This is the first half of a paper given at the Roehampton Postgraduate Conference, 17 June 2010.
What were the main health problems in the 18th century? The plague was no longer an issue (although there were occasional outbreaks even as late as the 20th century in the tenements of Glasgow). Smallpox and typhus were almost as bad, though, and there were also high death tolls from measles, scarlatina, diphtheria and tuberculosis, then called consumption. Particularly among the poor rickets and whooping cough were both dangerous, as was diarrhoea in infants. Skin and eye diseases and parasitic infections were common, as were rheumatism, ulcers, kidney and bladder stones, and bad teeth, which led to internal infections. Recipe books include remedies for everyday complaints such as coughs and colds, stomach upsets and headaches, as well as spots, warts and dandruff, cuts, bruises and burns.
When we’re ill in the 21st century, our first port of call is usually some kind of self-medication, normally obtained from the chemist, then our GP. The situation in the 18th century was actually quite similar, although then there was no state provision of healthcare and it was up to you what kind of treatment you chose, if indeed you could afford any. A Quaker called John Bellers, who advocated the establishment of hospitals to treat the poor and train doctors, wrote in his Essay Toward the Improvement of Physick in 1714, ‘A hundred thousand, Die Yearly of Curable Diseases; for want of Timely Advice, and Suitable Medicines’, mainly as a result of their poverty.
Given the prevalence of illnesses of all kinds, the predominant concern was to avoid being ill in the first place. In medical historian Roy Porter’s apt phrase, ‘People took care before they took physic.’ The proverb ‘Prevention is better than cure’ dates back at least to the seventeenth century and there was a growing tradition of preventive medicine to avoid what might be called dis-ease, including attention to diet, exercise and a healthy environment, extending to fads for balneology or cold-water therapy and vegetarianism, the latter said to include Isaac Newton and Alexander Pope among its adherents. Teetotalism was also in vogue, as in this extract from a letter from Sarah, Duchess of Marlborough in the 1730s – although you’ll note that her advice is moderated in her own case.
Drinking nothing but good water … is what nature first designed, and I really believe it is best for one’s health, and there can be no doubt that it would be for the advantage of young people to drink very little ale, beer or wine … people’s living so much longer formerly than they do now proceed[s] from their drinking water. I am convinced that the less wine or malt drink young people take, it is much the better. But for the people of my age that have been used to drink wine, one can only lessen it by mixing it with water.
However, if ill health did strike the first resort was a homemade remedy, as in this recipe for a salve:
A Very Good Salve for a Burn or Scald
Take 2 penniworth of oyle a penniworth of bees wax & allmost a quarter of a pound of fresh butter 2 good handfull of yellow mos which come of an Ash tree & boyle it together a Little & soe straine out the mos so keep it for your use, if you have none of this redy, this mos boyled in Cream is very good or vinegar mixed with oyle.
In the previous century Nicholas Culpeper in his Physicall Directory had said, ‘All the nation are already physicians. If you ail anything, every one you meet, whether a man or woman, will prescribe you a medicine for it.’ A collection of medical recipes, handwritten, haphazard and often passed from one generation to the next, was a vital part of a household’s possessions. To quote Roy Porter again, ‘A person ignorant of self-care would have been equivalent to a woman unable to bake, stitch and manage the servants, or a gentleman who could not ride.’ This kind of medication was particularly important outside the towns in an era when the nearest physician could be a few hours’ ride away.
As the century progressed remedies would more and more often be obtained from an apothecary or indeed a quack peddling nostrums from door to door. You could even buy a fully stocked medicine chest. These contained up to 100 different remedies, including ipecacuanha which is an emetic, and laudanum for killing pain – and for its general feel-good properties. There was also a handy instruction book telling you what to take when.
If self-medication failed or the illness was serious and you could afford the services of a professional, you would consult one of three kinds of medical practitioner, physicians, surgeons and apothecaries, in descending professional status.
- Physicians were university educated, usually attended on their patients (rather than the other way round) and provided a diagnosis, although they had no real cures. Top physicians were part of the elite and tended to concentrate in London, where much of fashionable society congregated.
- Surgeons had served an apprenticeship and had the role of treating external problems such as wounds and boils, setting bones and doing simple operations. It wasn’t until 1745 that the Barber-Surgeons Company of London split into two branches.
