Music in Film: Pride and Prejudice 1995

This post was first published on May 2, 2016 on Austen Variations.

Music and Jane Austen go together like…well, a poverty stricken but lovely young lady and a wealthy and handsome young man in search of a bride (even if he doesn’t know it yet)…

Jane Austen’s continued popularity almost 200 years after her death is a testament to the universal themes found in her books, which are as relevant today as they were in Regency England.  One of the devices she uses to round out and illustrate her characters is music, but as is typical for our Jane, she does not tell us what songs, or what composers her characters favor, but leaves us to our imaginations to decide what is played. Enter the movie industry! 

Austen’s works have been popular since their publication, but I believe that one of the reasons they are so immensely popular in the past 25 years is because the movie industry has made the characters so much more real to modern audiences. It is no longer necessary to guess what a well-dressed gentleman would look like in the stories or what a Regency ball gown looks like, and the most recent films (the past 25 years) have made great efforts to not only have the costumes reflect the the personalities of the characters and their place in society, but to also be correct for the era being filmed. Movie-goers and readers have become much more demanding of historically correct appearance, attitudes and even music in their entertainment and a jarring detail may bump the audience out of the world of the story when they should be immersed in it.

In Pride and Prejudice, Caroline Bingley praises the musical prowess of Mr. Darcy’s sister in order to emphasize the lack of ability of the Bennet sisters, who had a haphazard education at best.  Their disparagement of Elizabeth Bennet’s singing and playing skill, however, does not prevent Mr. Darcy from enjoying her natural and unaffected performance, in contrast to her sister Mary’s weak voice and conceited air while playing. When they meet again in Kent, Elizabeth’s playing and singing for Colonel Fitzwilliam draw Darcy inexorably to her side and he is entranced, against his will, by her and her playful nature.

Jennifer Ehle and Colin Firth in Andrew Davies' Pride and Prejudice, 1995

Jennifer Ehle and Colin Firth in Andrew Davies’ Pride and Prejudice, 1995

The 1995 BBC/A&E collaboration to film Pride and Prejudice for a mini-series developed by Andrew Davies improved on the previous film versions with its color, cinematography, and costuming. The “Making of Pride and Prejudice” book is an interesting read for avid fans as it goes through how each part of the film was approached. One area they didn’t cover, however, was music. The original score was written by and works very well with the characters. Who can forget Lady Catherine’s ominous theme as Elizabeth meets her at Rosing Park and when the opinionated lady appears without warning at Longbourn to chastise Elizabeth about the rumours of her impending marriage to her nephew, Mr. Darcy?!

In addition to the musical score by Carl Davis, which beautifully underlines the story and the characters of the story, there are three pieces of brief but significant Baroque music inserted into the story to help flesh out the characters. Early in the film, we hear Mary Bennet practicing Beethoven’s Six Variations from the opera La Molinara. We first hear her playing the simple base melody and later stumbling over the second variation with an awkward and irregular tempo which illustrates her determination to become “accomplished,” with a great deal of practice, but little talent, which became an embarrassment to her family later.

One of my favorite scenes in the film is when music is used to brilliant effect at the Netherfield ball, when Darcy and Elizabeth dance for the first time. She has sworn that she will never dance with Mr. Darcy even if he asked her, which she considered unlikely in the extreme, but courtesy demands that she accept him when that moment actually arrives. The music for their dance starts with the rather ominous introduction and with grim expressions on Darcy and Elizabeth’s faces as they rigidly start the dance in perfect formation. The dance tune then softens and continues as the cameras zoom closer and they finally start to converse during the dance.  The highly stylized English Country Dance is contrasted with Elizabeth’s pert comments when she finally decides that it would be much more amusing to annoy Mr. Darcy by forcing him to talk than it would be to go through the entire dance silently. Unfortunately, the name of this lovely dance piece is Mr. Beveridge’s Maggot…yeah, I know.

