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Posts Tagged ‘19th century medicine’

My blog has been silent again. Just as my schedule was letting up a bit, my father fell ill. In Jane Austen’s time, extended families lived in one village and often under the same roof. Healthy family members or friends took care of the sick, elderly, and very young. In this age, when sons and daughters and siblings live far apart, taking care of a loved one is not as convenient. I took time off from work, more to help my 88 year-old mother than my father, who was in the hospital, and to take some stress off my brother, who was starting a challenging and demanding new assignment. We thought Dad had suffered a stroke. In the 18th century, his condition would have been described as apoplexy, or “paralysis caused by stroke. Sudden deprivation of all the internal and external sensation and of all motion unless of the heart and thorax.” ( Glossary of Old Medical Terms Used in the 18th and 19th Centuries)

As he came out of a restaurant bathroom, my dad forgot to walk. I happened to be there, worried that he was taking so long. He began to slur his words and hallucinated that his father, who has been dead for 40 years, was joining us for dinner. We rushed him to the emergency room, where he wound up in good hands, receiving excellent diagnostic care. After four days of tests, he was transferred to a rehab hospital for the elderly to receive 10 days of speech therapy, physical therapy, and occupational therapy.

Stroke (apoplexy) satirical art work. 1822 copy of a Charles Aubry original. Click here to go to Fine Art America to read the details.

Stroke (apoplexy) satirical art work. 1822 copy of a Charles Aubry original. Click here to go to Fine Art America to read the details.

Back in the old days, those who suffered apoplexy or stroke were not so lucky. Many died within hours of the event, if not a few weeks later. Blood letting was one cure that was thought to be effective, although in most cases the practice was harmful and weakened the patient.

Some of those who survived successive attacks, especially the young, were mistaken for being mad. Romance author, Laura Kinsale, has written a remarkable book entitled Flowers From the Storm, in which a hedonistic and haughty duke is placed by his family into a mental institution after a major stroke. His sudden inability to communicate and lack of physical control is described in detail by this talented author in a story that, 15 years after I first read it, still stands out in my mind. I imagine the fate that this fictional Duke suffered was shared by many actual people of that era.

In our case, Dad benefited from modern medicine. An MRI showed previous minor strokes, but a CAT scan proved that this was not the reason for his illness. Dad’s illness was a “neurological event” that has been attributed to the progression of his Parkinson’s disease, once known as shaking palsy; the effects of a new medication, which made him hallucinate; the poisonous interaction among the 16 some medications he was taking per day; the slow advancement of his dementia; lack of exercise; and simply old age.

Two hundred years ago, I would have lived close enough to my parents to help on a daily basis. These days, Dad will be depending on home visits from medical personnel and the loving attentions of his wife.

My, how times have changed.

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Oak cask for making vinegar. Image @Taste of Croatia

Vinegar has had a long and noble history of uses for mankind. Since ancient times it has been used as a preservative. Delicate fruits and berries were ripe for such a short season that vinegar, with its acetic acid content, was used to to preserve them. (Blackberry vinegar recipe)

Add sugar and water, to the mixture and one had created a tart and pleasing beverage. Mix it with alcohol, and this sweet concoction became a tasty mixer! Vinegar Cocktails Are Making the Rounds 

As vinegar is so necessary an article in a family, and one on which so great a profit is made, a barrel or two might always be kept preparing, according to what suited.” – A new system of domestic cookery: formed upon principles of economy, and adapted to the use of private families (Google eBook), Maria Eliza Ketelby Rundell, Printed by Norris & Sawyer, 1808.

18th century French faience oil and vinegar set

Vinegar is made from many sources: grapes, apples, sugar cane, or malted barley or oats.

In foods it is used for its antibacterial properties, as an acidity stabiliser, diluting colourings, as a flavouring agent and for inhibiting mould growth in bread. In brewing it is used to reduce excess losses of carbohydrate from the germinated barley and to compensate for production variations, so producing a consistent quality beer.

It can be found in beer, bread, cheese, chutney, horseradish cream, pickles, salad cream, brown sauce, fruit sauce, mint sauce and jelly and tinned baby food, sardines and tomatoes.” – La Leva di Archimede

George III condiment set, silver 1782 Sheffield

Herbs, fruits and spices have long been added to vinegar for flavor, and recipes for infused vinegars were handed down for generations. ‘Sugars of lead,’ a sweet tasting substance, was made by pouring vinegar over lead. This liquid would be used to sweeten harsh cider, but as every self-respecting 21st century reader knows, this substance was quite poisonous. One can only conclude that sugars of lead must have been quite deadly to Europeans addicted to drinking cider. – Enzyme facts, vinegar history 

Recipes for vinegar are found as early as the 17th century. In the Delightes for Ladies (1602), Sir Hugh Plats offers this recipe for distilling and purifying vinegar. Notice his caution of the use of lead.

