where women were concerned, they worked on the philosophy that if no one knew about it, it wasn’t happening. If visiting brothels, taking a lover, or keeping a mistress, was all it took to be defined as a rake, most of the male half of Polite Society would be so called. And a fair percentage of the female half.

Drunkenness certainly didn’t make a man a rake—the consumption of alcohol recorded in diaries of the time is staggering. Fornication and adultery weren’t enough either, at least when conducted with a modicum of discretion (which meant in private or, if in public, then with other people who were doing the same thing).

In the late 18th and early 19th century, one in five women in London earned their living from the sex trade, guide books to the charms, locations, and prices of various sex workers were best-selling publications, men vied for the attention of the reigning courtesans of the day and of leading actresses, and both men and women chose their spouses for pedigree and social advantage then sought love elsewhere. The number of children born out of wedlock rose from four in 100 to seven (and dropped again in the Victorian). And many women had children who looked suspiciously unlike their husbands.

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Lord Byron. Described as mad, bad, and dangerous to know, Byron was admired for his poetry and derided for his lifestyle. When a series of love affairs turned sour, he married, but within a year his wife could no longer take his drinking, increased debt, and lustful ways (with men and women).

The more things change, the more they remain the same

Some of today’s sports and entertainment stars, and spoilt sons of the wealthy, certainly deserve to be called rakehells in the original sense of the word. And just as the posted videos and images of today show how much the serial conquests are about showing off to the rake’s mates, the betting books that are often a feature of historical romances performed the same function back then.

Given access to social media, yesterday’s rakehell would be on Tinder.

Lord Byron earned the appellation ‘rake’ with many sexual escapades, including—so rumour had it—an affair with his sister. His drinking and gambling didn’t help, either. But none of these would have been particularly notable if they had not been carried out in public.

The Italian adventurer Giacomo Casanova mixed in the highest circles, and did not become notorious until he wrote the story of his life.

On the other hand, William Cavendish, 5th Duke of Devonshire, lived with his wife and his mistress, who was his wife’s best friend. The three did not share the details of their relationship with the wider world, so there was gossip, but not condemnation. Devonshire is also rumoured to have been one of Lady Jersey’s lovers (the mother of the Lady Jersey of Almack fame). He was not, at the time, regarded as a rake.

Jude Knight

jude-knightJude 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.

Since publishing Candle’s Christmas Chair in December 2014, Jude’s name has seldom been off Amazon bestseller lists for one or more books. She is a member of Romance Writers of New Zealand, and of the Beau Monde chapter of Romance Writers of America. You can visit her at http://www.judeknightauthor.com

Website | Facebook | Twitter | Pinterest | Email

For Jude’s new companion piece, Writing a Believable Rakehell, please visit our sister blog here.

For a related history piece, check out Jude’s excellent Syphilis: Zoonotic Pestilence or New World Souvenir?

For more on John Wilmot, 2nd Earl of Rochester, read our post John Wilmot, 2nd Earl of Rochester: Satirist, Poet, and Libertine.

Syphilis: Zoonotic Pestilence or New World Souvenir?

mercury preparation for syphilis

Depiction of mercury treatments for syphilis.

The “French Disease”

In 1494, France was at war with Naples when the French camp was struck by a terrible disease.
It began with genital sores, spread to a general rash, then caused abscesses and scabs all over the body. Boils as big as acorns, they said, that burst leaving rotting flesh and a disgusting odour. Sufferers also had fever, headaches, sore throats, and painful joints and bones. The disease was disabling, ugly, and terrifying. And people noticed almost from the first that it (usually) started on the genitals, and appeared to be spread by sexual congress.

The Italian kingdoms joined forces and threw out the French, who took the disease home with them, and from there it spread to plague the world until this day.

Where did it come from?

Syphilis. The French Disease. The Pox. The Great Imitator (because it looks like many other illnesses and is hard to diagnose). The French call it the Neopolitan Disease. It is caused by a bacterium that is closely related to the tropical diseases yaws and bejel.

