The Wenches are delighted to welcome Dr. Josh King, who will answer some of the Wenches' questions about medicine in historical fiction.
Dr. King graduated summa cum laude from University of Maryland, earned his M.D. from Penn State College of Medicine, and is now a resident physician in internal medicine at the University of Virginia Health System.
He has some experience answering medical questions for writers, since he's the eldest son of Wench Susan Sarah, who regularly asks him how to get rid of villains, or how to strategically afflict and then treat heroines and heroes. He has also come up with some creative ways to poison and dose a few eleventh-century characters....
A word of warning, if you have a squeamish tummy for medical stuff, or are just about to eat a meal, you may want to proceed with care as you read his answers....
Dear Dr. Josh,
I am desperately curious about how people dealt with gonorrhea, how long they might have lived with it, and whether there was anything they might have done to alleviate symptoms (and imagine themselves cured) in days before antibiotics. Circa 1817, Lord Byron talks about getting the clap from this one and that one, which made me wonder. My 1887 edition of the Encyclopedia Britannica has some fascinatingly insane stuff about syphilis (like how it eventually goes away by itself or how one should give mercury to a syphilitic pregnant woman) but very little about gonorrhea.
-- Loretta
Dr. Josh: Gonorrhea's been around for a while... Galen named it way back in the 2nd century. Essentially, before antibiotics, it was treated the same as syphilis - with mercury! Actually, the two were often confused back then, and people were often coinfected. Since the symptoms of gonorrhea (burning on urination) often went away after a few weeks, it was often thought to have disappeared (although reinfection / reactivation of symptoms was common). Sulfa antibiotics came around in the 1930s, becoming the first treatment with any degree of reliability. Basically, my impression is that people just got used to it burning when they urinated. That's not all that uncommon, even today, as I've had patients who tolerate the symptoms for a long time before finally coming in for treatment.
Another note on syphilis - as far as the Great Pox (or, as the medical profession occasionally calls syphilis, the Great Imitator - so-called because its manifestations may be more protean than any other disease), there were quite a few treatments. Many of them were used for other sexually transmitted infections 'cause they couldn't tell which one was bothering them. Mercury was often used to treat venereal disease, as was guaiacum, the prepared sap of the guaiacum tree, since as early as the 15th-16th c. The final stage of syphilis is neurological involvement leading to madness; mercury toxicity can result in, you guessed it, madness (mercury also being the cause of 18th-19th c. mad hatter's disease, or erethism, as mercury was used in the preparation of felt). So a lot of people went crazy for one of the two reasons.
(Johnny Depp in The Libertine, as the Earl of Rochester-- before The Syph got him)
Dear Dr. Josh,
This is of interest to me, too, since all of my present group of characters seem to die one way or another from venereal disease. Dr. Josh has helped my research with this matter before, but I'd be curious about what kind of hereditary effects (if any) "poxed" parents would transmit to their offspring. -- Susan Miranda
Dr. Josh: Actually, quite a few. To use the vernacular medicalese, vertically translated (meaning from mother to child at birth) syphilis is associated with significant badness. The symptoms can be severe enough to cause stillbirth and early infant death. At first, the new baby has a runny nose, which is often followed by a severe, peeling rash over the entire body. If you cultured these lesions, you'd find them teeming with the bacterium that causes syphilis. The infection can then involve any organ in the body, including liver, kidneys, and lungs. If the infant survives without treatment, they then enter a latent period, where they may slowly develop bony and tooth deformities, eye problems, and neurosyphilis leading to psychiatric problems including psychosis and dementia. Not so good. Usually, mothers who acquire the disease during pregnancy are at greater risk to transmit it to their baby, as the organism is more active early on.
Dr. Josh, I've heard that maggots were used to clean infection from wounds, which was gross but effective. Any comments on that? -- Mary Jo
Josh, I'd also like to hear more about the treatment of wounds. I was very surprised to
read that stitching wounds wasn't done before antibiotics because they had to drain. Greater depth on that would be useful. Also, could you give us a guess on what sword and gunshot wounds were probably survivable in the past, and which probably weren't?
