Jane Austen's England

by Roy Adkins,Lesley Adkins

  A few days later, he was convinced that his remedy had worked: ‘He is got pure and well since I gave him a dose of rhubarb.’8

  Woodforde also habitually used rhubarb for all manner of ailments: ‘I was taken very ill this afternoon with a violent pain in my right ear and it continued so till I went to bed. I took a good dose of rhubarb.’9 The next day he felt unwell:

  I got up very ill this morning about 8 o’clock, having had very little sleep all the night, owing to the pain in my ear which was much worse in the night and broke and a good deal of blood only came away. The pain continued still very bad all the morning, tho’ not quite so bad as before. It made me very uneasy abt it. A throbbing pain in my ear continued till I went to bed. I put a rosted onion in my ear going to bed to night.10

  An onion roasted in embers was an old herbal remedy, one recommended by Culpeper’s Complete Herbal: ‘The juice of Onions…takes away all blemishes, spots and marks in the skin: and dropped in the ears eases the pains and noise of them.’11 Woodforde also tested various cures on his niece Nancy and on his servants. One servant was probably suffering from malaria, which was then common in England: ‘My boy Jack [Wharton] had another touch of the ague about noon. I gave him a dram of gin at the beginning of the fit and pushed him headlong into one of my ponds and ordered him to bed immediately and he was better after it – and had nothing of the cold fit after, but was very hot.’12

  If all else failed, an apothecary, a surgeon or a physician might be consulted. Apothecaries (druggists) were allowed to prescribe, prepare and sell substances for medicinal purposes, but many of these were little better than the strange concoctions sold by itinerant quacks. Such professional treatment often cost a great deal and may even have caused more harm than the folklore remedies. Many in the medical profession were not highly regarded, and as he set out on an excursion from London in 1781, John Byng was hoping to remain healthy so that he could avoid the country doctors: ‘We are tolerably well accompany’d with touring, road books, maps &c., and I am also stock’d with James’s powder; so shou’d a fever overtake me, I will hope that by taking some of his doses and being well wrap’t up in blankets I shall chase away sickness, without consulting the medical country blockheads, who kill, or cure, by chance.’13 In a diary entry in January 1800, Holland was of a similar opinion, saying of his local surgeon from Nether Stowey: ‘met Mr. Forbes on foot going to kill a few patients’.14

  Most surgeons were reasonably educated, and in their early to mid-teens they were apprenticed from three to seven years to surgeons or surgeon-apothecaries. At the end of their apprenticeship some continued practising without formal qualifications, while others were examined in London so that they could become members of the Company of Surgeons, a professional body formed when surgeons broke away from barber-surgeons in 1745.15 Many surgeons had medical degrees from universities such as Edinburgh, Glasgow and Leiden. London had no university, but it was an important medical centre where students were taught in private anatomy schools and by walking the wards at the leading charitable hospitals, practising their art on the poor.

  Holland’s acquaintance Penelope Benwell (later Hind) was distressed by the situation of the poor: ‘In sickness they must labour on till they sink into their beds; when there they have often neither medicine or food to assist them.’16 Catherine Hutton was equally concerned about the plight of the poor, and when staying at Blackpool in August 1788, she heard about the ‘Whitworth Doctors’, James and John Taylor, from the village of Whitworth near Rochdale: ‘Surgery is practised in a curious manner by some individuals [two brothers] of the name of Taylor…They were originally farriers [treating horse ailments], and, by a transition easy in the country, they became bonesetters and surgeons.’17

  Although untrained, the Taylors were highly successful and widely consulted by poor and royalty alike, and their business was passed down through the family.18 ‘No patient is visited at his lodgings,’ Catherine learned, ‘if he is able to attend at the house of his doctors; and there, no attention is paid to rank or circumstances, the first comer being first served.’19 The most famous of the two brothers was John Taylor, and Catherine related that the eminent Manchester physician Charles White ‘said to Dr. John…“Well, how many patients have you killed this year?” “It matters not how many,” replied John; “I kill them cheaper than you.”’20 Catherine added: ‘Cheap, indeed, does this doctor kill or cure; his terms to those who attend at his house being only two shillings a week, including operations, applications, and medicines.’21

