Cures & Remedies: 18thC Living Conditions, Part 8

The Medical Profession

A surgeon letting blood from a woman’s arm, and a physician Wellcome V0017549 See page for author, CC BY 4.0, via Wikimedia Commons

In general, the European medical profession was divided into four main sections, physicians, surgeons, apothecaries, and midwives. As can be expected, these divisions were not clear-cut, and general practices were becoming more and more common. Even in London where specialization could be expected, the apothecaries and surgeons began to resemble one another, whilst the demarcation between surgeons and physicians was becoming less clear. Surgeons were also encroaching on the midwives’ domain, and taking over difficult cases, as well as normal births if requested. Much to the midwives’ chagrin, in some Protestant countries such as England, south Germany and the Netherlands, man-midwives had started to muscle in on their preserve since the early 1700s, but in the Catholic countries of France, Italy and Spain the church insisted on the use of female midwives to protect female modesty.

In addition, the official medical hierarchy was supported by a whole host of unofficial figures, from straightforward charlatans or quacks, to folk healers and cunningmen, and people of other professions who practiced medicine as a sideline. Ramsey “Professional and Popular Medicine in France, 1770-1830: The Social World of Medical Practice” quotes the following examples from 1786 and 1800:

Unfortunately, the medical profession was ill-equipped to deal with any of these diseases, especially as the “germ theory of disease” had not yet been accepted. This theory states that many diseases are caused by the presence and actions of specific micro-organisms within the body and was scientifically proved by, Louis Pasteur in the 1860s and Robert Koch in the following decades. It eventually superseded the existing miasma and contagion theories of disease and in so doing radically changed the practice of medicine..

Given the poor state of medical knowledge, it’s no wonder that the population, and in particular, country people and those who were unable to afford medical treatment, resorted to some very strange remedies. The following recipe “to cure a great flux or looseness of the belly” comes from “The Queen’s Closet Open’d” which was published in 1696.

The following cures as practised by country folk give one an idea of the multitude of different things that were used by those who could not afford a physician, or preferred to put their trust in tried and trusted remedies.

A well-known cure for ague involved swallowing a live spider, wrapped in its own web on an empty stomach; another involved transferring the disease to an aspen tree as follows.

This is clearly an example of transference magic.

Even today such folk cures are alive and well. For example, one cure for shingles involves cutting the comb of a cockerel, squeezing the blood onto a plate, and then dabbing the blood in a wide band onto the back of the sufferer.

As Porter says “’medicine without doctors’ was a necessity for many but a preference for some.” Perhaps the following quote attributed to Voltaire was (and still is?) very apt. “The art of medicine consists in amusing the patient while nature cures the disease.”

It was not only the poor who believed in the efficacy of alternative medicine. Religion and magic still underlaid a great deal of vernacular healing. The author and lexicographer, Samuel Johnson, when an infant, was one of the last to be touched by Queen Anne for scrofula; whilst in France, Charles X revived the custom in 1825. John Aubrey, the antiquary, recorded numerous magic formulae, supposedly with curative powers. Family recipe books record healing salves, prophylactics and various remedial practices, some of which had their origins in the occult. Again, quoting from Porter: “Everyone had a cure for everything, and some may have worked, if only as placebos.

Comforts of Bath, Plate 7 MET DP881059 Thomas Rowlandson, CC0, via Wikimedia Commons

Affluent patients could “take the waters” at the many spa towns that were established in England and Europe. These had been known since Roman times, but it was only in the middle of the seventeenth century that their popularity really took off, so much so in fact, that between the years 1660-1800, over four hundred medical publications in Britain alone were written concerning this subject. At about the same time seawater bathing was being promoted as being very beneficial to health, and some medical practitioners even recommended that seawater be drunk on its own or in conjunction with a weird collection of ingredients such as coral, cuttle-fish bones, viper’s flesh, burnt sponge, snails, crab’s eyes, wood lice and tar, whilst other doctors recommended the efficacy of sea air. It is, perhaps, not surprising that sea water could affect almost miraculous cures. In an era of “the great unwashed” and the overindulgence of the rich, its disinfecting and cleansing qualities when used externally, and purging qualities when drunk, must have proved extremely beneficial.

Allied to these cures was the trade in patent medicines. Many, if not most, were of little or no value and were produced with little or no scientific basis. The trade in patent medicines was not to be ignored and huge fortunes would be made by those catering to a gullible public. The following advert , which appeared in the Kentish Gazette on 23rd of August 1783, is a typical example.