-- Jo
Dr. Josh: I combined these two questions ... The problem with stitching infected wounds is that doing so basically gives the bacteria a nice warm pocket to form abscesses. In fact, we often don't stitch together traumatic wounds if they're really dirty - we approximate the skin, slap some bandages over them and let them heal over weeks to months on their own, while giving them antibiotics. Wounds created in the operating room are sterile, so it's OK to stitch them up.
In terms of wound treatment, cautery was not always done because it caused death from tissue damage, later infection, and fluid loss. Of course, it was often done because not doing it often caused death from immediate blood loss. Maggots have several beneficial attributes - they disinfect wounds by killing bacteria, largely remove necrotic (dead) tissue, which stands the highest chance of getting infected, and stimulate wound healing through partially understood mechanisms. Nowadays, they are uncommonly used for patients with chronic wounds resistant to other forms of healing - I've only heard of them being used once or twice in my experience, and each time in a patient who was riddled with skin infections. I don't know much about herbal poultices and such, but my gut feeling is that the most important purpose they served was to avoid dehydration through open wounds - we often use wet gauze for the same purpose today, depending on the type of wound/burn.
Survivable wounds... basically, any gun wound that ruptures a major blood vessel, the heart, or perhaps the spleen would be likely to cause a fatal internal hemorrhage. Rupturing the intestines would be fatal, as they'd cause infection. Actually, a shot to the head (if it didn't rupture a blood vessel) might be one of the more survivable. Shoulder, arm, leg oughta be possible to survive. Chest wound that punctured a single lung might be survivable, often not - you'd have to get lucky and miss the aorta, its large branches, and the heart. Basically, internal bleeding kills you in a very short period, infection within hours to a few days. Same principles for sword wounds, but figure that a sword wound is more likely to cause severe tissue damage, bleeding, and infection in any area - so a shot to the leg might be survivable, but a deep cut to a muscular area of the leg would stand a greater chance of killing you from deep tissue infection (gangrene-like) or blood loss.
Could you also talk about how midwifery was more a woman's affair? -- Mary Jo
Dr. Josh: Midwivery...well, I don't know much about it, though I did my share in OB/Gyn rotations. I know that historically, men typically stayed away, including doctors (unless cases were complex), since it was considered a "woman's affair" as Mary Jo says.
In fact, this changed only in the 20th century, with (largely male) doctors getting in on the action.
However, history is coming full circle in the 21st century, with women being far more likely to go into OB/Gyn than men - my experience with current OB residency programs is that they're comprised of 80-90% (or higher) women. I'll just conclude with a brief suggestion that anyone considering the use of a midwife today is best advised to seek the services of a nurse midwife in a hospital in case a cesarean is necessary - there's a reason infant mortality is far lower today than in ages past, and it's not related to skill in delivering a baby (although nowadays we do have salad spoons, as Bill Cosby calls them).
Dear Dr. Josh,
Could you comment on plot-amnesia? I know novelists use amnesia shamelessly (I certainly have), and I've read some really interesting stuff about fugue states that aren't really organic in nature, but it could be interesting to hear him on the subject.
-- Mary Jo
Dr. Josh: Ah, amnesia! A concept far more common in fiction than reality. The only time I've ever encountered classic amnesia is in books, and I'm not talking about medical texts. The novelists' version of amnesia does occur, albeit very rarely; far more common is a selective memory loss of recent events associated with aging and dementia (not too useful to most novelists) and substance abuse (also not too useful to most novelists, although there's a certain subset).
There is a condition known as transient global amnesia where people lose their memory of recent events, but still tend to retain distant memories (the thought being that they are more 'hard-wired' into the brain). Frankly, no one really knows why it occurs, although there's some thought that it's somewhat stroke-like, and no one knows why it gets better. Because of this uncertainty, feel free to exploit at will - no one can fault you scientifically.
