by Daniel Pool
Apoplexy—A stroke. The victim was struck down suddenly and rendered unconscious, the result sometimes being death. In some cases, recovery was accompanied by paralysis. Apoplexy was—is—associated with violent emotional outbursts, too much exertion, high blood pressure and the like. In The Mill on the Floss Eliot talks of the “sort of remote pity with which a spare long-necked man hears that his plethoric short-necked neighbour is stricken with apoplexy.” At the end of Mansfield Park, Jane Austen tells us of a Dr. Grant, who “had brought on apoplexy and death, by three great institutionary dinners in one week.”
Cholera—Caused by a bacillus that lives in the intestine and is excreted in human waste. In the days when London sewers ran untreated into the Thames, which was London’s water supply, the disease was caught through drinking water. Cholera came from Asia originally and did not affect Europe until the 1830s, when it struck in recurrent epidemics that spread throughout the world, including the United States and South America. The symptoms included nausea, dizziness, vomiting, and diarrhea, followed by cramps and a desperate, burning feeling in the stomach with an overwhelming thirst—followed by death, often within twenty-four hours of the first appearance of any of the symptoms. It hit the poorer areas worst—some saw it as an Establishment plot to kill the poor off.
Consumption—A tuberculosis of the lungs. (There are other varieties.) It was spread through the air or by spitting or by a break in the skin. It could incubate for long periods of time and then erupt into weakness, fatigue, and the “wasting away” that characterized true consumption. The latter stages of the disease were often accompanied by a sudden burst of energy, glittering eyes, and a mania that sometimes produced a frenzied outpouring of creative work and so lent currency to the belief that the disease was somehow associated with artistic productivity or genius. Jane Eyre’s best friend, Helen Burns, dies of the disease at the Lowood School. The illness killed 60,000 people in Britain during the period of 1838–43 alone and ultimately wiped out more Britons in the 1800s than did smallpox, measles, typhus, whooping cough, and scarlet fever all combined.
Croup—A name originally applied to several different kinds of diseases, including diphtheria, with which it was often confused in the early 1800s. It mainly hit children. Croup led to trouble breathing and hoarseness when talking. In Pickwick the medical man Jack Hopkins tells of a child who swallowed enough beads to make him rattle when his father shook him; “he’s got the croup in the wrong place!” exclaims the parent. In severe cases there could be convulsions and death.
Diphtheria—The disease of which Eugene Lydgate ultimately dies at the end of Middlemarch. Not diagnosed accurately and named until the 1820s, it was often confused with croup. It affected children the worst, inflaming the mucous membranes to the point where breathing became extremely difficult and often impossible, causing death. It was transmitted by sneezing.
Dropsy—A symptom of something wrong and not a disease in itself. The root word means “water,” and dropsy meant a swelling of some part of the body with fluid, due to poor circulation, hardening of the arteries or kidney problems, such as, for example, might accompany diabetes or emphysema. “Dropsy!” says Lady Chettam in Middlemarch, of “poor Mrs. Renfrew.” “There is no swelling yet—it is inward. I should say she ought to take drying medicines, shouldn’t you?—or a dry hot-air bath.” Dyspepsia—Indigestion, with symptoms taking various forms. Perhaps more common in an age of bad teeth that made thorough chewing impossible and that often featured considerable overeating, to say nothing of food that was not refrigerated or otherwise well preserved.
Gout—A disease that can be hereditary and was common among the upper-class because of the superabundance of meats and wine they consumed. The basic problem was an excess of uric acid, which caused a swelling in the joints, especially in the foot and the big toes, of considerable painfulness. In Northanger Abbey “Mr. Allen . . . was ordered to Bath for the benefit of a gouty constitution,” where he would have drank or bathed in the waters there, while family and friends socialized—not that “the waters” in themselves were likely to do any good. We are presumably to measure the failure of Lydgate’s idealistic dreams of reforming the medical profession at the end of Middlemarch by the fact that he finished his career treating gout patients.