Also at the Netherfield, Ball Mary Bennet forces her way to the pianoforte (the only way she can get attention) when Bingley suggests that some of the ladies play during supper and she plays and sings a morbid song set to Handel’s Largo, “Slumber, Dear Maid”.  Her off key, affected singing makes her more sensible sisters cringe as everyone at the ball laughs and stares at the only plain, and most ridiculous Bennet girl. To make matters worse, Mr. Bennet interrupts Mary as she plunges into a second song, telling her to “Let the other young ladies have time to exhibit.” Mary’s shrill tone while singing is accented with the howling of the dogs and whinnying of the horses outside Netherfield as she sings. When Mary leaves the instrument in embarrassment, Bingley’s sister, Mrs. Hurst, promptly sits down and plays Mozart’s Rondo alla Turca very quickly and competently, and looks up with a smirk at the Bennets when she finishes to make sure they recognize her superiority.

This one-up-(wo)man-ship between the Bingley sisters and the Bennet sisters illustrate an important point between the two families. The Bingleys are now gentry, but their grandfather was a tradesman who earned a great deal of money, which has allowed his grandchildren to go to the finest school and to have all the accoutrements of the gentry.  Because of their background in trade, however, they are clutching at the hem of the true gentry and their lack of background makes them want to be more gentrified than those who has been gentry for generations, so that they can climb the social ladder. They try to separate themselves as much as they can from their antecedents and even mock Sir William Lucas for “having a very good sort of shop.” If things go well for the Bingley sisters, their children will be high enough and far enough away from the shop to sit comfortably there.

The Piano Lesson by Edmund Blair Leighton

The Piano Lesson by Edmund Blair Leighton

On the other hand, the Bennets are actually in the gentry because of Mr. Bennet’s background, but are teetering towards a downward fall. His family has generations of country gentry, as well as being prosperous enough landholders to make it unnecessary that they work (the definition of gentry, although ministers and officers, the haven of younger sons, are exempt from this rule). Mrs. Bennet comes from the tradesman class and a woman’s class is determined when she marries by that of her husband. If Mrs. Bennet had been quiet, dignified, and refined like Mrs. Gardiner there would have been no question about the family’s status in society. In addition to Mrs. Bennet’s defects, their close association with her sister, Mrs. Philips, who was as low class in her behavior as her sister (if not as hysterical and hypochondriacal). Mr. Philips, a solicitor, does not have the cachet of a barrister or a judge.

The Lucas’s are also on the fringe of society. Sir William was a tolerably well-to-do tradesman who won a knighthood via “an address to the king” when he was mayor of Meryton. This elevation gave him “a disgust to his business” and he settled at Lucas Lodge to enjoy his elevated rank. Sir William is friendly and courteous, but very foolish. His family behaves reasonably well for their place in society, but the knighthood will die with Sir William and his family will inevitably sink in consequence, unless his daughters can marry up, which is unlikely as they are good-hearted, but plain.

Mary Bennet’s musical skills are again contrasted with Elizabeth later in the film, when Elizabeth plays the pianoforte for Colonel Fitzwilliam. She plays Mozart’s Sonata in A Major, not much better than Mary played Beethoven early in the film, but Elizabeth’s unaffected playing and lack of arrogance (such as that of Lady Catherine when she talks about how superior her playing would be, if she had ever learnt) give both Darcy and the Colonel a pleasant evening though not playing “half so well” as her sister Mary had at Lucas Lodge.Jane Austen's World


  1. If you would like to play some of Carl Davis’ score from Pride and Prejudice you may buy the piano music from this, as well as some from Sense and Sensibility (by Patrick Doyle), Emma (by Rachel Portman), and Persuasion (by Jeremy Sams) in the music book, Jane Austen’s World. This book includes the beautiful “My Father’s Favourite” from Emma Thompson’s Sense and Sensibility, but that’s another story!
  2.  One last word: The instruments used in the orchestra at the   Netherfield ball were all period-style instruments. The violins have no chin or shoulder rests, and the bows are longer than what is used now requiring.  If any of you have ever tried to play the violin or viola without a chin and shoulder rest, you will know that they must all have serious neck problems after an evening of play!!