Lady Mary Montagu, writing from Italy declared:

By the end of the century there were more than 450 patent medicines listed in Schedule B of the 1804 Medical Stamp Act.

The following rhyme was said about the notorious quack, Joshua Ward, who made a fortune in the 1700s selling patent medicines, claiming that his preparations would cure everything, including gout, scurvy, syphilis, and cancer. Whilst living in exile in France, he invented his famous Ward’s Pill and Ward’s Drop, which must have captured the public’s imagination, as a contemporary wit made up the following doggerel about them:

Conclusion By today’s standards, 18th century towns and villages were very insalubrious places. Living conditions were often primitive in the extreme, with only a few houses having proper sanitation or fresh, clean running water. Rubbish and sewage would often be left to rot in piles, thrown in the nearest river, or carted away by night-soil men who dumped it outside the town without disposing of it properly. The following quote from Dobson (Contours of Death and Disease in Early Modern England, pp.10–11) admirably sums up the situation.

Overcrowding in graveyards was a perennial problem, particularly in towns and cities, perhaps the most notorious example being the cemetery of Les Innocents in Paris. Another problem that city residents had to endure was the choking, smoky atmosphere from thousands of domestic and industrial coal fires and the harmful effects it must have had on the inhabitants’ lungs, and this fact was commented on by John Evelyn writing in the mid-seventeenth century.

There were many different diseases which plagued the population living in the 18th century, and we have seen how they could be transmitted by mechanical means, either by air, contaminated food, or water; examples of these being influenza, E-coli and typhoid; by human to human contact, smallpox and tuberculosis are but two examples of this type; and last but by no means least, animal and insect vectors which transmit diseases such as typhus, brucellosis and malaria. The lack of sanitation which resulted in unclean water seeping into wells or other means of water supply caused periodic outbreaks of intestinal disease, with typhoid mentioned above – and infantile diarrhoea being just two of them.

Whilst smallpox was, perhaps, the most feared disease, often causing severe epidemics with many fatalities, others, such as typhus, could be just as deadly. Tuberculosis another devastating infection was, more usually, endemic rather than epidemic, and was particularly rife in the squalid housing conditions of the rapidly growing industrial towns. It could also be classed as an occupational disease caused by the horrific working conditions in, for instance, the Manchester cotton mills. Occupational diseases, which were many and varied, killed over a period of time, mainly through the ingestion of minute particles into the lungs – one only has to think of silicosis, a disease of miners and stone workers – or by the absorption of noxious substances through the skin or mucous membranes of the nose and lungs, for example, the inhalation of mercury vapour which caused mad hatter disease.

Although they have many deficiencies, the London Bills of Mortality give us the best snapshot of 18th century disease, albeit many of the terms used would not be recognisable today. The number of infant deaths during this period was horrifying, as can be seen by the figures recorded in the London Bills; approximately 33% of all fatalities in the years 1783 and 1784. Not all of these were by natural means, and several authors have commented on the fact that infanticide was a common occurrence. To attempt to combat this, many foundling hospitals were set up where unwanted infants could be looked after and cared for. Although well intended, these institutions had an exceedingly high death rate, in one case up to 95% by the end of the century, caused in part by the spread of highly infectious diseases due to massive overcrowding, and lack of adequate feeding arrangements.

Illnesses caused by volcanic eruptions can be placed in three categories, irritant, noxious, or inert. The Laki dry fog was an irritant consisting mainly of SO2 and much smaller amounts of HCl, HF and NH3,and these may have been deleterious to the health of asthmatics and people suffering from bronchitis or other respiratory ailments.

The medical profession was only just emerging from the dark ages as far as the treatment of disease was concerned and was unable to cope effectively with most infections. Epidemic diseases such as smallpox, influenza, and fevers of various kinds, were rife and it is no wonder that a large part of the population, especially the poorer sort who were unable to afford doctors, were fitting targets for the quacks and charlatans that travelled the countryside. In an era when death was just around the corner, it is hardly surprising that many people relied instead on old wife’s tales or tried and tested home remedies. It was into this climate of uncertainty that the patent medicine industry started to take off and was positively booming towards the end of the century.

To add to these woes, the food eaten by most of the population was, by today’s standards, extremely unhealthy, both for the rich and poor. The rich probably suffered from vitamin deficiency through eating a high protein diet of meat with little fruit and vegetables, whilst the poor subsisted on little meat, brown bread, and fruit and vegetables when in season. However, according to Misson, the middling sort could eat very well, even if not very healthily.

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