How to distill wine vinegar or good Aligar that it may be both cleare and sharpe

I Know it is an usuall manner among the Novices of our time to put a quart or two of good vinegar into an ordinay leaden stil, and so to distill it as they doe all other waters. But this way I do utterly dislike, both for that heere is no separation made at all, and also because I feare that the Vinegar doth carry an ill touch with it, either fro the leaden botto or the pewter head or both. And therefore I could wish rather that the same were distilledin a large bodie of glasse with a head or receiver, the same beeing placed in sand or ashes. Note that the best part of the vinegar is the middle part that ariseth, for the first is fainte and phlegmatick, and the last will taste of adustion, because it groweth heavie toward the latter end, and must be urged up with a great fire, and therefore you must now and then taste of that which commeth both in the beginning & towardes the latter end, that you may receive the best by it selfe.

18th C. French vinaigrette bottle

Aromatic vinegar in the minds of 17th-19th century users had many medicinal purposes for preventing infections and megrims (headaches), reviving a fainting person, and covering bad odors. It was used to treat dropsy, croup, stomach aches, as well as sore throats. Vinegar teas were consumed by diabetics, and the liquid was used to heal wounds and fight infections. (Bragg, Health Information.) Vinegar was also a well-known cleaning agent and furniture polish, although it was not recommended for polishing marble, since the acid would eat into the smooth surface, leaving it pockmarked over time.

Vinegar was considered an indispensable item in the 18th century for arousing a fainting person or masking foul odors. When the sponge was soaked only in vinegar, its original use, it could help prevent the wearer from fainting. A person stepping outside a crowded London street might carry aromatic soaked sponges to hold close to the nose to mask the odor of raw sewage and rotting garbage.

19th c. Victorian silver vinaigrette

In the early 19th century, there wasn’t garbage men that carted away the trash. People threw the stuff out the window. Slop pails went out the window in the 18th century. And when you left your house, you would encounter odors that made you just choke. So they invented a device called the vinaigrette. And it was a box or a little trinket carried to revive oneself if one felt faint.

So now they can’t breathe, they go outside, they smell the rotten garbage and the sewage, and they think they’re going to faint. They opened up their vinaigrette, which they held in their hand, and inside is a gold-pierced grill with beautiful decoration. But underneath the grill is a sponge. They would soak that sponge in an aromatic solution, sort of a mixture of perfume and ammonia, like smelling salts.” – Barry Weber, Antiques Road Show 

Vinaigrette and train holder. Image @Antiques Road Show

That was the concept of the vinaigrette. But the other end of this, you seldom see these all together. This is called a train holder. And this is shaped like a shell. When you squeeze it, it opens. The train was the long part of the ball gown. And they didn’t want it to drag in the dirt and be soiled. So they would hook the train holder onto the edge of the train, and then they would hold the vinaigrette in their hand, and this kept the train from dragging behind them.” Barry Weber, Antiques Road Show 

Vinaigrettes were small decorative containers that held the vinegar-soaked sponges. The inside of the vinaigrette would be gilded to protect the silver from staining.

Used by both men and women, vinaigrettes were suspended from chatelaines, placed in pockets, hung from long chains, bracelets or finger rings. Often designed in the shape of a rectangular box, the more spectacular vinaigrettes took on the look of a vase of flowers, a purse, an urn, almost any contemporary theme. Made from multicolored gold or silver and sometimes silver-gilt, many were decorated with Italian mosaics, mother-of-pearl or other gem materials. – Antique Jewelry University

18th century French ladies carrying canes

The soaked sponges were also carried in a compartment in the head of walking canes.

…many ladies of the 18th and 19th centuries carried a “vinaigrette” cane to protect them from a variety of ailments. Throughout history, vinegar has been heralded for its medicinal qualities. A sponge soaked in the healing liquid was placed in a small container with holes in it on the handle of the cane. Should a lady’s tight corset cause her to faint or should she encounter someone with a dreaded illness, her vinaigrette tucked into her cane was close at hand to protect her.” – Collecting Antique Walking Sticks or Canes 

Vinaigrette, Nathaniel Mills. Image @Leopard Antiques

Often spices such as cinnamon, lavender, roses, or orange were added to sweeten the smell.