Meet My Main Character Game

Author photo A 150X157I am participating in the Meet My Main Character game sponsored by the English Historical Fiction blog.  Thanks to Diana Birchall for tagging me for the game!  You can meet Diana’s main character in her current work in progress here:

Find other game participants on the English Historical Fiction Authors Facebook page:

Here are my answers to the game questions:

regency_1818 woman with ballet slippers1)   What is the name of your character? Is she historical or fictional?

This book is a continuation of Jane Austen’s “Pride and Prejudice” and continues after my previous book, “Mr. Darcy’s Little Sister.” We pick up the story when Caroline Bingley marries the Comte de Tournay, an impoverished French nobleman who escaped the French Revolution with his family as a young adult. Both of these characters are fictional and are a collision between Austen’s “Pride and Prejudice” and Baroness Orczy’s “The Scarlet Pimpernel.”

2)   When and where is the story set?

The story is set in 1814 England, primarily at the Comte de Tournay’s manor, to which he and his new wife retire after their wedding.

3)   What should we know about her?

Caroline is a snob, as in Austen’s book, but is able to suppress her sarcastic comments in order to get what she wants.

Portrait-of-Baron-Joseph-Vialetes-de-Mortarieu4)   What is the main conflict? What messes up her life?

Caroline has married the Comte to associate herself with his aristocratic background and show up Fitzwilliam Darcy, who rejected her in “Pride and Prejudice.” The count has married her with his eyes open to her abrasive personality because he wants her dowry to enlarge his land holdings and he hopes that she will give him an heir. He has had two previous wives who were of the English nobility and they were both sickly and died at a young age. He has decided that he must be less particular about good breeding in the hope that Caroline’s sturdy good health will enable them to have healthy children…particularly a healthy son.

The main conflict in this story is the opposing goals of the two partners: she wants to show off her refined French nobleman in London society, and he wants to spend her dowry on land and improve the inheritance for his future heir. In addition, the count makes a bet with his best friend that he can tame Caroline and turn her into a proper wife.  When she inadvertently learns of his wager she is furious…until she comes up with a better way to punish him than hiding in her room…

5)   What is the personal goal of the character?

Caroline has several goals, as already mentioned: she wants to put herself on a higher social level than Mr. Darcy to show that she doesn’t care that he rejected her advances, and she wants to show him off in London society.

6)   Is there a working title for this book and can we read more about it?

The title is “Miss Bingley’s Pas de Deux.” The pas de deux is a ballet form in which a female and a male dancer do a dancing duet- both together and in separate virtuosic performances, with a finale where they come together again and return to some of the themes from the earlier parts. The pair begins and ends together but in between they pursue their individual themes. In my pas de deux the two participants not only have their separate parts, but they act in opposition to each other. I hope to share more about it on Austen Variations blog!

7)   When can we expect it to be published?

Hmmmmm, that is a good question. I’m afraid this is not a WIP, but a WILP (a Work in Little Progress)! The demands of my “real job” have taken up most of my time in the past two years and “Pas de Deux” has been the victim of my distraction and exhaustion. I am hoping that I can finish it this year and release it in 2015.

1001 English Nights: Part the third

1001 English Nights is a group vignette involving Henry Tilney, minister, man of many bot mots and opinions on ladies’ dress, and his young wife, the former Catherine Morland, heroine of Jane Austen’s Northanger Abbery. This special production was composed for September, 2012 ‘s Austenesque Extravaganza.  For the complete schedule go to Austenesque Extravaganza.

Part I of 1001 English Nights, by Amy Smith, may be found at: All Roads Lead to Austen

Part II of 1001 English Nights, by Lory L, may be found at :  Meryton press.