Scientists theorise that somewhere in the late 15th Century, perhaps right there in the French camp outside of Naples, a few slightly daring yaws bacteria found the conditions just right to change their method of transmission. No longer merely skin-to-skin contact, but a very specific type of contact: from sores to mucus membranes in the genitals, anus, or mouth.

They’ve found a couple of possible sources.

One was the pre-Columbian New World, where yaws was widespread. Did one of Columbus’s sailors carry it back? It would have had to have been the first or second voyage to be outside of Naples in 1494.

The other is zoonotic. Six out of every ten human infectious diseases started in animals. Was syphilis one of them? Monkeys in Africa suffer from closely related diseases, at least one of which is sexually transmitted.

Gerard de Lairesse

Portrait of Gerard de Lairesse. Rembrandt, 1665. Gerard de Lairesse was an artist who suffered from congenital syphilis.

Mild is a relative term

At first, syphilis killed sufferers within a few months, but killing the host immediately is a bad strategy when you’re a bacterium. Especially when you’re a frail little bacterium that can’t live outside of warm, moist mucus membranes.

So, syphilis adapted. Soon, few people died immediately. The first sore (or chancre) appears between ten days to three months after contact. About ten weeks after it heals, the rash appears, and the other symptoms mentioned above. These symptoms last for several weeks and tend to disappear without treatment, but reoccur several times over the next two years.

For more than half of sufferers, that’s it. The disease has run its course. But it is a sneaky little thing. It is still lurking, and a third or more of those who contract the disease will develop late complications up to thirty years after the original chancre. These are the ones to fear. During the latent phase, the disease is cheerfully eating away at the heart, eyes, brain, nervous system, bones, joints, or almost any other part of the body.

The sufferer can look forward to years, even decades, of mental illness, blindness, other neurological problems, or heart disease, and eventually the blessed relief of death.

How was it treated?

Until the invention of antibiotics, the treatment was as bad as the cure. Physicians and apothecaries prescribed mercury in ointments, steam baths, pills, and other forms. Mercury is a poison, and can
cause hair loss, ulcers, nerve damage, madness, and death. (see image above)

Syphilis was the impetus for the adoption of condoms, their birth control effect noticed later and little regarded (since conception was a woman’s problem). The first clear description is of linen sheaths soaked in a chemical solution and allowed to dry before use. Animal intestines and bladder, and fine leather condoms also appear in the literature.

They were sold in pubs, apothecaries, open-air markets, and at the theatre, and undoubtedly every wise prostitute kept a stock.

Not having sex—or at least not having sex with multiple partners—would have been a more effective solution, but it appears few of society’s finest took notice of that!

Syphilis in romantic fiction

Those of us who write rakes would do well to remember how easy it was to catch the pox. Indeed, in some circles it was a rite of passage!

“I’ve got the pox!” crowed the novelist de Maupassant in his 20s. “At last! The real thing!” He did his part as a carrier by having sex with six prostitutes in quick succession while friends watched on. (Perrottet)

The mind boggles.

We can, I am sure, have fun with the symptoms and the treatment, though we’d do well to remember that it was not an immediate death sentence, and suicide might be considered an overreaction to the first active stage, when most people got better and were never troubled again.

Scattered across a few of the books I’m writing, I have my own syphilitic character in the final stage, suffering from slow deterioration of his mental facilities and occasional bouts of madness, though his condition is a secret from all but his wife, his doctor, and his heir.

Watch this space!

Jude Knight is the pen name of Judy Knighton. After a career in commercial writing, editing, and publishing, Jude is returning to her first love, fiction. She writes strong determined heroines, heroes with the sense to appreciate them, and villains you’ll love to loathe.

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References

Cohen, Ann and Perlin, David. Syphilis: A Sexual Scourge with a Long History. Infoplease.

Harper, Kristen, Zuckerman, Molly, and Armelagos, George. Syphilis: Then and Now. The Scientist. 

Harvard University Library Open Collections Program. Contagion: Historical Views of Diseases and Epidemics. Syphilis. 

Mroczkowski, Tomasz F. History, Sex and Syphilis: Famous Syphilitics and Their Private Lives.

Perrottet, Tony. When Syphilis Was Tres Chic. The Smart Set.