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!

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.

cowpoxThe 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.

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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.

Mediomania: Spiritualism, Crisis, and Mediumistic Hysteria of the 19th Century

A depiction of table-turning in Le Magazine L’Illustration, 1853

Who doesn’t love a good ghost story?

The residents of Hydesville, New York were sure intrigued when rumors erupted of the Fox sisters and their ability to communicate with the dead through taps and rappings in their home. Kate and Margaret Fox invited the public to demonstrations of their abilities, asking the spirits to respond to questions with the correct number of knocks. And from these few taps, a religious movement grew.

But it wasn’t the need or the determination to speak with the dead that drove the development of Spiritualism. The religion came along at the right time when it was needed most by those wishing to enact social change. In the 1850s, Quakers were looking for an escape. Abolitionist Quakers in particular were in a fix. Their religion forbade them from taking a stance on measures such as abolition and women’s rights. But when the Fox sisters started knocking, those looking for an answer saw a way out.

Taking spiritualism by the horns, Quakers began to convert, picking up the torch of spiritualism in the name of women’s leadership, abolition, and a host of other social crusades. Spiritualists traveled the country to speak at assemblies and conventions, some on the subject of spiritualism, but most often at the conventions of social endeavors such as women’s right to vote and abolition. Spiritualism simply served as a means for working toward such change.

With such a surge in social improvement, women were put in a position of opportunity. Suddenly communicating with the dead meant women could assume leadership roles in the community. They became trance speakers, touring the country to speak to large assemblies. Trance mediums wrote books, counseled the distressed, and even ran for president. That would have been Victoria Woodhull in 1872. Women harnessed a power that seemed to favor the female body and used it to propel themselves up in terms of equality with men.

But with such upward movement came backlash, and such backlash took the shape of an accusation of insanity. Dr. R. Frederic Marvin finally gave a name to the disease of which spiritualism was considered to be a result. Mediomania was suddenly a diagnosis spread far and wide, labeling mediums with a type of female insanity. The female reproductive system was to blame, a system so much more “complex” than a man’s and thus in danger of such insanity. While it was not used in place of utromania, the two diseases were often linked. It was determined the angle of the uterus was the cause of the disease. If it were tilted too far forward, women would develop this mediomania and begin to exhibit its horrible symptoms.

Symptoms of this “mediumistic hysteria” often were a woman’s determination to leave traditional roles and her propensity to overuse her mind. Historian Ann Braude argues, “Doctors asserted that, if women used their brains to attempt the mental exertion required for higher education, they would overtax their systems and suffer gynecological disease.” As Marvin asserted, “She becomes possessed with the idea that she has some startling mission in the world.” Such an idea was horrifying by late 19th century standards, and mediums were deemed insane for such behavior.

Treatment was often forced upon the afflicted. I say forced because most often the cure of mediumship was the “Rest Cure.” It entailed the female subjecting to the will of the male doctor. It was believed she must no longer assert her own will in order to be healed. Such a cure inherently suggests a level of force upon the afflicted.

So while women enjoyed a blitz of equality through their abilities as mediums, it quickly came crashing down in the 1870s and into the 1880s as “science” proved these women to be simply insane. Spiritualism lost favor as it failed to organize successfully, and heretics took advantage. Doctors proclaiming the “rest cure” pronounced mediums fit for asylums, and hoax mediums caught in charades gave the movement a bad reputation. More, the movement had already accomplished a major goal in the abolition of slavery, and because of this, lost momentum in their endeavors. The Spiritualism movement would fade away by the 1880s, and with it the persecution of female mediums for their mediomania.

Jessie Clever

Source:

Braude, Ann. Radical Spirits: Spiritualism and Women’s Rights in Nineteenth-Century America. Bloomington: Indiana University Press, 2001.