Palsy—Paralysis. There were various kinds: Parkinson’s disease (shaking palsy), sciatica, muscular dystrophy, the partial paralysis caused by apoplexy, paraplegia, and so forth.
Pleurisy—An inflammation of the pleura, which are two sacs in the chest. Dry pleurisy just produced coughing. In the other kind, gunk seeped into the pleura and you could get a sharp pain in your side or chest. If chronic, the swelling might compress the lungs or other internal machinery and the sufferer could wind up hunched over with spinal curvature and internal organs somewhat rearranged.
Quinsy—The old word for bad tonsillitis. Your throat swelled up and you could get chilled and run a temperature.
Typhoid fever—Often confused with typhus due to somewhat similar symptoms and the difficulty of accurately differentiating it without laboratory tests, the disease was first recognized as different from typhus in the 1820s. Drinking water or eating food contaminated by human waste either directly or by flies or by a human carrier (the infamous “Typhoid Mary” was a cook) brought it on. The disease killed one in four if untreated and could cause delirium and a rash like that caused by typhus. Prince Albert is thought to have died of it.
Typhus—The disease, so Jane Eyre tells us, that laid low forty-five of the eighty girls at the horrible Lowood School. This is not surprising. The illness was spread by body lice and consequently developed in dirty conditions; Napoleon’s army lost thousands upon thousands of men to the disease in the retreat from Russia in 1812. Symptoms included delirium, headaches, a rash and high fever, which usually cleared up unless the disease—in about two weeks’ time—proved fatal. (In 10 to 40 percent of the cases it did.) Mr. Willoughby tells her sister at one point in Sense and Sensibility that he heard “Marianne Dashwood was dying of a putrid fever,” this being another name for the disease.
Yellow fever—A disease of tropical Africa and America that is spread by mosquitoes and was generally of local incidence, e.g., in a port city or ship or jail. The name was derived from the jaundice that accompanied severe cases (mild ones were like flu), which were often accompanied by kidney and liver failure and then death. “Mine a yellow face?” says George Osborne in Vanity Fair. “Stop till you see Dobbin. Why, he had the yellow fever three times, twice at Nassau, and once at St. Kitts.” In Dombey and Son, Joey Bagstock describes how “his elder brother died of yellow Jack in the West Indies.” The disease gained the nickname Joey gives it because of the yellow flag required to be flown by ships that had infected persons on board.
DOCTORS
The next thing I remember is waking up with a feeling as if I had a frightful nightmare, and seeing before me a terrible red glare, crossed with thick black bars . . . someone was handling me, lifting me up and supporting me in a sitting position,” says Jane Eyre, recalling a horrible experience of her childhood. “I scrutinized the face of the gentleman; I knew him; it was Mr. Lloyd, an apothecary, sometimes called in by Mrs. Reed when the servants were ailing; for herself and the children she employed a physician.”
It is a neat little vignette that sums up a good deal about early nineteenth-century English medicine and tells the reader familiar with the social standing of various English medical men what Mrs. Reed thought of Jane Eyre. The rich got the physician, the poor got the apothecary, and—though such a figure was not in the Reeds’ sphere, apparently—both of them might call for, as Mr. Rochester does later on in the novel, a surgeon.
Physicians had the most prestige in 1800. They were called physicians because they only administered drugs, or “physic.” They did not deal with external injuries or perform surgery or set bones or do physical exams, other than of the patient’s pulse and urine. They took detailed case histories and then w
rote out a prescription to be filled by an apothecary. “Professional practice,” as George Eliot dryly observes in Middlemarch, “chiefly consisted in giving a great many drugs.”