Dear Dr. Josh,
My question has to do with comas. I've been told that people in comas sometimes hear, but cannot respond. My ex-husband went into a diabetic coma when he was 13, and though he was immobile and couldn't open his eyes or speak, he remembered hearing the doctor telling his mother he was going to die, and his mother crying.
Is it possible to bring a person out of a coma (or speed their recovery) by external stimulation, such as reading or talking to them, or playing music, or by touching them? If not, then is it possible for a person who comes out of a coma on their own (whatever that is!) to remember things that were said to them while they were in a coma?
-- Sherrie
Dr. Josh: Well, coma is a tricky word... it basically refers to a level of unconsciousness, which can be due to a number of different conditions. Novelists' comas are like novelists' amnesia - useful in a plot sense, but not very realistic.
Coma states vary in the level to which they alter someone's level of consciousness - we have multiple scoring systems used to evaluate them. They can be short-lived, often seen with severe infections requiring hospitalization, shock from blood loss, metabolic disturbances (as your husband had), or drug-induced (e.g., modern anesthesia intentially induces a comatose state with short-acting drugs continuously infused). These are usually completely or nearly completely reversible, depending on the amount of permanent brain damage.
Longer comas usually result from a neurological insult - stroke, bleeding inside the head, brain damage from shock, or, as we commonly see, brain damage after cardiac resuscitation (loss of blood flow for minutes can cause very profound levels of brain damage. Those are usually reversible to a certain extent, but with increasing severity of the coma, the likelihood of a person emerging decreases. However, people can come out of them after either months or decades; the bad news is that they often have persistent neurological deficits.
As for your question, well, it depends on what caused the coma, and I assume you mean a longer coma (though I could be wrong). Modern medical science doesn't really have a good answer as to whether external stimulation can bring someone out of a coma. But since people rarely accept this as an answer, why should you? Many friends & family members of patients say they feel that stimulation helps their loved one to be more aware. I honestly haven't seen it myself as yet, but stimulation is unlikely to make matters worse.
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Dr. King will return now and then to answer more questions concerning historical medicine, and maladies and injuries that may afflict fictional characters ... be sure to watch Word Wenches for the next "Dear Dr. Josh" column!
Meanwhile, if you're curious about historical and medieval medicine, you may want to check out this informative video clip featuring "Theodoric of York, Medieval Barber" .... http://www.nbc.com/Saturday_Night_Live/video/#mea=2888
Thanks, Dr Josh, for such an informative post. I look forward to your next column.
Nina
Posted by: Nina P | Friday, July 13, 2007 at 05:27 AM
Josh, what a great post! I'm glad to hear that my playing around with amnesia isn't quite as idiotic as I've thought. :) As a writer, I find amnesia interesting because of the issues of identity that it raises. Great fun.
A minor question--you said that syphlis is caused by a bacterium. I've always thought it was caused by a spirochete, from which I infer that sphirochetes are a subclass of bacteria?
Mary Jo, grateful Dr. Josh had time to do this.
Posted by: maryjoputney | Friday, July 13, 2007 at 08:26 AM
What I'd really like to know is how prevalent disease such as syphilis and gonorrhea were. There are lots and lots of rakes in romance, and I can't help but think that they'd be bound to have at least one venereal disease, which is not really a recipe for a happy-ever-after and lots of healthy babies. Yet the aristocracy clearly did reproduce successfully, so they weren't all rendered infertile by gonorrhea or had unhealthy babies because of syphilis.
So, to get away from the medical side of things, how many Regency rakes were there? Have their numbers been grossly exaggerated in the same way that Romanceland abounds with Dukes in their thirties and in need of a wife? How common was promiscuity, did attitudes vary according to social class and how many men would have remained virgins until marriage for health and/or religious reasons?
Posted by: Laura Vivanco | Friday, July 13, 2007 at 08:59 AM
Excellent questions, Laura! And thank you, Dr. Josh. We're so spoiled by our antibiotics and anaesthesia that it's sometimes difficult to imagine how the species managed to survive without them.