The vinaigrette was a most necessary adjunct to the toilette in the late eighteenth and early nineteenth centuries, when it was considered the correct thing for a lady to show symptoms of fainting on occasion. The little boxes with a grating inside—through which the essence contained in a saturated sponge could be inhaled— are of all sorts and conditions. Some are quite plain, others have delicately chased or monogrammed tops, or views engraved on the lids; others, again, are of fantastic shapes. The vinaigrette was the descendant of the old pomander, and the forerunner of the midVictorian smelling bottle; but whereas the vinaigrette is accessible to the most modest purse for a very small sum, the real old genuine pomander is very scarce indeed, and it means a lot of money to come by one at all. The pomander was round, and often of china, and contained a wonderfully strong-smelling ball, compounded of spices and pungent scents which could hardly fail to bring round the most upset of ladies. – Byways of Collecting, 1908, Ethel Deane, Pp 170-172.

The small containers known as vinaigrettes were actually an English invention. The French called them “boite de perfum”. They came in many shapes and sizes, and eventually became decorative items that lovers exchanged as tokens of affection. (Limoges Boxes: A Complete Guide)

The vapours from a vinaigrette caused the person to inhale sharply and then breathe more rapidly. Restoratives carried different names and were made from various recipes, not just with vinegar: In addition to vinaigrettes, there are smelling-salts, hartshorn, and Hungary water or lavender water. Ladies prone to fainting would also keep a bottle of laudanum nearby. Laudanum, a painkiller, was an alcoholic herbal preparation that containing approximately 10% powdered opium. Smelling-salts were an infusion made with ammonium carbonate and alcohol and scented with lemon or lavender oil. Hartshorn (aqueous ammonia)was made from carbonate of ammonia distilled from the shaved or powdered horns of a male deer. Hartshorn and smelling salts or sal volatile could be mixed with water and drunk as a restorative. Hungary water was a perfumed restorative made with distilled water and sweet-smelling herbs and flowers. This was dabbed on the skin of a person suffering from “nerves.”- Jennifer Kloester, Georgette Heyer’s Regency World, 157-58

Pauline Bonaparte transformed into a goddes of antiquity on her day couch. Neoclassical statue by Canova, 1805-1808, @ Borghese Gallery

And so we finally come to the fainting couch or a chaise longue, or a reclining chair with a long seat that supported the legs of the fainting person. These couches were placed in drawing rooms and dressing rooms, and were used for relaxation as well.

Early 19th century Recamier day bed. Image @Victoria & Albert Museum

This post will not go into the myriad reasons why women of this era fainted with such regularity. Tightly laced corsets certainly had something to do with the condition, but with so few rights and options open to them in their life’s choices, one cannot blame women of that time for reacting to the child-like treatment their husbands and fathers accorded them with fits, vapours, nerves, and fainting spells.

The Bennet family is well acquainted with Mrs. Bennet's nerves. Pride and Prejudice 1995

A character like Mrs. Bennet, who had her origins in Jane Austen’s real life observations, did not have many opportunities for maturing or turning into a well-educated and sensible woman. Mr. Bennet had given up on her and her childish behavior was enabled by her caring daughters and siblings.

Scene from 1995 Pride and Prejudice. Mrs. Bennet is overcome from the thought of Lydia's elopement. Note that she is not using the day bed but has a chair propped under her feet.

Vinegar had many other uses:

A recipe for black dye

Let one pound of chopped logwood remain all night in one gallon of vinegar. Then boil them, and put in a piece of copperas, as large as a hen’s egg. Wet the articles in warm water, and put them in the dye, boiling and stirring them for fifteen minutes. Dry them, then wet them in warm water, and dip them again. Repeat the process, till the articles are black enough. Wash them in suds, and rinse them till the water comes off clear. Iron nails, boiled in vinegar, make a black dye, which is good for restoring rusty black silks. – A Treatise on domestic economy for the use of young ladies at home and at school, by Catharine Esther Beecher, 1849, p. 299-303

For whitening scorched articles of  clothing

Scorched articles can often be whitened again by laying them in the sun wet with suds. Where this does not answer, put a pound of white soap in a gallon of milk and boil the article in it. Another method is to chop and extract the juice from two onions and boil this with half a pint of vinegar, an ounce of white soap, and two ounces of fuller’s earth. Spread this when cool on the scorched part, and when dry, wash it off in fair water. Mildew may be removed by dipping the article in sour buttermilk, laying it in the sun, and after it is white, rinsing it in fair water. Soap and chalk are also good, also soap and starch, adding half as much salt as there is starch, together with the juice of a lemon. Stains in linen can often be removed by rubbing on soft soap, then putting on a starch paste, and drying in the sun, renewing it several times. Wash off all the soap and starch in cold fair water. – A Treatise on domestic economy for the use of young ladies at home and at school, by Catharine Esther Beecher, 1849  p 296.