Jessie Clever decided to be a writer because the job of Indiana Jones was already filled. Taking her history degree dangerously, Jessie tells the stories of courageous heroines, the men who dared to love them, and the world that tried to defeat them. Jessie makes her home in the great state of New Hampshire where she lives with her husband and two very opinionated Basset hounds.
Don’t miss To Save a Viscount. Find out more at jessieclever.com.

Civil War Hospitals Were Enough to Make You Sick

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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_heroinesofmercystreetLondon: 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.

Hysteria and Medicinal Masturbation: The 19th Century Origins of the Vibrator

M0017861 Vaginal examination , from Maygrier, Nouvelles...1825Yes. You did just read the words ‘medicinal masturbation’ although it certainly was never called that in the 19th century! But more of that later. To start this little article, I need to talk to you about first about ‘hysteria’, a medical condition which was recognised and widely believed for two thousand years. The condition was blamed for causing all manner of maladies in women from nervousness and stomach pain to lunacy.

It was probably the Egyptians who first believed it was a medical problem, but we have to blame the Ancient Greeks for all of the nonsense which came later. The term comes from hystera, the Greek word for uterus, and eminent Greek physicians who followed the teachings of Hippocrates had some funny ideas about this particular female organ.

Aretaeus of Cappodocia describes it thus:

“In the middle of the flanks of women lies the womb, a female viscous, closely resembling an animal; for it moves itself hither and thither in the flanks… it is altogether erratic. It delights, also, in fragrant smells, and advances towards them; and it had an aversion to fetid smells and flees from them; and, on the whole the womb is like an animal within an animal.”

Scary indeed.

tumblr_kpz8iinokh1qztiu5o1_500Hysteria, or wandering womb, was caused when this fidgeting strange little animal was not sufficiently ‘irrigated with male seed.’ Left to wander too far, it could interfere with the delicate female brain. Hippocrates believed hysteria needed to be treated with smells, foul ones at the nose and perfumed ones around the nether regions, to coax the nomadic beastie back into the pelvis, and recommended regular coupling with a vigorous man. Male seed, after all, would prevent it wandering in the first place.

This ridiculous theory persisted through time. By medieval times they had mixed the flawed science with religion as they did with so many things. Hysteria was the Devil’s work and needed to be treated with prayer or penance. Persistent hysterics might even have to be executed for their lustful, unruly, wayward wombs.

By the 17th century as science began to usurp the power the church had over medicine, treating hysteria rather than punishing it became the norm. But with physicians estimating at least three quarters of the female population suffered sporadically from the malady, treating it became a daily part of every doctor’s life.

It was, in many ways, like lancing a boil. Every physician worth his salt knew that if the poison could be drawn from a festering carbuncle, within a few days the surrounding skin would be back to normal. Hysteria simply needed expunging. If smelling salts or a brisk gallop across the fields on the back of a horse did not work, the most effective way to do that was ‘pelvic massage’- a very scientific term for masturbation. The subsequent ‘Hysterical Paroxysm’ would quickly relieve all of the patient’s symptoms. Thanks to the medieval church, masturbation was still considered a sin in the 19th century and one which would very likely send you blind, but if it was a bonafide medical procedure, there was nothing wrong with it. In fact, it was positively encouraged! As a result, doctors earned a fortune doing it for the masses who required it.

This practice was not only widely accepted by the prim and proper 19th century society, it was lauded for its health-giving benefits and the most skilled physicians were inundated with repeat business. Unfortunately, it was time consuming and hard work. Physicians from the time complained about the toll it was taking on their poor wrists and arms. Some women, they lamented, took almost an hour to achieve the necessary hysterical paroxysm, and with so many patients in dire need of their services, the poor fellows were physically exhausted. Some even complained of such persistent symptoms, which today would be called repetitive strain injury, they were unable to work. It went without saying that if a hysteria doctor was not in any shape to be working then he could not reap the bountiful financial benefits from the huge proportion of women suffering from wandering wombs! Something had to be done.