  Even though surgery was developing into a skilled profession, physicians were higher in status because they did not undertake manual work. Instead, they examined patients and prescribed appropriate treatments and medication, largely for internal ailments. In order to become a fellow of the Royal College of Physicians, it was necessary to belong to the Church of England and to be a graduate of Cambridge or Oxford university (where practical training was of no consequence). Graduates of other universities were admitted only as licentiates. For medical training, physicians went to universities like Leiden or Edinburgh or into hospitals and the private anatomy schools.

  The Royal Navy employed surgeons, not physicians, on board their warships, because they needed medical men with practical skills. These surgeons were also expected to act as apothecaries and physicians. The medical men employed in the army varied, with some highly trained and experienced surgeons and physicians, while others had a limited education. There was no government regulation of medicine, and especially outside London, a medical man would often practise as a combined apothecary, surgeon and physician, rather like the Whitworth Doctors. The Apothecaries Act of 1815 introduced some regulation, after which such general practitioners were obliged to be qualified apothecaries.22

  Some effective medical treatments were beginning to be developed, the most notable of which was a method of preventing smallpox – a frightening, virulent disease that affected all classes. It had a high mortality rate (up to 60 per cent) and left survivors with disfiguring scars and sometimes even blindness. Inoculation (or variolation) had begun in Britain from 1721, using the technique of cutting a patient’s arm or leg and introducing infected pus from someone already ill with smallpox. Around 2 per cent of those inoculated died. Parson Woodforde made several references to smallpox and inoculation in his diary, as in November 1776:

  Dr. Thorne of Mattishall came to my house and inoculated my servants, Ben Legate and little Jack Warton…Ben is about 25 years old, Jack about 9. The Dr. took out of his pocket a small [container] where the matter was…They then each stripped, and the Dr. taking a small bit of the cotton thread saturated with matter between his left hand finger and thumb, with the launcet in his other hand, he then dipt the point of the launcet in the cotton thread, and with the point of the launcet made two dotts…about two inches apart in each of their arms, dipping now and then his launcet in water and then with the cotton thread, scarce to be felt or to draw blood, they then stood with their arms exposed to the cold air for about 3 minutes, till almost dried up. The matter took effect almost instantaneously…No plaister or any thing else whatever to be put to their arms afterwards.23

  Inoculation was too expensive for the poor, but Woodforde paid for these servants because smallpox was ravaging the parish at the time. Five days later, he settled Dr Thorne’s bill:

  My inoculating folks brave [well]. Ben complained of a pain under his arms to day. Jack complained of nothing at all…Dr. Thorne who inoculated my servants dined and spent the afternoon with us…I paid the Dr. for inoculating our people 0.10.6. I gave him also towards inoculating a poor family 0.10.6…The Doctor’s price for inoculating a single person is only 0.5.3…Ben’s arms look much inflamed, much forwarder than the boy’s, Jack complained of a pain under his arms to night.24

  Smallpox remained a killer despite inoculation, but the situation was transformed when Edward Jenner developed vaccination. After serving an apprenticeship to a surgeon in Gloucestershire,
Jenner had studied at St George’s Hospital in London and then returned home in 1772, where he made the first scientific investigation into cowpox (vaccinia). He experimented by inoculating patients with cowpox to offer some protection against smallpox, calling this procedure vaccination. By 1800 vaccination was increasingly employed, making smallpox the first infectious disease to be curbed in this manner. Even so, medical men could be backward, and in 1809 Holland was unhappy that Jenner’s vaccination was not being used:

  I went to Dodington in the morning very few at church as there is an innoculation for the small pox which shuts up Mr. Farthing and one or two families more. But now the cow pox [vaccination] is so much approved of and so much safer I do not think it right in Mr. Bennet recommending innoculation for the small pox, which is infectious and if one family begins it obliges others to adopt the same measure whether they approve of it or not.25

