The Physician in the 19th Century

As I noted in an earlier review of Cranford, the plot of this Elizabeth Gaskell adaptation revolves around change. Episode Three, to be aired on PBS this Sunday, carries this point further. The two physicians, one of the old school and one trained with new techniques, his head filled with knowledge of the latest medical advances, take center stage as they try to save their patients from the dreaded diseases that rarely afflict civilized society today: croup, whooping cough, scarlet fever, tuberculosis, cholera, dysentery and typhoid fever. Young Dr. Harrison redeems himself time and again by applying new solutions to old problems, thereby saving patients who would not have survived their ordeal with traditional remedies.

In Jane Austen’s time, or the early part of the 19th century, there was a clear distinction between a doctor, surgeon, and apothecary. Doctors were gentlemen of the old school and deemed socially acceptable. They were often invited to dine with the families they treated, or spend the night as guests.

Doctors and physicians occupied the highest rung on the social ladder. Such citizens were considered gentleman because 1) their training did not include apprenticeship and 2) the profession excluded, supposedly, manual labor. Doctors were permitted to dine with the family during home visits, while other practitioners took dinner with the servants. A physician’s fee was wrapped and placed nearby, for theoretically gentleman did not accept money for their work.

Illustration of Lecture Hall from the Glasgow Looking Glass, 1825-1826

A young man embarking on a medical career would attend a prestigious school at Cambridge and Oxford. There he would study Greek and Latin, and, rather than practice on patients, he would observe medical procedures in a lecture hall. Chances were that he received his license without ever having any clinical experience at all.

Cartoonists and satirists, such as Hogarth and Rowlandson, showed little mercy towards doctors and their poor attempts at treating patients. Even the life-saving vaccine for small pox was treated with some humor and derision by James Gilray, since the innoculant came from a cow.

The Cow Pock, James Gillray, 1802

Accepted practices of the day did not include washing hands or changing soiled clothes or bandages, so that doctors often spread illnesses or caused infections. Bleeding through cutting or leeches was an accepted form of treatment:

The most common way of treating a high fever, for example, was to cut open a vein and drain blood from the patient — and not in a small way: a good doctor was expected to cut deep enough that the patient’s blood would spurt into the air with every heartbeat! To make matters worse, the most commonly prescribed “drug” of the time was the toxic element mercury, usually in the form of mercuric chloride.

Surgery was extremely painful, and anesthesia in the form of ether did not appear until 1846. Until that time, doctors relied on mandrake, alcohol, opium, and cannabis for pain relief. (Cocaine was only available in the New World.) Non drug methods of pain relief included cooling the patient or affected area, hypnosis, nerve compression, and blood letting. Because surgeons actually treated the patient by performing physical labor – a trade, so to speak – they occupied a lower rung on the social ladder.

Apothecaries, who learned their profession through apprenticeship and who were definitely considered to be in “trade”, ranked even lower on the social scale. As a group they had “seceded from the Worshipful Company of Grocers, and were incorporated as a separate city livery company in 1617, were supposed to stay in their shops and dispense the prescriptions written by the physicians.” [Apothecaries, Physicians and Surgeons, Roger Jones]

In regions where doctors were scarce, apothecaries also made house calls and treated patients, but largely they mixed drugs and dispensed them, and trained apprentices. A drug’s efficaciousness was hit or miss. By sheer accident, some effective substances were discovered: digitalis, quinine, and calamine, to name several; and a number of proven herbal remedies helped to relieve symptoms. Generally, however,

The technology of making drugs was crude at best: Tinctures, poultices, soups, and teas were made with water- or alcohol-based extracts of freshly ground or dried herbs or animal products such as bone, fat, or even pearls, and sometimes from minerals best left in the ground—mercury among the favored. The difference between a poison and a medicine was a hazy differentiation at best: In the 16th century, Paracelsus declared that the only difference between a medicine and a poison was in the dose. All medicines were toxic. It was cure or kill.

The life of a country doctor was an itinerant one. The 1999 mini-series Wives and Daughters aptly depicted a doctor’s long day, in which he rose at dawn to make his rounds and see patients, often returning exhausted past sunset on his equally weary horse.

Illustration, George du Maurier, 1913

By the end of the 19th century, the medical field had become more professional and organized. Scientific breakthroughs, which included anesthesia, rabies vaccinations, techniques for immunization, sterilization of medical equipment, and an understanding of the origins of infections and of the bacterial world, helped to move the field forward.

Find more links below about medicine during this era:

• Health and Hygiene in the 19th Century

• Click here to view an 18th Century Apothecary’s Prescription

• Anesthesia: Medicine’s Greatest Gift

• History of Anesthesia

• Student Paper on 19th Century Medicine

• From Hogarth to Rowlandson: Medicine in Art in 18th Century, Fiona Haslam, Liverpool University Press, 1996, ISBN:0853236402

• From Apothecaries to Florence Nightingale: A Medical Museums Trail

• Rowlandson, The Third Tour of Dr. Syntax

• Dr. Syntax Prints

• Apothecary items

• English surgical sets

• Analgesics and Painkillers

Images: Photo stills from Cranford and Sense and Sensibility (bleeding Marianne Dashwood); James Gillray cartoons