This led to a variety of labour-saving devices being created with the express
purpose of mechanically ‘alleviating’ hysteria while saving the doctors’ joints in the process. And they invented some corkers.

horse-machineGeorge Taylor’s steam powered manipulator involved a coal fired engine in one room connected to a peculiar table-like contraption in another. In the middle of the table was a convenient hole which the hysterical woman sat astride, while the steam made a metal ball vibrate in the cavity. As beneficial as many patients found it, the doctors complained about the amount of coal they had to shovel in the engine, so it’s time was scandalously cut short. There were several hand-wound devices but as they also required the physician’s energy to vibrate, the hunt was on for something easier.

Vigor & Co’s Horse-Action Saddle could be used in the privacy of one’s own home. As could the hilariously named ‘Chattanooga’. I could not for the life of me find a picture of that one, but learned it was almost five feet tall and so cumbersome they mounted it on wheels.

Finally, in 1869, Dr Joseph Mortimer Granville, a man horrified at the idea of using his hands to perform pelvic massage, patented the first electromagnetic vibrator, The Percussor (a term used now for the sort of tools doctors use to test reflexes). The Precussor was the modern precursor to today’s buzzing buddies and was known affectionately–and to its inventors mortification–as ‘Granville’s Hammer’ because it was exactly the right tool for the job!

sears_vibratorsBy the late 19th century and in the early part of the 20th century, a huge variety of vibrating personal massagers came on the market to treat women and they were even widely advertised in newspapers and periodicals, claiming all manner of health benefits and directly aimed at women. They didn’t hide from what it did either. One advertisement in the Sears catalogue of 1903 called a vibrating massager “a delightful companion… that will throb within you”!

Since then, even though the theory of hysteria has been debunked and forgotten, the world continues to feel the good vibrations of Granville’s invention. I just wish I could find a way to put all of this into one of my books!

Virginia Heath writes witty, fast-paced Regency romantic comedies with a modern twist for Harlequin Historical. The Discerning Gentleman’s Guide is out now.

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Suffering in Some Strange Heaven: An Introduction to Laudanum

rossetti-golden_head

Illustration for the cover of The Goblin Market. Dante Gabriel Rossetti, 1862

“– I should much wish, like the Indian Vishna, to float along an infinite ocean cradled in the flower of the Lotus, and wake once in a million years for a few minutes – just to know that I was going to sleep a million years more.” – Samuel Taylor Coleridge

While the medicinal properties of opium have been known since prehistoric times, it was 16th century Swiss alchemist Paracelsus who first developed laudanum. He discovered that when mixed with alcohol as opposed to water, opium’s pain-killing properties were heightened. He mixed it with crushed pearls, musk, saffron, and ambergris* and called it laudanum, from the Latin word laudare: to praise.

Now thought of as primarily a Victorian drug, laudanum first reached England in the 1660s when physician Thomas Sydenham developed his own recipe. While Sydenham left out the ambergris, the fundamentals remained the same: alcohol and opium was a potent cure-all and in his Medical Observations Concerning the History and Cure of Acute Diseases (1676), he gave it the praise Paracelsus had predicted a century before. Laudanum took off during the eighteenth century and by the nineteenth, it could be found in almost every home in Britain.

bottle_of_papine_london_england_1890-1920_wellcome_l0058548

“Papine,” an opium tincture

Although the recipe was flexible, it remained at heart an uncomplicated but potent combination of alcohol and opium. It was an over the counter drug cheap enough to be used across the social spectrum and simple enough to be brewed at home. Laudanum was used for an endless list of ailments including but not limited to teething, insomnia, anxiety, nerves, hysteria, menstrual cramps, pregnancy pains, mood swings, depression, stomach upset, diarrhea, consumption, cough, heart disease, and cholera.