Reviving a person overcome with fumes:

In case of stupefaction from the fumes of charcoal or from entering a well, limekiln, or coal mine, expose the person to cold air; lying on his back, dash cold water on the head and breast, and rub the body with spirits of camphor vinegar or Cologne water. Apply mustard paste to the pit of the stomach, and use friction on the hands feet and whole length of the back bone. Give some acid drink, and when the person revives, place him in a warm bed in fresh air. Be prompt and persevering. – A Treatise on domestic economy for the use of young ladies at home and at school, by Catharine Esther Beecher, 1849 p. 243.

This late 19th century poem by Edith Willis Linn talks nostalgically about vinaigrettes as a thing of the past. At this time, lovers gave each other these small decorative items as tokens of affection:

AN OLD VINAIGRETTE – Poem by  Edith Willis Linn, C. W. Moulton, 1892.

LITTLE gleaming box of silver

Wrought in flowery design;

Drifted down the silent ages

To this humble hand of mine;

From the days of kingly France,

From the days of minuet dance,

From the days of stately graces,

Powdered hair and painted faces;

Bring a shining thread of story

To this all-prosaic hour;

From those castles proud and olden,

Those salons of wit and power.

You have known the love and woe

Of fair dames of long ago;

Round you like a love-tale wreathing

Is the perfume of their breathing.

Silent! Not a word to give me!

See, I raise your flowery lid;

Whisper in your heart my secret

Knowing you will keep it hid.

An Old Vinaigrette.

One more life now leaves its trace;

One more love has lent its grace;

Keep it sacred down the ages

On your shining silver pages.

Now my imprint I have given

Though you never bear my name:

Graven with your silver roses

Are all lives of praise or blame.

All things that we touch or wear

Must the spirit’s impress bear.

Every hand that ever won you

Left a fadeless mark upon you.

Love and hate and jealous passion,—

All I feel have been your own;

Shall my life not breathe about you

Purer love than you have known?

Nobler grows this life with years,

Grander grow earth’s hopes and fears;

May the traces of my living

Make this heirloom worthier giving.

Whence and Whither.

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One can imagine that during her final illness, Jane Austen was no stranger to leeches. This method of bloodletting was so common in Great Britain (Wales especially) and France that by the 1830’s Hirudo medicinal leeches (common in Europe) were hard to find and had to be imported or home grown .

Leech finders, 1814. George Havell, Costumes of Yorkshire.

Gathering leeches was a traditional female occupation, although there are always exceptions to the rule. Take this passage about leech-fishers in France from the Gazette des Hopitaux:

Man leech fishing in a marsh in Bretagne. 1857. Image @Shutter Stock

If ever you pass through La Brenne, you will see a man, pale and straight-haired with a woollen cap on his head, and his legs and arms naked; he walks along the borders of a marsh, among the spots left dry by the surrounding waters. This man is a leech- fisher. To see him from a distance,—his wo-begone aspect, his hollow eyes, his livid lips, his singular gestures,—you would take him for a maniac. If you observe him every now and then raising his legs and examining them one after another, you might suppose him a fool ; but he is an intelligent leech-fisher. The leeches attach themselves to his legs and feet as he moves among their haunts; he feels their bite, and gathers them as they cluster about the roots of the bulrushes and aquatic weeds, or beneath the stones covered with a green and slimy moss. He may thus collect, ten or twelve dozen in three or four hours. In summer, when the leeches retire into deep water, the fishers move about upon rafts made of twigs and rushes.”  – Excerpt taken from Curiosities of Medical Experience (1838) by John Gideon Millingen, via The Condenser: Hunting Down Good Bits

Despite the many strides that were made in medicine regarding human anatomy and diseases, the knowledge about treatments lagged behind. Lack of anesthetics made surgery an excruciating experience, and there were no antibiotics. Useful plants, such as digitalis, were discovered more by luck than by science. Bloodletting or ‘breathing a vein’ was one way in which a patient could be treated by a physician who had few options. Applying leeches often resulted  in a severe loss of blood, which was more detrimental to the patient’s condition than not. A human with a poor immune response could suffer from wound infections, diarrhea and septicemia, all influenced by the bacterium, Aeromonas veronii, carried in the leeche’s gut.

