Fanny Burney and Her Mastectomy

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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.

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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.

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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 

61yLoQ9ugKL._SX345_BO1204203200_-347x381Geri 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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Sex, Contraception, and Abortion in Medieval England

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Artemisia absinthum (Wormwood)

Centuries of nostalgic medievalism have given us some funny ideas about sexuality in the Middle Ages. We know religion ruled, no one married for love, and sex was for procreation only…right?

Not so much. When studying the Middle Ages, you need to consider the sources. Every author had a bias and could only write what they saw. Most of our modern ideas about sexuality come from Canon Law, but people did not obey all of the laws of the Church in the Middle Ages any more than they do today. To get a better idea of what life was really like, we have to draw on other sources as well.

Today we’re going to jump into the deep end with medieval contraception and abortion. The popular assumption is that contraception did not exist and abortion must have been a serious crime, if it happened at all. The issue with this argument is that we take for granted that they must have had a similar understanding of pregnancy and a greater sense of religious morality when it came to the issue of contraception and abortion. To get to the bottom of this, we have to throw out these assumptions and start at the beginning.

Sex

Fornication was still a sin, but it was one most were guilty of. When primogeniture became the rule in the eleventh century, it created a whole class of people were unlikely to ever marry. Noble families with multiple children could only pass on their property to the eldest. The rest of the children would remain in the household even as adults until they married other property-holding people or until circumstances changed. Many entered the Church, where marriage and concubinage among the clergy was still common until the twelfth century. Wealthy families might equip younger sons as knights. Knights could not be expected to marry until they inherited property or came by it through other means; most younger sons never married at all. As for daughters, the pool of landed noblemen to marry was pathetically small. With larger families and fewer opportunities for marriage, much of the nobility never married. To assume they all remained celibate in a culture that all but deified love and had a popular handbook for conducting romantic, sexual, and frequently extramarital relationships is naïve at best. (1)

As for the lower classes, marriage was almost a fluid concept. It was common for people to marry in secret, and these marriages were every bit as valid as any performed outside a church. According to Gratian’s Decretum, all it took to make a marriage legal was three things: love, sex, and consent. As long as the love and consent were there, sexual relationships including those with concubines could be considered informal marriages.

Because the line between fornication and legal marriage was a bit blurry, fornication was more or less accepted in practice. Who’s to say the consenting couple did not marry in secret? Many penitentials appearing during and after the twelfth century classified sex outside of marriage as only a minor sin. Members of the Synod of Angers in 1217 stated unequivocally that they personally knew many confessors who gave no penance for it at all. In practice, the Church tolerated fornication as long as there was no adultery being committed.

Prostitution was legal and common. Although the Church did not condone it, this did not stop it from regulating and profiting from it (see Prostitution and the Church in Medieval Southwark). After all, someone had to see to the needs of the scores of unmarried men and those who had entered the Church out of necessity rather than desire. The Church viewed prostitution as a necessary evil. While active sex workers could not be viewed as respectable members of society, they nevertheless performed an important public service.

Outside of the Church, many medieval writers, such as Albertus Magnus and Constantine the African, viewed sex as a crucial component to overall health on equal footing with food, sleep, and exercise. Sexual release was believed to be the best way to get rid of toxic humors and abstinence could lead to weakness, illness, madness, and death. Sexual enjoyment was necessary for men and women, and was an essential component to conception.

Sex happened. Penitentials were distributed throughout the Church to prescribe penance for every vice we can imagine today (and a fair few we can’t). Troubadours sang about it in their filthy, filthy songs. Pregnancy was inevitable and dangerous. So how did they deal with it?

Menstrual Regulators

It sounds obvious, but people in the Middle Ages did not have the same understanding of pregnancy that we have today. As they could not pinpoint the moment of conception, there was no distinction between the prevention of pregnancy (contraception) and the ending of one (abortion). “Remedies to regulate the menstrual cycle” were common and arguably more widely accepted than they are now. Recipes were recorded in medical texts, shared between women, and they appeared in household handbooks. They could be made at home with a few ingredients most women would recognize.

This ninth century recipe appeared in the Lorsch Manuscript, a medical treatise written by Benedictine monks:

A Cure for All Kinds of Stomach Aches
For women who cannot purge themselves, it moves the menses.

8 oz. white pepper
8 oz. ginger
6 oz. parsley
2 oz. celery seeds
6 oz. caraway
6 oz. spignel seeds
2 oz. fennel
2 oz. geranium/ or, giant fennel
8 oz. cumin
6 oz. anise
6 oz. opium poppy

These recipes did not come out of the blue. There is evidence that similar abortifacients had been used as far back as ancient Egypt. Pepper had been used since the Roman period as a contraceptive, and fennel is related to silphium, the ancient plant farmed to extinction for its contraceptive properties. The other ingredients have been found to have antifertility effects, and the opium was used as a sedative. Other similar recipes were employed throughout the period and beyond; menstrual regulators using the same ingredients continued to be sold as late as the nineteenth century.

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Juniper

In addition to those mentioned above, artemisa and juniper were both known to inhibit fertility. Artemisia is a genus of plant in the daisy family asteraceae. There are more than two hundred types of artemisia, among them mugwort, tarragon, and wormwood, the key ingredient in absinthe centuries later. In the twelfth century, Trotula recommended artemisia as a “menstrual stimulator” and in the thirteenth century, Arnald of Villanova advised taking it with capers for maximum efficacy. Modern medicine has confirmed its use: artemisia inhibits estrogen production and can prevent ovulation much like pharmaceutical contraceptives today.