It was certainly an effective cough suppressant; related opioids such as morphine and codeine are still prescribed for cough today. It was a potent painkiller, induced deep sleep and vivid dreams, produced feelings of euphoria, and was addictive as it was cheap. Not to be limited to medicinal purposes, laudanum was taken recreationally or mixed with other alcohol such as absinthe to stimulate creativity among artists. Some notable fans of the substance include Dickens, Bram Stoker, Samuel Taylor Coleridge, George Elliott, Dante Gabriel Rossetti, and Rossetti’s wife, model Elizabeth Siddal, who tragically died of a laudanum overdose.

Women tended to be medicated more than men, and many opium-derived medications were known euphemistically as “Woman’s Friend.” Likewise, Godfrey’s Cordial, a mixture of water, treacle, and opium specifically for infants was knows as “Mother’s Friend.”

Charles Kingsley describes opium addiction in Alton Locke (1850) as ‘elevation’, a particular problem of women:

“Oh! ho! ho! — yow goo into druggist’s shop o’ market-day, into Cambridge, and you’ll see the little boxes, doozens and doozens, a’ ready on the counter; and never a ven-man’s wife goo by, but what calls in for her pennord o’ elevation, to last her out the week. Oh! ho! ho! Well, it keeps women-folk quiet, it do; and it’s mortal good agin ago pains.” “But what is it?” “Opium, bor’ alive, opium!”

There were several different laudanum varieties available and they could be made at home. It was dreadfully bitter, so sweeteners like honey and spice were added to improve the flavor. Sydenham’s recipe from 1660 was still in use by the 1890s when it was published in William Dick’s Encyclopedia of Practical Receipts and Processes:

“Sydenham’s Laudanum: This is prepared as follows: opium, 2 ounces; saffron, 1 ounce; bruised cinnamon and bruised cloves, each 1 drachm; sherry wine, 1 pint. Mix and macerate for 15 days and filter. Twenty drops are equal to one grain of opium.”

Dick’s Encyclopedia contains dozens of recipes for homemade laudanum, and even more for other remedies containing opium. As relatively appealing as cinnamon and cloves sound, by the 19th century, laudanum could also be mixed with mercury, ether, chloroform, hashish, or belladonna; if it didn’t kill you, it would make you see some very interesting things.

Whether or not the malady justified the use of such a powerful drug, laudanum and other opium derivatives were used frequently and without a great deal of hesitation. It was a good cough suppressant, kept children quiet, and induced restful sleep. Rhapsodic descriptions of its effects make it sound like magic.

In The Picture of Dorian Gray, Oscar Wilde conveys the horrors and pleasures of an East End opium den in a single paragraph (it isn’t exactly laudanum, but it’s the same active ingredient):

opium_smoking_1874

Opium Smokers in the East End of London. Illustrated London News, 1874.

“As Dorian hurried up its three rickety steps, the heavy odour of opium met him. He heaved a deep breath, and his nostrils quivered with pleasure. When he entered, a young man with smooth yellow hair, who was bending over a lamp lighting a long thin pipe, looked up at him and nodded in a hesitating manner. […] Dorian winced and looked round at the grotesque things that lay in such fantastic postures on the ragged mattresses. The twisted limbs, the gaping mouths, the staring lustreless eyes, fascinated him. He knew in what strange heavens they were suffering, and what dull hells were teaching them the secret of some new joy.”

Strange heavens aside, laudanum was not a friendly substance. In 1889, The Journal of Mental Sciences published what was purported to be an anonymous letter by the wonderful title of Confessions of a Young Lady Laudanum-Drinker which describes at length her experience of addiction:

“It got me into such a state of indifference that I no longer took the least interest in anything, and did nothing all day but loll on the sofa reading novels, falling asleep every now and then, and drinking tea. Occasionally I would take a walk or drive, but not often. Even my music I no longer took much interest in, and would play only when the mood seized me, but felt it too much of a bother to practice. I would get up about ten in the morning, and make a pretence of sewing; a pretty pretence, it took me four months to knit a stocking!