- Theoretically, the apothecaries dispensed the medicines which the physicians had prescribed. In practice, in small towns there was one practitioner who took on all three roles, often termed a surgeon-apothecary, the forerunner of the modern GP.
The first commercial Medical Register, published in 1779, listed about 3000 practitioners of all types, which is reckoned to be an understatement.
However, you didn’t go to see a doctor to find out what was wrong with you, but frequently to confirm your own diagnosis, obtained either through experience, guesswork or consultation of one of the many printed books of medical self-help, such as the Methodist John Wesley’s Primitive Physick or William Buchan’s Domestic Medicine. And especially since there were no miracle cures, in fact very few cures at all, the doctor’s advice was often ignored. Even among those who consulted physicians there was a good degree of scepticism, as in this letter from Mrs Elizabeth Montagu to the Duchess of Portland in 1741:
I have swallowed the weight of an apothecary in medicine; all the tribe of pills, beginning from the mighty bolus, powders of all tastes, electuaries of all consistencies, juleps of all kinds; and what I am the better, except more patient and less credulous, I don’t know; I have learnt to bear my infirmities, and not to trust to physicians for the curing them.
Multiple opinions were frequently sought. The patient, as an active consumer, was the one in charge, not the doctor as tends to be the case today.
The 18th century has often been described as the first true consumer society, in which more people had more disposable income than ever before, and medicine was a commercial commodity like any other. In addition, the wider availability of imported and manufactured goods meant that functions that had traditionally been carried out within the household were starting to be subcontracted to outside suppliers or bought ready made. Off-the-shelf patent medicines were something new and exciting to the conspicuously-consuming, luxury-loving Georgians, and they had a huge appetite for medicaments of all kinds.
One of the most ubiquitous of the patent medicines was Dr James’s Powder, a mixture of the emetic metallic antimony and phosphate of lime that was as frequently used in the 18th century as aspirin is today. The eponymous Dr James was a member of the College of Physicians and patented his powder in 1746. Its main effect seems to have been to promote sweating, but it also acted as a depressant and George III’s insanity was sometimes attributed to his copious use of this medicine.
The sweeping popularity of these widely marketed ready-made remedies is also a reflection of the way faith in science, however unscientific it was, was starting to replace religion, as described by the acerbic Lady Mary Wortley Montagu, she of smallpox inoculation fame, in 1748:
The English are easier than any other nation infatuated by the prospect of universal medicines, nor is there any country in the world where the doctors raise such immense fortunes. I attribute it to the fund of credulity which is in all mankind. We have no longer faith in miracles and relics, and therefore with the same fury run after recipes and physicians. The same money which three hundred years ago was given for the health of the soul is now given for the health of the body, and by the same sort of people – women and half-witted men.
Note it’s the men who are half-witted.
Even the most powerful remedies had little true efficacy and many people lived with the constant presence of some degree of pain or disability. In contemporary letters and diaries there are frequent mentions of conditions that required a considerable amount of stoicism. Eliza Pierce, for example, writes:
my Aunt is rather worse then better for the Rheumatism torments her so all Night that she scarce Sleeps a Wink from the time she goes to bed till she rises.
From Elizabeth Montagu (who I found out today is a distant relative of mine) we have:
my eyes are but indifferent, and seem to want something to mend them; to alter nature is easier much than to mend it, so I believe I may as well be quiet.
And the Duchess of Malborough comments:
Last night I was terribly tormented with my itching [from the scurvy], and I am now sore again … and when the smarting was ceased, I was not so well in my stomach. But I am sure whatever I do, I can never be well.
There is a modern-day psychological concept called hedonic adaptation or the hedonic treadmill, which may help to explain why what we would regard as a limited degree of wellbeing did not seem to have a drastic effect on 18th-century people’s overall happiness. The theory goes that we adapt to both good and bad situations, changing our expectations accordingly, and that our level of happiness remains about the same. There is thus no clear correlation between health and wellbeing. What interests me about this is that it runs counter to our notion that what we see as progress in medical terms, to do with improvements in prevention, diagnosis and treatment, has necessarily led to an increase in the sum of human happiness. Maybe we’ve just replaced one form of dis-ease with another, for example the pressures of modern living.