Anne here, and today I'm diving down another research rabbit-hole — medical treatments in Regency-era England. (And be warned, this blog is a little bit gruesome.)
Whenever I have a character who is injured or falls sick in one of my novels, I research it. I choose the disease or injury that the plot requires and consult helpful friends — I have two doctors, several nurses and a very knowledgable paramedic in my circle, and they're all very good about having their brains picked.
Of course they know how the injury or disease will unfold today, but I'm writing about a time when there were no antibiotics, and even germ theory was barely born. Most doctors in the Regency era simply didn't believe in such nonsense as germs or bacteria. Surgery was performed with no regard for cleanliness, doctors wore filthy coats—often coming directly from the autopsy room to the operating room—with pride.
So researching the treatments that were common in my historical era is fascinating—and horrifying. To my modern eye they read like a torture manual.
For instance if a character caught the 'flu or pneumonia, measles, smallpox, and most kinds of fevers, the common medical practice was to first to bleed them, cutting into the skin (no anaesthetic back then) and draining the blood into a bowl — a pint (half a litre) or more was not uncommon. This was mostly performed by barber-surgeons, not by physicians. Scarification was another method — using a spring-loaded instrument to produce a series of small cuts.
The purpose of this was to "balance the humors". Disease was believed to result from an imbalance in the natural humors, or fluids, of the body—they being blood, black bile, yellow bile and phlegm — a theory dating back to ancient Greek medicine.
By the 19th century, "One British medical text recommended bloodletting for acne, asthma, cancer, cholera, coma, convulsions, diabetes, epilepsy, gangrene, gout, herpes, indigestion, insanity, jaundice, leprosy, ophthalmia, plague, pneumonia, scurvy, smallpox, stroke, tetanus, tuberculosis, and for some one hundred other diseases.
Bloodletting was even used to treat most forms of hemorrhaging such as nosebleed, excessive menstruation, or hemorrhoidal bleeding. Before surgery or at the onset of childbirth, blood was removed to prevent inflammation. Before amputation, it was customary to remove a quantity of blood equal to the amount believed to circulate in the limb that was to be removed." (Source)
In 1799 George Washington died while being treated for a nasty throat infection resulting from severe weather exposure. Within a ten-hour period, more than 5 pints (around two and a half litres) of blood was taken from him. He died.
Louis XIV's oldest son, the Grand Dauphin, grandson (the Duke of Burgundy), and his wife, the Duchess, and their oldest son, the Duke of Brittany, all died within a year and a half because their doctor tried to cure smallpox and measles with bleeding. (Source)
Medicines routinely contained mercury, arsenic and other chemicals we would not dream of using today. Opium was widely used — laudanum (which contains opium) was routinely prescribed. To read more about the contents of the home medicine chest pictured, click on the link,
So widespread was the belief in the benefits of bleeding that even healthy people sometimes had themselves regularly bled as a preventative measure. Blood-letting was “recommended in spring and the beginning of September, its benefits…included sound sleep, toning up of the spirits, calmness, and better sight and hearing.” [Porter, p116, Norton, NY. 1998]
Leeches were also widely used for the same purpose, and they are coming back into medical use today, though not to "balance the humors". Hungry leeches are placed against the patient's skin, where they feed on their blood until sated, and drop off. At the same time they inject a thinning agent into the person's blood, which kept the blood flowing.
Another common treatment was cupping, which also seems to be having a resurgence today in the alternative medicine area. (That's a modern-day photo) Cupping involved the heating of a small class or ceramic cup, then applying it, inverted to the patient's skin. It created a vacuum and broke the small blood vessels under the skin, resulting in bleeding under the skin. It also left livid bruise-like marks on the patients' skin.
Purging was also a standard treatment for all kinds of diseases — influenza, pneumonia, and many more — presumably balancing the black bile and yellow bile humors. They induced vomiting and diarrhea. The most common purgative was Calomel (mercury chloride) and while I have no statistics on the results of such treatment, a common result was the loss of teeth and hair. And often, death. (See above to the link for the contents of that home medicine chest)
Truly, the more I read, the more I wonder how such treatments stayed in use for so long. Bleeding as a treatment for pneumonia was still included in at least one medical textbook as late as 1942. (William Osler’s 14th edition of Principles and Practice of Medicine).
But a friend of mine, a big believer in alternative medicine, suggested that some of these extreme treatments might have stimulated the body's immune system — a bit like giving a non-performing fruit tree a good hard prune to stimulate its fruiting survival response. Who knows? But certainly even the finest and most fashionable doctors of the time persisted with these treatments, so they must have believed they did some good.
However including this kind of thing in novels can provoke a backlash in some readers. When I wrote The Perfect Kiss, the heroine's best friend's father was thought to be dying. After relentless bleeding and purging, the poor man was on his last legs and his daughter was in despair. My heroine sacked the doctor, and let a local wise-woman take over, figuring that at least he would die in some sort of peace.
In fact the man's illness had been suggested by one of my doctor friends, who also described for me the progress it would take and the best treatment for it (with no modern medicine). So of course in my book the man recovered.
But I got several emails and one or two reviews to the effect of "How dare that heroine think she knew better than the doctor! How arrogant!" There was also a lot of skepticism abut the hero's recovery in The Perfect Stranger — another scenario I'd run past a doctor friend.
So I guess research can only take you so far. Readers will always think what they want to think, and trust in doctors, no matter what the century or treatment, is obviously a powerful thing.
Medicine has come a very long way, and I have to say I'm grateful to be living in the 21st century and not in the 19th century. But I wouldn't be surprised if some treatments we think of as routine today will, in the future, be regarded as rather barbarous.
Have you experienced any treatments like these? Can you think of any modern treatments that future people will wince at? Share your thoughts. . .