Of course it wouldn't have been just veneral diseases that would persist without modern treatment; there must have been a host of other infections that clung on because there was no way to get rid of them. Not to mention parasites, blood poisioning, tetanus, etc.
If I had lived in the Regency period, I would have been dead at 30, the age at which I had the ectopic pregnancy. I wonder what a Regency-era doctor would have made of that? You could probably die in, like, four minutes from internal hemorrhaging.
I'm just glad Dr. Josh will be coming back, because there is SO MUCH MORE to find out!!! I can hardly wait.
Posted by: Elaine McCarthy | Friday, July 13, 2007 at 10:19 AM
I can't answer Laura's question about how common promiscuity was amongst the Regency upper classes, but one thing that should be remembered is that condoms were available, and were probably quite widely used as protection against disease. The earliest archaeological evidence for condoms dates to the later 17th century in England.
Posted by: AgTigress | Friday, July 13, 2007 at 10:24 AM
From Sherrie:
Dr. Josh, what a wonderfully informative post! I have saved it in my research files. Lots of really good, concise information.
Two of my favorite research tools are medical books published a long time ago. "Dr. Chase's Recipes" was a wildly popular medical handbook for homeowners first published in the 1860s. It's wonderfully pompous and is chock full of the medical wisdom of the time--some of it hilarious. Dr. Chase was an itinerant doctor who traveled extensively across the American West, peddling his book, dispensing medical treatment, and collecting folk medicine recipes. Nearly every home had a copy of his book, and it was updated and reprinted frequently, through the 1890s. Hundreds of them can still be found in UBS at a reasonable price. It's quite useful for the historical writer and great bedtime reading!
My other treasure is a large medical reference book for doctors published in 1906. It has photographs and treatments for a variety of normal as well as truly bizarre medical cases. Included are photos and treatment histories of people who survived bullet wounds through the head, gruesome saber cuts, syphillis, birth defects, tuberculosis, etc. Besides being morbidly fascinating, the author often compares "modern" medical practices with "barbaric" practices of the past, making it a great research tool.
Posted by: Sherrie Holmes | Friday, July 13, 2007 at 10:51 AM
Dr. Josh and Susan/Sarah, thank you! What fascinating stuff is here!
My follow up Q: Do we see any similar long-term effects to untreated gonnorhea as with syphilis? Apart from the burning? As AgTigress points out, condoms were available but it seems that, as is the case today, they were not used consistently. Also, they were made of more permeable materials, so probably not as effective, even when used consistently. So I wonder how untreated gonnorhea affects longevity, sanity, reproduction,etc. Not that they would have known the difference back in the early 19th C--but I'd like to understand a little better.
Posted by: LorettaChase | Friday, July 13, 2007 at 12:09 PM
Dr. Josh, thank you for a very interesting post. As a former EMT and the survivor of six surgeries on a broken arm with multiple fractures and a shattered elbow which left me with resident staph Aureus in my lower arm I have a great interest in how medicine has or has not progressed. I have no elbow at all and the surviving bones in both my uppper and lower arm have been shortened. I manage very well in this state, but I wouldn't have survived without antibiotics. Thanks again for the great information.
Posted by: Bonnie | Friday, July 13, 2007 at 12:16 PM
A spirochete is a type of bacterium. They resemble thin spiral-looking worms, hence the name. Syphilis was in fact a highly prevalent disease. Beethoven, Guy de Maupassant, and Stalin were some well known historical figures that were afflicted (among many many others). For more reading on the topic of syphilis in history, you may want to check out Deborah Hayden's book, "Pox: Genius, Madness, and the Mysteries of Syphilis".
Posted by: MicrobioJen | Friday, July 13, 2007 at 01:01 PM
Great questions, Wenches and great answers Dr. Josh! I am always amused when the hero manages to have intercourse rather shortly after receiving whatever nearly fatal wound he's received. Good for the plot but bad medicine? And I cannot resist...what about the refractory period for the male? How realistic are our beloved heroes?