19th century leech advertisement

Regardless of adverse consequences, bloodletting has been practiced for at least 2,500 years. The earliest instruments, or lancets, were sharpened pieces of wood or stone, but it is leeches that I want to write about. (I am more repulsed by their sight than a snake’s, and had a hard time searching for an image that did not make me gag.)  The ancient Greeks believed in the humoral theory, which proposed that when the four humors, blood, phlegm, black and yellow bile in the human body were in balance, good health was guaranteed. An unbalance in these four humors led to ill health. Fast forward to the middle ages, when superstition and religion gave weight to the art of bleeding. If you recall, the earliest surgeons were barbers as well. Their leeches cured anything from headaches to gout!

Bloodletting with leeches is an ancient tradition

Leeches are commonly affixed by inverting a wine-glass containing as many as may be required, upon the part affected. The great disadvantage of this practice is, that some of them frequently retire to the upper part of the glass and remain at rest, defying all attempts to dislodge them, without incurring the risk of removing those that may have fastened.” – James Rawlins Johnson, A Treatise on the Medicinal Leech

Francois Broussais proposed in  his Histoire des phlegmasies ou inflammations chroniques (1808) that all disease resulted from excess build up of blood. The alleviation of this condition required heavy leeching and starvation. Leeches subsequently became the most prevalent way of treating a patient, especially in France, where tens of million of leeches were used per year, resulting in a drastic leech shortage. The British were equally enamored with this form of therapy. It is conjectured that Princess Charlotte’s death in childbirth in 1817 was exacerbated by her physician, who prescribed a rigorous course of blood letting and starvation diet during her pregnancy, weakening her before her agonizing 50+ hours of labor. (Read my article on this topic.)

In 1833, bloodletting became so popular in Europe, that the commercial trade in leeches became a major industry. France, suffering a deficiency, had to import 41.5 million leeches. The medicinal leech almost became extinct in Europe due to the extremely high demand for them. Leeches were collected in a particularly creepy way. Leech collectors would wade in leech infested waters allowing the leeches to attach themselves to the collector’s legs. In this way as many as 2,500 leeches could be gathered per day. When the numbers became insufficient, the French and Germans started the practice of leech farming. Elderly horses were used as leech feed where they would be sent into the water and would later die of blood loss. – Maggots and Leeches Make a Comeback

Oh, how I pity those elderly horses!

 

Large leech collector jar.

Intestinal tract of the hirudo leech

Leeches are quite extraordinary in that they have 31 brains and can gorge themselves up to five times their body weight before falling off their host. Afterward they require no feeding for another 6 months. There are over 650 known species of leeches, not all of which are bloodsuckers (some eat earthworms, for example). Placing leeches onto a patient (making sure the frontal sucker with teeth was directed to the skin) is relatively pain free, for their bite releases an anaesthetic. During feeding they secrete compounds, such as a vasodilator that dilates blood vessels and anticoagulant that prevents the blood from clotting. The worms are hermaphrodites, functioning as both the male and female sex. Even after being frozen, leeches can be coaxed back to life!  Needless to say, these creatures must provide an endless source of interest to scientists.

Early 19th century rare cobalt blue transportable leech jar. These were mostly made of clear glass. Cloth covered the everted lip to prevent escapees.

People (meaning mostly women) stood in fresh water marshes, lakes, pools, and the edges of river banks, and allowed the leeches to attach to their legs. (I shudder as I type this.) Once the leeches were gathered, they were placed in a basket, ceramic pot with breathing holes, or a reservoir.

One of these traders was known to collect, with the aid of his children, seventeen thousand five hundred leeches in the course of a few months; these he had deposited in a reservoir, where, in one night, they were all frozen en masse.” But congelation does not kill them, and they can easily be thawed into life, by melting the ice that surrounds them. Leeches, it appears, can bear much rougher usage than one might imagine: they are packed up closely in wet bags, carried on pack-saddles, and it is well known that they will attach themselves with more avidity when rubbed in a dry napkin previous to their application. Leech-gatherers are in general short-lived, and become early victims to agues, and other diseases brought on by the damp and noxious air that constantly surrounds them ; the effects of which they seek to counteract by the use of strong liquors.”  Excerpt taken from Curiosities of Medical Experience (1838) by John Gideon Millingen, via The Condenser: Hunting Down Good Bits

Pewter box for transporting leeches. Image @Science Museum of london

Leeches were carried in a variety of containers made of glass, silver, or pewter. Small bowls were portable, and the larger ones were probably kept in an apothecary’s shop or pharmacy. The everted lips were used to attach a cloth, which prevented the hapless creatures from escaping.