Physicians made up only a tiny handful of the doctors practicing in early nineteenth-century England, but they were concentrated in London, where it was perhaps easier to find a substantial patient population of wealth and social standing. To practice as a physician in London you had to be licensed by the Royal College of Physicians. If, in addition, you had gone to Oxford or Cambridge, you could become a Fellow of the College (F.R.C.P.) too, which meant a good deal more status, exemption from unpleasant things like jury duty, and the right to a say in the internal governance of the college. There was no system of medical school training and only a handful of hospitals (in 1851 there were only some 7,500 hospital patients in the United Kingdom out of a population of 18 million). No doubt if there had been any medical schools, many of the physicians would not have been interested in them anyway, because they believed quite firmly that medicine was to be taught largely out of books, and antique ones at that. As late as 1819, the licensing exam given by the Royal College could require the applicant to construe passages from first-century and seventeenth-century medical texts; the fellowship exam took place entirely in Latin.
For to be a physician was to be rather a gentleman (their wives could be presented at court, while those of surgeons could not), and anything that smacked of manual labor—like, for example, cutting people open or doing serious physical exams, was not gentlemanly. Tapping on the chest and the use of the stethoscope were apparently slow to be adopted in British medicine for just that reason.
Next below the physicians in the medical hierarchy were the surgeons. They were the men who cut people open, dealt with fractures, skin diseases, V.D., eye problems—anything, in short, for which a physician could not simply give a prescription. “John is gone for a surgeon,” says the housemaid at Thornfield when Mr. Rochester tumbles from his horse. When Mr. Dombey also falls from a horse, the surgeon is likewise sent for; indeed, accidents involving horses apparently made up a good deal of surgical practice.
From a social point of view the problem with being a surgeon was that the actual work involved was like manual labor; you did, after all, use your hands to treat people and did something with them—unlike the physician—besides just write on a piece of paper. In addition, it had not been so long—1745, in fact—since surgeons had been formally linked with barbers, and what’s more, until 1833 surgeons got the bodies on which they learned their anatomy from graveyards—sometimes by rather unscrupulous means.
Perhaps because of this difference in status the physician was usually addressed as “Dr.,” while the surgeon made do with plain “Mr.” On the other hand, you did not need a license to practice surgery, and it cost less to train as a surgeon than as a physician. The cost of the usual necessary preliminary education at Oxford and Cambridge put physic out of reach for most poor boys. Instead, surgery was learned, like other manual skills, largely by being apprenticed. If you really wanted to find out what was going on in the surgical world, you went to Edinburgh and Paris, as does the reforming Lydgate in Middlemarch.
However, the boundaries between physician and surgeon began to blur as the century wore on. The surgeons tried to make themselves more prestigious by allowing the Royal College of Surgeons in London to create Fellows like the ones the physicians had. At the same time, with scientific discoveries coming thick and fast it was becoming apparent even to the physicians that you now had to study germs and bodies the same way a surgeon did. Hence, the rise of the “general practitioner”—the man who, like Lydgate, “resolved to resist the irrational severance between medical and surgical knowledge,” as Eliot puts it. Such a man, knowledgeable in both physic and surgery, became an increasingly influential figure in the English medical world.
And then there was the apothecary—the man for whom Mrs. Reed sent to attend to Jane Eyre while her own children were cared for by a physician. The apothecary was the lowest man on the medical totem pole. He was originally only supposed to make up prescriptions for the physicians, but in many areas there were no physicians so the apothecary began giving advice, too. This was officially permitted in the eighteenth century—but with the stipulation that he could not charge for the advice, only for the drugs. Like the surgeon, he learned his trade by apprenticing himself to a man with experience. He was selling things over the counter and, hence, “in trade,” which made him hopelessly lacking in social status.
DEATH AND OTHER GRAVE MATTERS
Death—early death—was no stranger to the nineteenth-century English family, and perhaps that is why they loved to weep over the lingering demises of Dickens’s small heroes and heroines. Certainly, they made a big production out of it in every other respect.
In some rural communities the ritual began even before one died, with the ringing of a “passing bell” in the parish church to signal that a member of the community lay on his or her death bed. Characteristically, the bell tolled six times to indicate the passing of a woman, nine (the famous “nine tailors”) to indicate the passing of a man, followed by a peal for each year of the dying person’s life.