“Worse than all, I got so deceitful, that no one could tell when I was speaking the truth. It was only this last year it was discovered; those living in the house with you are not so apt to notice things, and it was my married sisters who first began to wonder what had come over me. By that time it was a matter of supreme indifference to me what they thought, and even when it was found out, I had become so callous that I didn’t feel the least shame. (…) My memory was getting dreadful; often, in talking to people I knew intimately, I would forget their names and make other absurd mistakes of a similar kind. As my elder sister was away from home, I took a turn at being housekeeper. Mother thinks every girl should know how to manage a house, and she lets each of us do it in our own way, without interfering. Her patience was sorely tried with my way of doing it, as you may imagine; I was constantly losing the keys, or forgetting where I had left them. I forgot to put sugar in puddings, left things to burn, and a hundred other things of the same kind.”

While this anonymous writer did recover, laudanum addiction was difficult to beat. People became tolerant to it quickly, and recovery was more likely to be achieved by tapering doses. Although laudanum was a common cough suppressant, it could work too well by causing shortness of breath and respiratory depression, or keeping the user from breathing at all. It can also inhibit digestion, cause constipation, depression, and itching. It was so potent that it was easy to overdose accidentally as an adult, and many infants and children died from it, as well. Tragically, it was also a common method of suicide.

laudanumWe might not understand the appeal of such a debilitating and ultimately lethal substance, but for most people in the nineteenth century, laudanum must have felt like a godsend. Disease, poverty, and hunger were widespread, and those lucky enough to be employed suffered through long hours in terrible conditions to earn their pittance. Even for the wealthy and well-to-do, Britain was cold, wet, and overrun with discomforts that may necessitate its use. Menstrual cramps, insomnia, anxiety, nerves, cough, stomach upset, cholera, tuberculosis — if one drug could treat them all and that drug happened to be miraculously affordable and so common there was little to no stigma attached to it, there was no reason not to rely on it from time to time.

Laudanum is still in production today, but it is no longer available over the counter. Now referred to almost exclusively as Tincture of Opium, it is listed as a Schedule II substance due to its highly addictive nature and is used for stomach ailments, pain, and to treat infants born to mothers with opioid addiction.

Jessica Cale

Sources

Anonymous. Confessions of a Young Lady Laudanum-Drinker. The Journal of Mental Sciences January 1889

Berridge, Victoria. “Victorian Opium Eating: Responses to Opiate Use in Nineteenth-Century England,” Victorian Studies, 21(4) 1978.

Dick, William B. Encyclopedia of Practical Receipts and Processes. New York: Dick & Fitzgerald, Publishers, 1890.

Diniejko, Andrzej. Victorian Drug Use. The Victorian Web. http://www.victorianweb.org/victorian/science/addiction/addiction2.html

Kingsley, Charles. Alton Locke (1850).

O’Reilly, Edward. Laudanum: A Dose of the Nineteenth Century.

Sydenham, Thomas. Medical Observations Concerning the History and Cure of Acute Diseases (1676)

Wilde, Oscar. The Picture of Dorian Gray (1890).

*presumably crushed diamonds would have been too extravagant

The Age of Agony: Surgery in the 19th Century

Amputation. Thomas Rowlandson, 1793.

Amputation. Thomas Rowlandson, 1793.

Surgery in the early 19th century usually meant a death sentence. It was the last resort and never undertaken lightly. Statistics from the time put the chance of dying as a result as high as 80% and surgeons were still not really considered to be proper doctors. Even the simplest of procedures carried a level of risk because there were three ferocious killers that had to be contended with: infection, pain, and bleeding.

Complex operations on the internal organs were impossible, so most operations at this time were either amputations of gangrenous limbs or the hacking away of obvious and engorged tumours and growths. It was not uncommon for a person to succumb to shock and die during such an operation. The pain must have been excruciating. Without anaesthetics, they would feel every cut, their only comfort a leather strap to chew on while they were forcibly held down by however many people it took to keep them in place. In the British army, soldiers had to ‘bite the bullet’ before the field surgeon got to work, although all surgeons were trained to prefer their patients screaming. It was a good gauge to know whether or not they were actually still alive.