Now I feel like a dirty old lady, but at least I'm not covered with maggots. Which reminds me of body lice. I know the human body is covered with all sorts of little organisms, but how were lice treated...or were they just ignored?
Posted by: Maggie Robinson | Friday, July 13, 2007 at 03:18 PM
Mary Jo asked about fugue state and this really is a real, although very rare condition. A person facing a severe sudden life crisis can unconciously "escape" the problem by forgeting who they are and fleeing their previous home. Usually the fugue ends within hours or days and the person remembers who they are but no longer remembers what happened during the fugue.
One example I know involved a young man for whom medical school had been not only a personal dream but also the enthusiastic hope of his immigrant family. On the first day at school he went to anatomy lab to start dissection of a cadaver and suddenly realized he couldn't. He walked out the school and a freight train was slowly crossing the road and he jumped on. Two days later, he called from Minneapolis wondering how he had got there. His sudden realization that he couldn't stand to be a doctor combined with the impossibility of explaining the situation to his family caused the fugue.
Posted by: Helen | Friday, July 13, 2007 at 03:47 PM
Hi Dr. Josh!
I have a couple of questions, though probably they're more in the ob/gyn arena.
I heard an author talking on the radio about her biography of Emilie du Chatelet (physicist, writer, mistress of Voltaire). She said that when Emilie became pregnant in 1749 at age 43, she knew she would die because "in those days pregnancy after 40 was a death sentence." Is this true? What does this mean about all those Older Heroines we are starting to see and their delight at getting pregnant?
(Emilie did die after delivery,the same day she finished her translation of Newton's Principia).
Also--did the Caesarean section exist in those days in any form? Was it post (maternal) mortem? When did it start to become a viable alternative?
Thank you Dr. Josh!
PS Maggie, you stole my question about "rebound time." That is one of my Pet Peeves about Romance Heroes (but my experience is admittedly limited, LOL).
Posted by: RevMelinda | Friday, July 13, 2007 at 04:03 PM
An excellent post. The blog is a very fascinating one.
Posted by: Jean-Luc Picard | Saturday, July 14, 2007 at 07:46 AM
RevMelinda, the reason that Caesarean section has that name is because Julius Caesar was said by ancient commentators to have been delivered by that means. While it would hardly have been common in Antiquity, it was certainly possible, as surgery was by far the most advanced branch of Roman medicine. I doubt if it was used much in the Middle Ages, since the medical standards, like so many other things, regressed pretty drastically because of poor standards of hygiene, and major surgery must often have been fatal because of infection.
Posted by: AgTigress | Saturday, July 14, 2007 at 03:03 PM
I forgot to say how interesting I found this blog, and the questions to which it has given rise. Good stuff!
:-)
Posted by: AgTigress | Saturday, July 14, 2007 at 03:04 PM
AgTigress, how I would love to meet you and talk All Things Roman over tea! I was a Latin major (did you ever know George or Phillippa Goold?) and had heard the story about Caesar's birth--what I didn't know is that "surgery was by far the most advanced branch of Roman medicine"! This is fabulously fascinating! What kind of surgeries did they do? Is there a book on the subject?
Posted by: RevMelinda | Saturday, July 14, 2007 at 04:36 PM
Hi all - glad you enjoyed the blog! Some quick comments & answers to questions... standard disclaimer regarding the fact that you are receiving the answers from a physician in residency (i.e., training). That being said...
Regarding STIs (the new term being used by docs is "sexually transmitted infections," which replaces STDs, which in turn replaced venereal disease), I don't know what the prevalence of gonorrhea/syphilis was in the Regency, but I can speak to the long-term effects of gonorrhea. There are often no long term effects for either sex, but when there are, men have it easier - the worst common effects are infertility and epididymitis (inflammation of part of the testicle), neither of which are fun. Women, however, can get PID (pelvic inflammatory disease), a potentially fatal infection of the ovaries and uterus. This still happens at a higher rate than we wish today.