When a person died a large funeral was held with everyone dressed in black (unless the deceased were a child or a young, unmarried girl, when the costume was white); mourners received black gloves and black scarfs. Sometimes special mourners carried staves wrapped in black; when he returns for Mrs. Gargery’s funeral, Pip finds at the house “two dismally absurd persons, each ostentatiously exhibiting a crutch done up in a black bandage.” The not atypical hearse used to convey the body of little Paul Dombey in Dombey and Son is described in terms of there appearing at Mr. Dombey’s “four black horses at his door, with feathers on their heads; and feathers tremble on the carriage that they draw.”
In most communities funerals were an important social event, and propriety and due regard for the family’s social standing necessitated that they be done right. “Funerals were always conducted with peculiar propriety in the Dodson family,” George Eliot tells us in The Mill on the Floss. “The hatbands were never of a blue shade, the gloves never split at the thumb, everybody was a mourner who ought to be, and there were always scarfs for the bearers.” Characteristically, the undertaker would provide professional mourners or “mutes” dressed in black to stand about and lend dignity to the affair. “There’s an expression of melancholy in his face, my dear,” says Mr. Sowerberry, the undertaker, to his wife when he takes on Oliver Twist as an apprentice, “which is very interesting. He would make a delightful mute, my love . . . I don’t mean a regular mute to attend grown-up people, my dear, but only for children’s practice. It would be very new to have a mute in proportion.” When the body was actually brought to the gravesite for burial, there was often an additional tolling of the bells—the death knell—to let the parish know of the final laying to rest of the deceased. From the standpoint of the workhouse authorities, this was often considered a luxury; when Fanny Robin is buried in Far from the Madding Crowd, the “Union” refuses to pay the shilling demanded for performing this office.
There were exceptions to the rules governing these matters. “Correctly,” scowls Heathcliff when Hindley Earnshaw dies of drink, “that fool’s body should be buried at the cross-roads, without ceremony of any kind . . . he has spent the night in drinking himself to death deliberately.” Heathcliff’s allusion is to the contemporary statute dealing with self-destruction. If you were a suicide, until 1823 you were required to be buried by law at a crossroads with a stake through your heart, a ceremony actually witnessed by Thomas Hardy’s mother. The stake was to prevent the ghost from walking, and the burial at a crossroads was believed to dilute the evil influence of the deceased by spreading it in four separate directions. Until 1870, all your personal property was forfeit to the Crown, too, and, once the stake business was ended, you were, until 1832, required by law to be buried at night only, between th
e hours of nine and midnight. And, although suicides were thereafter permitted to be buried in a Church of England graveyard, no service could be said over the body.
Once a corpse was buried, there was for many years a decent possibility of premature resurrection. This was because there was no way for surgeons to get cadavers to dissect except by using the bodies of executed criminals and—despite the contemporary enthusiasm for capital punishment—there were never a sufficient number for the purposes of anatomical study. Accordingly, surgeons retained “resurrection men” to obtain suitable material for them at two guineas a cadaver. Decedents’ families were, of course, not enthralled with this practice, and it became the custom for some of them to set watchers or even traps at graveyards to ensure that no one made off with the remains of Uncle Edward in the wee morning hours. The cagy body snatchers struck back—they would hire a superannuated prostitute, who, suitably attired in black, would arrive at the gravesite just after the service concluded, pretending to be a tardy mourner. She would then mentally photograph the layout—including traps, if any—and report to the body men who would then set to work with the information that night to retrieve the corpse. The actual exhumation took only a short time if the resurrection men knew their job. You dug down to where the head was, opened the top part of the casket and drew the body out, thereby causing minimal disruption to the site, and then you removed any graveclothes. Strangely enough the law was not harsh on people having bodies, unexplained, in their possession, but if the bodies had graveclothes on them, the punishment was seven years’ transportation.