Portable leech carriers made of glass, silver and pewter. Small leech tubes directed the worm to difficult to reach places in the mouth, larynx, ear, conjunctiva, rectum and vagina, begging this question: How did one retrieve the engorged leech?

After the 1830s, the practice of leeching began to decline as medical diagnostic skills improved. Physicians realized that patients who were leeched did not often recover more fully than those who were not, and other, more beneficial treatments,  including pharmaceutical and homeopathic remedies, began to replace leeching

Red and cream Staffordshire leech jar

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Leech bowl

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It’s a truth universally acknowledged that after a bride and groom consummate the marriage the pitter patter of little feet will surely follow (and follow and follow and follow). Such was the case during Jane Austen’s day. Her mother bore eight children and luckily survived her ordeals. The wives of Jane’s brothers Edward and Frank did not, both dying in childbirth with their eleventh child. That these two women were able to survive so many pregnancies was a miracle in itself, given that the chance of a woman dying in childbirth at the time was 20%.

Queen Charlotte, King George IIIs consort, gave birth to 15 children in 21 years. The King and Queen are depicted with their 6 eldest.

Deborah Kaplan writes in Jane Austen Among Women:

“On the birth of his fourteenth child in 1817, Thomas Papillon received this advice within a letter of congratulations from his wife’s uncle, Sir Richard Hardinge: It is now recommended to you to deprive Yourself of the Power of Further Propagation. You have both done Well and Sufficiently.”

The fashionable mamma, or the convenience of modern dress, James Gillray

Abstinence was one method of birth control, as Sir Richard recommended. Breast feeding was another. If a mother breasfed her child for 3-4 years, the pregnancies would be naturally spaced inbetween periods of amenorrhea (the absence of menstruation). While breastfeeding regained some popularity during the Georgian and Regency eras, women did not feed their babies long enough to supress menstruation for very long and often handed them over to a wet nurse. Cassandra Austen farmed her children to a nurse in a nearby village after six to eight months, guaranteeing that her lactation would soon cease and that she would soon be fertile again. The common belief that having intercourse during lactation would in some way harm the mother and child did offer some added protection from pregnancy, but large families were still common.

Amanda Vickery shows a bachelor cadging food from an irritated married friend. The poor young man probably lived in a modest rented room.

Social customs also served to keep pregnancies down. Amanda Vickery mentioned in At Home with the Georgians that a bachelor needed to acquire a house and reliable income before he could seriously contemplate marriage. Such acquisitions took years to amass and would hold up the young man’s inevitable role as parent. Once the young man could afford to marry, however, his long period of delayed consummation with a chaste woman ended and he would waste no time in siring a legitimate child.

A woman’s chaste reputation owed much to the urgent necessity of her not getting pregnant before marriage. Conceiving a child out of wedlock turned a woman into a pariah. In medieval times a chastity belt guaranteed that no bride would enter her marriage bed sullied. Unfortunately, these contraptions came in only one size and were therefore extremely uncomfortable for the larger sized woman.(Johannah Cornblatt, Newsweek). Update: Information about chastity belts in medieval times is being debunked these days as a myth. See links in the comment section below.

James Gillray's priceless caricature.

Married couples anxious to reduce their number of offspring (or who had reached their limit of 10, 11, or 15) tried coitus interruptus and the rhythm method. Since the female fertility cycle was not fully understood until the early twentieth century, the latter form of birth control resembled a game of Russian Roulette more than family planning. Several religious institutions, the Catholic Church in particular, frowned upon a married couple attempting any form of birth control at all, but there was evidence that birth control was effectively practiced. “Some couples managed to delay the first conception within marriage and few babies were born in the months of July and August, when the heaviest harvest labor took place.”-History of Birth Control.

Condoms, which were made of linen soaked in a chemical solution or the lining of animal intestines, had been in use for centuries, but this method of birth control was linked to vice and was mostly practiced in houses of ill repute.

Casanova blowing up a condom with prostitutes looking on.