For older births and cesarean sections (note the American spelling is different from the British), again, I'm not an expert in women's health/OB. That being said, childbirth at older ages carries higher risks in most every category, including complications of labor that would lead to a cesarean today. For the time periods we're talking about (basically, anything before the 20th century), abdominal surgeries were usually a death sentence, due to the lack of the three major advances that essentially enabled modern surgery: anesthesia, sterility, and antibiotics. The most successful surgeries back in days of yore were generally amputations (most of which were still fatal from blood loss and infection). It is possible to do a cesarean section without the abovementioned things - but the vast majority back then were still fatal. I don't know how often they were done; however, I suspect that a plethora of information exists on the topic.
Posted by: Josh King | Saturday, July 14, 2007 at 10:40 PM
Melinda, if you are interested in Roman medicine, I strongly recommend *Doctors and Diseases in the Roman Empire*, by Ralph Jackson. It was first published in the 1980s, and the author has done a great deal of work on Roman medicine since then, and has published extensively on the subject, but this general book remains an ideal introduction, and is still in print.
I suppose that recommending a book by one of my oldest and best friends is not *quite* as iffy as recommending one of my own books, which I did a few blogs ago here!
:-D
Posted by: AgTigress | Sunday, July 15, 2007 at 08:37 AM
Great blog and great discussion, I've been enjoying this. And I'm so glad the definite Ick Factor didn't bother you all too much. *g*
Josh, M.D., will return sometime in the future. If you all have any historical medical questions (I was going to say "burning questions" but then rethought it! haha!) that you'd like Dr. J. to consider, you can post them here as comments to this blog, or you can send them to me at [email protected].
AgTigress says ...
>>I suppose that recommending a book by one of my oldest and best friends is not *quite* as iffy as recommending one of my own books, which I did a few blogs ago here!
Oh, no problem! We were very happy and very impressed to learn something about your books, AgTigress, so feel free to mention them whenever.
Which goes for everyone -- we love learning more about what our blog readers are reading and writing!
~Susan Sarah
Posted by: Susan Sarah | Sunday, July 15, 2007 at 09:01 AM
Whoops, meant to add that if you have historical medical questions that pertain to a fictional situation, even better -- like what sort of illness or injury would keep a heroine stuck in the hero's house, and hero's bed, for at least three weeks, and yet keep her functional for romance. **G**
If you have some ideas, post them here, or send them to me at the email given above, and I'll forward them to Josh.
One topic I'd like Dr. Josh to address would be symptoms for Post Traumatic Stress Disorder as seen in the 19th century -- those lads returning from Waterloo must have experienced that a lot, and sometimes we can attribute some aspects of the "darker" heroes to that, I think.
For example, my next Sarah Gabriel book (TO WED A HIGHLAND BRIDE, Avon, December) involves a hero who was in a Highland regiment at Quatre Bras, the day before Waterloo, when the Scots and the French had a major disastrous clash. He comes away wounded and haunted...so has a touch of PTSD, for sure.... luckily, the heroine shows up to help him deal. :)
Susan Sarah
Posted by: Susan Sarah | Sunday, July 15, 2007 at 09:20 AM
Susan/Sarah, I'm sooooo glad you mentioned PTSD! I'm definitely interested in how this was (or was not) recognized and treated in older times. And what did they call it? Surely the disorder has been in existence since man began fighting in wars, and even it they didn't call it PTSD back then, there had to have been a word or group of words to describe the condition.
I'm having the devil of a time even describing it without lapsing into anachronistic language. I find I can't use the term "shell shocked" because that didn't come into use until WWI, and "thousand yard stare" came after WWII--or was it Vietnam? Right now, my hero calls it "battle-dazed," for lack of a better descriptor.
I can't wait for Dr. Josh to come back!