  Despite new medical discoveries, there was much to dread from other viral and bacterial diseases and assorted afflictions, including consumption (tuberculosis), gonorrhoea, syphilis, malaria, cholera, typhus, scarlet fever, measles, rabies from dog bites, cancer and influenza. ‘Very sickly in London in the influenza. Very few escape,’ Woodforde remarked during a visit to the capital in June 1782.26 Luckily, he kept healthy, since an influenza pandemic had recently spread across Europe from Asia, and deaths in London reached a peak during his visit.27 In November 1807 Nelly Weeton expressed concern in a letter to her brother about another killer, whooping cough (also then called ‘chincough’): ‘How are your little ones? Do they escape the hooping cough? Great numbers have it here, and it is very fatal. Many die of it; several children have gone blind with it, and some thrown into fits. My cousin Latham’s two youngest boys have it; the youngest is very ill.’28

  In an age of poor food, scant hygiene and no refrigeration, other commonplace disorders included intestinal worms and food poisoning. Gout was a problem that often afflicted the better-off who consumed too much alcohol and meat, causing a crippling inflammation of the joints of the extremities, especially the big toe. Holland wryly recorded that ‘Old Weymouth our neighbour I called upon to see his foot which is much swelled. I think it is the gout. I congratulated him on becoming a gentleman, as the gout never attacked any but gentlemen. He shook his head and said that he could not be a gentleman without money.’29

  Woodforde was first aware that he himself had gout in April 1790: ‘When I got up this morning, perceived a violent pain in my right great toe on my foot about the middle joint and swelled a great deal indeed, could scarce get on my slipper, and then could not keep him on long, but get into a pair of shoes. I should think it must be the gout. This is the first attack I ever met with before now.’30 Gout becomes a recurring topic of his subsequent diary entries, as in mid-January 1795: ‘Got up this morning very bad indeed in the gout in my right foot, could scarce bare to put him on the ground, and so it continued the whole day and night, not free one minute from violent pain…I had my bed warmed to night and a fire in my bed-room. I never was attacked so severe before in my life. Obliged to put on my great shoe, lined with flannel.’31 Like many at the time, he thought gout floated around the body: ‘The gout, tho’ not very painful, but continually flying about my constitution makes me very weak both in body and mind &c.’32 His constant dosing with rhubarb would actually have exacerbated his condition.

  For those with money, it was fashionable to take the waters at spas, to maintain good health or to cure disease, sometimes as a last resort. Spas were situated where a good supply of mineral water could be exploited, such as at Bath, Cheltenham, Leamington, Hotwells in Bristol, Buxton and Harrogate. The water was not simply drunk. Communal baths, filled with warm or hot water from the springs, were considered especially effective for those with skin diseases and running sores. Such collective bathing was a novelty for most people, who otherwise never bathed in their lives, in the same way that sea bathing became popular for reasons of health.

  It was still widely believed that health problems were caused by an imbalance of the four humours of the body – blood, phlegm, black bile (melancholy) and yellow bile (choler). Dr Radcliffe’s Elixir claimed to cure this problem: ‘FOR a general alterative Medicine this Elixir has stood unrivalled for more than Eighty Years, and the Public cannot have recourse to a more efficacious Remedy, as a Purifier of the Blood from all Humours, whether contracted by too free Living, or from Surfeits, Jaundice, Scurvy, or Humours after the Measles, or Small-Pox, &c.’33 For good measure, the advertisement added: ‘For all Obstructions in the Bowels and for the Cure of Worms in Children or Adults, it will be found equally serviceable.’34

  Medical treatments to ensure the proper balance of these humours concentrated on purging and bleeding, and such treatments mainly comprised bloodletting, cupping (blistering), the application of leeches, emetics to cause vomiting and clysters (enemas). When his maid Nanny was ill, Woodforde ‘gave her a vomit [emetic] about noon and it kept down near an hour and then it operated very briskly indeed, brought off a great quantity of nasty green thick stuff from her stomach. She was soon after better…in the evening gave her a small dose of rhubarb with a little ginger.’35