Artemisia was not without its side effects. Wormwood is a notorious toxin known to cause hallucinations and changes in consciousness. Ingested in large quantities, it can cause seizures and kidney failure. (2)

Juniper had been used as a contraceptive since the Roman period. Pliny the Elder recommended rubbing crushed juniper berries on the penis before sex to prevent conception. Its popularity continued throughout the Middle Ages; Arabic medical writers Rhazes, Serapion the Elder, and ibn Sina all list it as an abortifacient, and this knowledge was made more readily available throughout Europe when Gerard of Cremona translated their words in the twelfth century. According to ibn Sina, juniper produced an effect very similar to a natural miscarriage, and so it could be employed without detection.

Historian John Riddle argues that all women knew which plants inhibited fertility and how to use them effectively. They were under no illusions as to their purpose. Although most of what we know about medieval contraception and abortion does come from medical texts written by men, they would have come by the information from women who were using it on a regular basis.

Morality

In the ancient world and even the early Christian Church, abortion was not considered immoral. Although it is often interpreted differently today, the medieval church followed the guidelines of the Bible in believing that life began at birth (Genesis 2:7). St. Thomas Aquinas argued that souls are created by God, not by man, and that the soul did not enter the body until the infant drew its first breath.

Abortion or “menstrual regulation” was not explicitly mentioned in the Bible except to recommend it in the case of suspected unfaithful wives (Numbers 5:11-31) (3), and whether or not it was immoral in the Middle Ages depended on who was asked.

Burchard of Worms’ Decretum tackled the issue of abortion in the section titled Concerning Women’s Vices. Burchard unequivocally opposed it, but the penance recommended varied. To Burchard, the severity of the sin was not dependent on the act itself, but the status of the woman and the circumstances of conception. The worst crime was that resulting from adultery. For this he orders seven years of abstinence and a lifetime of “tears and humility.” Abortion stemming from fornication was also bad (penance for ten years on fast days), unless the woman was poor or a sex worker (statistically likely). If the woman was poor and acted because she would not be able to feed a child, it was understandable and no penance was prescribed.

Regardless of the Church’s recommendations, abortion was not actually illegal. In fact, the first law that made abortion illegal in the English-speaking world did not come until the Ellenborough Act of 1803, and even that only outlawed abortions obtained by taking “noxious and destructive substances.” It was not until 1869 that the Catholic Church decided that life began at conception.

Conclusions

If there is one thing we should take away from this, it is that when it came to sex, the Middle Ages were not as different from today as we often assume. People married for love, they had sex for fun, and family planning existed and was used more or less effectively. Due to centuries of literature and art portraying the Middle Ages as an idealized time of chastity and moral superiority, we have come to collectively accept a fiction that bears only a passing resemblance to a much more complicated truth.

Through this Contraception in History series, I have tried to show that although reproduction has been the primary purpose of sex throughout history, it was not the only purpose, and people have always found ways to take their reproductive destinies into their own hands.

Jessica Cale

Sources

Brundage, James. Sex and Canon Law. Garland Reference Library of the Humanities Volume 1696. Issue 1996: Pages 33-50.
Burchard of Worms. Decretum (c. 1008).
Burford, EJ. Bawds and Lodgings, a History of the London Bankside Brothels c. 100-1675. London, Peter Owen, 1976
Cadden, Joan. Western Medicine and Natural Philosophy. Garland Reference Library of the Humanities Volume 1696. Issue 1996: Pages 51-80.
Capellanus, Andreas. The Art of Courtly Love. Translated by John Jay Parry. New York, Columbia University Press, 1960
Gaddesden, John. Rosa anglica practica medicine. Venice, Bonetus Locatellus, 1516.
Gies, Frances and Joseph. Marriage and Family in the Middle Ages. New York, Harper & Row, 1987
Payer, Pierre J. Confession and the Study of Sex in the Middle Ages. Garland Reference Library of the Humanities Volume 1696. Issue 1996: Pages 3-32.
Riddle, John M. Contraception and Early Abortion in the Middle Ages. Garland Reference Library of the Humanities Volume 1696. Issue 1996: Pages 261-274.
Tannahill, Reay. Sex in History. New York, Stein and Day, 1992

1. See The Art of Courtly Love.

2. Fun fact: Nicholas Culpeper claimed that wormwood was the key to understanding his 1651 book The English Physitian. Unlike the rest of the book, the entry for wormwood is a stream-of-consciousness ramble that reads like someone who was ingesting it at the time.

3. It is very possible the bitter waters in this verse refer to wormwood, a notoriously bitter substance known to induce miscarriage.

If you would like to know more about Contraception in History, see below for the rest of the series:

Contraception in History I. Aristotle, Hippocrates, and a Whole Lotta Lead

Contraception in History II. Contraception in Ancient Egypt: Hormonal Birth Control, Pregnancy Tests, and Crocodile Dung. 

Contraception in History III. Ancient Birth Control: Silphium and the Origin of the Heart Shape

Contraception in History IV. Minos, Pasiphae, and the Most Metal Euphemism for V.D. Ever

Contraception in History V. “Love’s Pleasing Paths in Blest Security”: Seventeenth Century Condoms

 

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

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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

wounded-at-fredericksburg

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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