Giacomo Girolamo Casanova (1725-1798) was among the first to use condoms to prevent pregnancy. The famous womanizer called the condom an “English riding coat.” His memoirs also detail his attempt to use the empty rind of half a lemon as a primitive cervical cap. The engraving shows the Italian seducer blowing up a condom. The photo shows an early 19th-century contraceptive sheath made of animal gut and packaged in a paper envelope. – Newsweek

Condom made of animal gut with paper envelope. Image @Newsweek

One can imagine that such clumsy barriers to impregnation failed on too many occasions to count, although they did manage to prevent venereal disease.

Georgian caricatures made much sport of condoms. This one is entitled: "Quality control in a condom warehouse."

There were other means of pregnancy prevention. Aristotle recommended anointing the womb with olive oil. His other spermicides included cedar oil, lead ointment, or frankincense oil.

Pessaries, 1755. Image @The Global Library of Women's Medicine

“The pessary [mechanical tool or device used to block the cervix] was the most effective contraceptive device used in ancient times and numerous recipes for pessaries from ancient times are known. Ingredients for pessaries included: a base of crocodile dung (dung was frequently a base), a mixture of honey and natural sodium carbonate forming a kind of gum. All were of a consistency which would melt at body temperature and form an impenetrable covering of the cervix. The use of oil was also suggested by Aristotle and advocated as late as 1931 by birth control advocate Marie Stopes.” – History of Birth Control

Other societies had used methods of blocking sperm including plugs of cloth or grass in Africa, balls of bamboo tissue paper in Japan, wool by Islamic and Greek women, andlinen rags by Slavic women. Ancient Jews used a sea sponge wrapped in silk and attached to a string. – History of Birth Control.

Many young girls who had been seduced, engaged in pre-marital sex, or been raped would attempt not to get pregnant by any means. The unfortunate women who did were ostracised, much like Colonel Brandon’s young charge, Liza, who had been enticed by Willoughby in Sense and Sensibility to give up her virginity. These women were frantic to end their pregnancies rather than lose their standing in society or their livelihood, for no pregnant unmarried woman could work as a maid, shopgirl, or seamstress. They would try anything to end their pregnancies, including ingesting turpentine, castor oil, tansy tea, quinine water into which a rusty nail was soaked, horseradish, ginger, epsom salts, ammonia, mustard, gin with iron filings, rosemary, lavender, and opium. Severe exercise, heavy lifting, climbing trees, jumping, and shaking were also attempted, in most instances to no avail. – History of Birth Control

Tess of the D'Urberfield and her baby, Sorrow. Thomas Hardy wrote about the consequences of seduction. (Nastassia Kinski as Tess, 1980)

Infanticide has been practiced since the dawn of time, most famously with the Greeks, who left deformed babies to die outdoors. In Regency times, desperate women would leave their babies in the streets to die. Many left their infants at workhouses, a form of infanticide as the quote below attests, and a large number, too poor to support themselves and unable to work off their debts, wiled away their time in prison.

“When the poor stayed with their children in workhouses, the outcome was little better. Between 1728 and 1757, there were 468,081 christenings and 273,930 infant deaths in those younger than the age of 2 in London workhouses. Foundling hospitals and workhouses were institutionalized infanticide machines.” – Global Library of Women’s Medicine

Women at Bridewell Prison, 1808. Rowlandson and Pugin for Ackermann's Repository of Arts

Once children were born and the family was large, it was not unusual to farm out a few children, some to work in their childhood, as Charles Dickens did, and other to live with relatives, as was the case with Fanny Price, who lived with her aunt’s family in Mansfield Park and Edward Austen Knight, who was adopted by a rich, childless couple.

Early 20th century attitude towards an unwanted child. Image @Newsweek

It has been said that families had many children during the 18th and 19th centuries because of the high rate of infant mortality and the need for many helping hands on the farm. But as society became industrialized, large families became a hindrance. With many mouths to feed and limited resources (except in the case of the rich), it is no wonder that couples since time immemorial have searched for ways to limit the number of their offspring.  Update: As Nancy Mayer rightly pointed out in her comment, most women during the Georgian and Regency eras thought it their duty to bear their husbands children and oversee the family household. The matter of family planning might well have been influenced by women of a certain class who could not allow pregnancies to interfere with the rhythm of the work cycle, single women who were desperate to seek ways to end their pregnancies before their condition became obvious, and in houses of ill repute, where condoms would offer some protection against disease. Mistresses and prostitutes would find pregnancies to be more of a hindrance than help in their work. I have often wondered, for example, how Emma Hamilton managed to have so few children and yet enjoy the charms of so many men.