Posted by: Sherrie Holmes | Sunday, July 15, 2007 at 07:39 PM
Sherrie, I think that it was not until the First World War that 'shell-shock' first *began* to be recognised as a condition that was actually beyond the control of the sufferer, and that is why there is no older word for it; before that, and even during that war, it was generally attributed to a moral failing, namely cowardice. Many boys (and I use the term 'boy' advisedly) who deserted from the British Army during the Great War were later executed as traitors and cowards. There have been cases in this country quite recently of families still trying to get this 'stain' removed from the memory of great- and great-great uncles who died in that way in 1914-18, on precisely the grounds that the psychological effects of combat were not necessarily within the control of these youths, and that they did not deserve to be stigmatised as cowards. This is something that we know now, but was genuinely not known then, less than a century ago.
Of course the actual condition must always have existed, but until after 1918, it would therefore have garnered no sympathy at all in most quarters. There are parallels with the attitudes towards mental illness generally, and with conditions such as alcoholism, which was treated primarily as a moral failing, wholly within the conscious control of the sufferer, until after the middle of the 20th century.
I think that to have characters who are clearly suffering from what we now call post-traumatic stress disorder in, say, the 18th or 19th century is absolutely realistic, but the general response to any manifestation of that disturbance would have been hostile and contemptuous.
A MAN was supposed to be able to endure all the horrors of war unscathed, and any lingering after-effects such as nightmares and flashbacks would have been hidden as far as humanly possible, because they would have been regarded as marks of weakness and shame.
Posted by: AgTigress | Monday, July 16, 2007 at 06:48 AM
OMG! What an awesome and interesting feature! I'm really blown away. Hooray for Doc Josh!
But with the amount of expertise doled out, I'm afraid y'all are going to be in for a shock when y'all see the doctor's bill...
;)
Posted by: Susie | Monday, July 16, 2007 at 09:13 AM
PS: I suspect that the term Post-Traumatic Stress Disorder is very recent - late 1970s, maybe? I certainly never heard of it till about 20 years ago. There was more sympathy for the effects of warfare during and after the Hitler War than there had been in the Great War, but I don't think a specific pyschological disorder had been described and named.
Now the label appears to be applied to the most trivial upsets, and is in danger of becoming seriously devalued.
Posted by: AgTigress | Monday, July 16, 2007 at 09:19 AM
Jo here, late because I was at the RWA conference. Thanks so much, Josh! All fascinating stuff.
Ag Tigress, did Caesar's mother die of the C-section? Cutting out a baby after the mother's death would be possible, I assume.
Jo
Posted by: Jo Beverley | Monday, July 16, 2007 at 09:14 PM
I just read Dr Tatiana's Sex Advice to All Creation. She adds a different angle on Laura's question about rakes.
A rake might be infertile from STIs, but also if he really possessed the awesome recovery time lauded in fiction, he probably had an extremely low sperm count! So pregnancy from a one-time encounter with a rake... pretty unlikely.
The link for my name quotes the passage on animal/human sperm counts.
Posted by: RfP | Tuesday, July 17, 2007 at 11:44 AM
Jo: okay, this will teach me to check my sources before I post!
The statement that has been interpreted as meaning that Julius Caesar was delivered by surgery is in Pliny, and as anyone who has used Pliny knows, his work is a baffling mixture of fact and colourful hearsay. And what he actually seems to say is that the name - Caesar - is etymologically derived from the verb *caedere*, to cut, which would tend to suggest than an *ancestor* of J. Caesar's, rather than the man himself, had been 'cut' from his mother (the cognomen, was, after all, inherited). So far, so confused. Pliny also mentions that Scipio Africanus was born in this way.
The other salient fact is that in Roman law, if a woman died in childbed or close to the time of her confinement, it was required that an attempt should be made to save the infant, in case it was still alive, by extracting it from her body. Soranus, one of the major ancient authorities on obstetrics and gynaecology, evidently does not mention caesarean delivery as an option in cases of difficult labour (I haven't checked that, though).
There is some written evidence that J.Caesar's mother was still alive when he was an adult, and this, together with the fact that many modern authorities ASSUME that nobody would have survived such major surgery in antiquity, and the fact that Pliny is as ambiguous as ever, has led to a large question mark over the story that Caesar was born in this fashion.