  Bloodletting was the staple work of surgeons, though it was more likely to weaken sick patients and give them blood poisoning. Cupping involved applying a warmed glass to the skin, which created a vacuum as it cooled and caused a blister, or else it could be used to extract pus from a boil. The skin might be incised or scarified beforehand so that blood was drawn. Woodforde certainly believed in blistering: ‘This morning taken very ill, could scarce get down stairs. Sent for Mr. Thorne, who ordered me immediately to bed…In the night had a blister put between my shoulders which discharged very much indeed in the night and which made me soon better.’36

  Cupping was a treatment to which Jane Austen’s father at Bath was subjected, as she described in a letter to her brother Francis: ‘Our dear Father…was taken ill on Saturday morning, exactly in the same way as heretofore, an oppression in the head, with fever, violent tremulousness, and the greatest degree of feebleness. The same remedy of cupping, which had before been so successful, was immediately applied to, but without such happy effects. The attack was more violent, and at first he seemed scarcely at all relieved by the operation. Towards the evening however he got better.’37 Two days later, on 21 January 1805, he died.

  The most common method of taking blood was to cut the vein of an arm with a lancet or fleam, and Catherine Hutton was told that the Whitworth Doctors undertook bloodletting in a workshop which patients visited: ‘on Sundays, the days they bleed gratuitously, the patients are arranged around the room; one operator opens the veins, another holds the basins, and a third follows and binds the arms’.38 Applying live bloodsucking leeches, obtained from ponds and streams, did a similar job. When walking in the Lake District in October 1800, Dorothy Wordsworth and her brother William encountered an elderly man, bent almost double. ‘His trade was to gather leeches,’ she remarked, ‘but now leeches were scarce, and he had not strength for it. He lived by begging, and was making his way to Carlisle…He said leeches were very scarce…He supposed it owing to their being much sought after, that they did not breed fast, and were of slow growth. Leeches were formerly 2s 6d per 100; they are now 30s.’39 Based on this chance meeting, William wrote a poem, ‘The Leech-Gatherer’, with the lines:

  He with a smile did then his words repeat;

  And said that, gathering leeches, far and wide

  He travelled; stirring thus about his feet

  The waters of the pools where they abide.

  ‘Once I could meet with them on every side;

  But they have dwindled long by slow decay;

  Yet still I persevere, and find them where I may.’40

  When Holland was at the hamlet of Rose Ash in Devon in September 1803, he suffered such severe pain in his face that he requested Mr Bryan from nearby South Molton to call: ‘He soon perceived what was the matter with me, a perfectl
y nervous case he said…Said that he would send over Mr Ling [his assistant] with leeches and give me Dover’s powders.’41 Mr Ling called later that evening, but Holland found the treatment with leeches distasteful: ‘He did come at last, we dined and after dinner I had leeches put to my cheek, or rather lip under the nose. It is a tedious, unpleasant operation and I hope it will do me good. It is over after two or three hours.’42

  Similar notions of medicine were applied to animals, and bloodletting was commonly carried out with the aim of curing and preventing illness. In mid-May 1779, Woodforde noted: ‘Bled my three horses this morning – 2 quarts each.’43 Treatises were published to help farmers and others keep animals healthy, but Woodforde’s methods were contrary to the advice of a manual published five years earlier: ‘It is safer to take a gallon at five or six bleedings, than two quarts at once, for it robs him of two [too] much animal spirits. Always bleed a horse in a pint or quart pot, for when you bleed at random upon the ground, you never can know what quantity you take, nor what quality his blood is. From such violent methods used with ignorance, proceed the death of a great number of horses.’44

  On a post-chaise trip in Sussex in July 1811, Louis Simond encountered similar ignorance:

  we perceived that one of the horses was streaming with blood about the neck; he had been put in harness too soon after a bleeding. The post-boy stopped on the road, and wept through the operation of fresh twisting the skin, tying, and pinning,—very clumsy and painful,—but unavoidable: he agreed with me that it was very wrong to work the horses too soon after bleeding, for, said he, this is the third time we have had in this situation, and the others died of a mortification, and they cost L.37 [£37] a-piece!45