1920's Lysol Advertisement. Image @The Museum of Menstruation and Women's Health

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In 1798, the famous caricaturist Thomas Rowlandson drew The Comforts of Bath, a series of satiric drawings. The cartoons were used to illustrate the 1858 edition of the New Bath Guide, written by Christopher Anstey and first published in 1766.* Rowlandson depicted both the social and medical scene in Bath just before the period described by Jane Austen in Northanger Abbey and Persuasion, and by Georgette Heyer in her Regency romances.

The Portrait, Comforts of Bath, 1798, Thomas Rowlandson

In this post I combined Rowlandson’s images with excerpts from an 1811 guidebook, A new guide through Bath and its environs By Richard Warner. The scenes depict the use of mineral water therapy for the invalids who flocked to Bath, a city whose fashionable post-Nash reputation was already well past its prime and whose medical men were generally regarded as quacks or, worse, “potential murderers”. The rotund gentleman in front and center of all these scenes (who undoubtedly suffered from gout, a painful rich man’s disease), was conjectured to be based after Tobias Smollet’s Mr. Bramble. In the pictorial’s subtext, notice how “Mr. Bramble’s” young wife (companion or daughter) flirts with the young officer who boldly woos her (Image above). Even while satirizing them, Rowlandson gets the social details just right. Underneath each image sits a quote from the guidebook.

King Bladud's Bath, Comforts of Bath, Rowlandson

It is fit for the patient when he goeth into the bath to defend those parts which are apt to be offended by the bath, as to have his head well covered from the air and wind and from the vapours arising from the bath, also his kidneys if they be subject to the stone, anointed with some cooling unguents as rosatum comitiffs infrigidans Galeni Santo linum &c. Also, to begin gently with the bath till his body be inured to it, and to be quiet from swimming or much motion which may offend the head by sending up vapours thither at his coming forth, to have his body well dryed and to rest in his bed an hour and sweat, etc.” – A New Guide Through Bath, 1811

The Pump Room, The Comforts of Bath, 1798, Rowlandson

The new Pump Room supplied water from a covered pump. Before the room was built, the populace drank the waters in the open air. But the new rooms allowed them to

…  take the exercise prescribed to them sheltered from the inclemency of the weather. The work was accordingly begun in 1704, finished two years afterwards, and opened for the reception of the company under the auspices of Mr Nash, who had just then become the Arbiter Elegantiarum of Bath…A New Guide Through Bath, 1811

Black and White detail of above print

In the year 1751 [The Pump] Room was enlarged. Accommodated with a beautiful Portico stretching from it in a northern direction in 1786, and adorned with superb Western Frontispiece in 1791, The Corporation further beautified the city in 1796 by taking down the old Pump Room entirely and building on its site the much larger and more magnificent edifice known at present by that name…A New Guide Through Bath, 1811

Public Breakfast, The Comforts of Bath, 1798, Rowlandson

Pertaining to the construction of  the Harrison rooms and the Assembly Rooms:

Temporary booths had hitherto been the only places in which the company could drink their tea and divert themselves with cards, but Mr Harrison, a man of spirit and speculation, perceiving that a building of this nature was much wanted and would probably make him a very suitable return, undertook at the suggestion of Mr Nash to erect a large and commodious room for the purpose of receiving the company.  The succes of this attempt induced a similar one in the year 1728, when another large room was built by Mr Thayer.  A regular system of pleasurable amusements commenced from this period, and the gay routine of public breakfasts, morning concerts, noon card parties, evening promenades, and nocturnal balls rolled on in an endless and diversified succession. – A New Guide Through Bath, 1811

Company at Play, The Comforts of Bath, Rowlandson

Rules card games:

That no persons be permitted to play with cards left by another party;  That no hazard or unlawful game of any sort be allowed in these Rooms on any account whatever nor any cards on Sundays...A New Guide Through Bath, 1811

The Concert, Bath Chambers, Rowlandson

For music sweet music has charms to controul; And tune up each passion that ruffles the soul; What things have I read and what stories been told; Of feats that were done by musicians of old – The New Bath Guide, 1779

Dinner, Comforts of Bath, 1798

Bath has little trade and no manufactures; the higher clafles of people and their dependents conftitute the chief part of the population, and the number of the lower clafles being but fmall…A New Guide Through Bath, 1811

Bath Races, Rowlandson

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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:

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

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