However, sweeping assumptions about Greek, Roman and ancient Egyptian medicine are unwise. We tend to be too influenced by the fact that major surgery was so extremely dangerous in Medieval and Early Modern times; the fact that a given procedure was a certain death-sentence in the 14th or even the 17th century does not mean that it necessarily was in the 2nd century AD. In fact, the standards of hygiene were very much higher in Classical times than they were later on. Keeping the body clean was considered highly desirable in Antiquity, and it is not at all likely that a surgical scalpel wielded by a good Roman surgeon would be unwashed. Although this, and the use of wine for cleansing wounds, is a long way from modern antisepsis, it would still have given people a considerably better chance than the sometimes filthy practices of some medieval and early modern practitioners.
Posted by: AgTigress | Tuesday, July 17, 2007 at 12:52 PM
AgTigress -- That's fascinating, and I have heard some of that, but have not seen it put together so lucidly, thank you.
I think these and others surgeries were doable and survivable in the ancient and medieval eras -- there is plenty of evidence that surgeries were attempted in almost every culture, often with a fair amount of care and knowledge. The threat of infection was ever present, certainly, and not very well understood.
I wrote a 14th century historical romance, LADY MIRACLE, in which the heroine was a physician, and the hero basically a field surgeon. She was trained in Bologna, Italy, one of the very few places that that women could receive a medical education at the time, and her teachers were primarily Arabs, or Arabian-taught. The best medical knowledge during the Middle Ages came from the Middle East -- and cleanliness was astutely practiced and advised by physicians trained in that tradition. Those trained in the Western way were less aware of the consequences of dirt on skin, clothing, instruments and environment.
Both traditions used wine rinses for antiseptic, for instance, as AgTigress pointed out, and did necessary surgeries using clean sharp blades and stitching wounds closed with silk, using steel needles. This included C-sections -- I've seen medieval manuscript illustrations of this operation. Though who knows if the mothers survived; without research, I couldn't guess.
The research for that book was fascinating, as I recall, and I've always wanted to return to the topic in another book. I hope to do that someday!
Susan Sarah
Posted by: Susan Sarah | Tuesday, July 17, 2007 at 01:14 PM
Ah, yes - the Arab medics! They were streets ahead of most medieval doctors and surgeons in Christendom, in great part because they had continued and built upon the traditions of the Classical world, whereas the West had tended to reject them as being tainted with paganism.
Herbal knowledge was good in Europe, I think, but that's not enough with surgery.
:-)
Posted by: AgTigress | Tuesday, July 17, 2007 at 01:45 PM
"Of course the actual condition must always have existed, but until after 1918, it would therefore have garnered no sympathy at all in most quarters."
AgTigress, I'm sure you're right. And it makes sense that the term "shell shock" coincided with the dawning awareness of the long term effects of battle fatigue.
I'm wondering how people would react to, say, a Regency soldier not manifesting PTSD symptoms until months after he'd returned home? I wonder if they would even associate it with being related to battle trauma, (unless it was something like recurring nightmares about battle, or extreme agitation every time he hears a noise that sounds like gunfire) Interesting question!
Surely there were ex-soldiers who had nightmares, and whose wives or friends would know they were related to being in battle, and I feel if that were the case, there would be those who were sympathetic and not condemning.
Definitely an interesting subject, and perhaps worthy of a blog some day!
Posted by: Sherrie Holmes | Tuesday, July 17, 2007 at 02:34 PM
Interesting blog--thanks!
Regarding childbirth, there actually were some man-midwives as early as the 16th century when the Chamberlen forceps were invented by a member of that family. Around the middle of the 18th century forceps became more popular and that in part (there were other factors) led to increased popularity of male birth attendants, at least for upper class women.
That was part of the controversy regarding the death of Princess Charlotte in childbed in 1817. Many people blamed Dr Croft, who oversaw her case, and argued that a midwife would have done better. The medical establishment reacted by blaming Croft for not resorting to forceps and this helped lead to increased male involvement in the birth process throughout the 19th century.
Posted by: Elena Greene | Wednesday, July 18, 2007 at 04:13 AM