L0001337 Amputation of the thigh, 19th century Credit: Wellcome Library, London. Wellcome Images images@wellcome.ac.uk http://wellcomeimages.org Amputation of the thigh, 19th century 1820 Illustrations of the Great Operations of Surgery Bell, Sir Charles Published: 1820 Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0 http://creativecommons.org/licenses/by/4.0/

Amputation of the Thigh. Sir Charles Bell, 1820.

Assuming these tragic individuals did not expire from heart failure on the table, the loss of blood would probably kill them. The discovery of blood types, which made successful transfusion possible, would not come until 1901, so surgeons had to devise other ways to stop their patients bleeding out on the table. Tourniquets were standard issue, but when amputating a limb, many arteries and veins would be cut through. To quickly stem the flow of bleeding the only weapon a surgeon had in his arsenal was a cautery, a metal tool which could be heated in a fire and then pressed firmly onto an open wound to seal the blood vessels. This technique was more successful on smaller wounds than larger, and even then, speed was off the essence. The poor soul on the table would enjoy both the horrendous pain of cauterisation alongside the sounds and smell of his own burning flesh.

Because of the risk of excessive blood loss, operations had to be quick, and no one was quicker than Robert Liston. Although brilliant for his time, Liston was also a bit of a showman and throngs of eager fans turned up to watch him work. He would stalk into the operating theatre at the same moment the patient had been restrained, with the ominous words “Time me, gentleman!” Then he would grab the unfortunate’s offending leg and begin to cut. Spectators reported Liston frequently held his knife in his teeth while he quickly sawed through the bone, then threw the severed limb into a bucket at his feet before he tied off the arteries. His average speed from first incision to wound closure was two and a half minutes. As barbaric as this seems, few people died on Liston’s table…of course, they died afterwards in their droves.

His legend was further embellished by his brutish behaviour. Once, when a patient fled the operating room crying in terror and barricaded himself into an adjoining room, Liston single-handedly broke down the door and dragged the man kicking and screaming back to the table. In one operation, not only did he amputate a man’s leg, he accidentally cut off his testicle as well. In another, he sawed through both the leg of the patient and three of the fingers of the man holding the patient down. Both men later died of infection.

Robert Liston Operating. Ernest Board, 1912.

Robert Liston Operating. Ernest Board, 1912.

Infection was by far the biggest risk. In 1800, the concept of germs and bacteria even existing was at least another sixty years away. As was antiseptic. Surgeons worked in unhygienic conditions, rarely washing either their hands or their knives before an operation. Often in hospitals, because it was such a rarity, the procedure would be carried out in front of an audience, hence the term ‘operating theatre’ we still use today. The opportunities for contamination under these circumstances were huge. Both the surgeon and the audience wore their street clothes and boots, and the cramped gallery would be filled with the potentially deadly microbes released by their breath. ‘Surgical sepsis’ could set in within hours of the operation, and once that occurred, it was curtains for the patient. In a world where germs had yet to be discovered, they certainly did not have any medicines to treat them.

In fact, people would try anything to avoid having surgery. There are hundreds of recorded cases of giant tumours which would be inconceivable today. Liston once removed a forty-five-pound tumour from one man’s scrotum which was so large, the patient pushed it around in a wheelbarrow rather than face the spectre of a death which came from a visit to a sawbones. Despite all of my research, I still have no idea if this poor fellow actually survived. Statistically speaking, I sincerely doubt that he did.

Virginia Heath writes witty, raunchy Regency romances for Harlequin Mills & Boon. That Despicable Rogue is available now and her second novel, Her Enemy at the Altar, comes out in July 2016.

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