And now………..Part III of 1001 English Nights!

When Henry returned from the parish duties which had drawn him from home, he found Catherine sitting by the window in the sitting-room, fanning herself with a packet of paper. When he greeted her he was surprised to see her blush vividly and stammer a greeting as she ran to him and flung her arms around his neck.

“My dear wife! Why are you so agitated? Has something happened?”

“N-no, indeed not! But you were not here when I awoke and I missed you!” She blushed again, embarrassed by the lack of poise that her mother would gently deplore. Before she could speak the footman came in and announced dinner. She pulled herself up into a dignified stance appropriate for a married woman and added, “Shall we dine, Mr. Tilney?”

Henry gravely answered her, “Indeed, my dear, I am famished.”

Catherine took his arm a little nervously and they went to the dining parlour.

During the meal Catherine kept up a flow of chatter about plans for their house, gossip that the housemaid had shared with her, her plans for some alterations to a ball gown which she was not satisfied with, and comments about the delicious dinner the footman was serving them. When they had finished and the covers were removed, Catherine asked Henry, “Would you like to have your port in here, or would you prefer to join me in the parlour?”

“I will join you my dear…as you know my port has much more flavor when I have you to talk to.” He smiled at his wife and she blushed.

By the time they had settled down in front of the fireplace and she had a glass of port for Henry and a cup of tea for herself, Catherine had recovered some of the aplomb that she had worked so hard to gain since her marriage.

“So what did you do with your day, my dear?” was Henry’s first question after the footman had closed the door behind him.

“Oh, talked to Cook and gave instructions to Betsy about dusting the parlour. Nothing very exciting. Oh, that stain on your shirt from when Balthazar knocked your wine over did not come out. I do not know what to do about it.” She glared over at the Newfoundland, who had opened his eyes at the sound of his name, then quickly added, in a low voice, “Oh…and I worked on my story”

Henry turned his eyes from the offending Balthazar and lifted a brow at his wife, a smile tugging at the corners of his mouth. “Really? You must read it to me.”

Oddly, Catherine blushed once again and stammered, “Y-you must read it yourself. I-I would rather you read it yourself.”

Henry smiled wider and said, “Oh, really? Why do you not bring now and I will read it while we have our tea.” He put his empty wine glass aside and poured himself a cup of tea.

Catherine gulped nervously, but nodded and picked up the pages she had been fanning herself with. “Here they are.” She handed them to him a little reluctantly.

With another quirk of his left brow, he took the sheets and settled himself to read.

When he finished he looked up at his wife, two spots of pink in both his cheeks and his eyes a little…unfocussed. “My goodness…this is quite…a vivid portrayal.” He took a deep breath and looked at Catherine again, this time examining her expression intently. Her face was blanched and she could not look him steadily in the eye. Henry took in her expression and her posture, then patted the settee next to him. “Come sit next to me, my dear.”

Catherine did so, and burst out before he could continue, “I’m sorry! I know that this is not a proper thing for a wife…especially a minister’s wife…to write! It just happened and when I was done I was so…flustered that I could not change it right away.” She twisted her handkerchief around and around until the lace edge was on the verge of tearing free.

She opened her mouth to speak again, but Henry gently placed a finger over her lips.

“You are correct that it would not do to have anyone else read your writing, but I must admit that I found it very…stimulating. Perhaps we should keep any further pages locked in your trunk where the maids cannot find them.”

“You…you do not mind that I wrote them?” Catherine frowned, not quite understanding the expression on his face.

“No I don’t mind, my love. I just do not want to share the tales that my Scheherezade spins.” He drew her onto his lap, his fingers tangled in her hair.

“W-who is Scheherezade?” Catherine was having difficulty remembering what they were talking about with Henry’s gaze burning into her eyes.

“I’ll tell you later,” he whispered before his lips met hers.

Happy Birthday, Jane Austen!

Dearest Jane:
I just wanted to send my best wishes on your 236th birthday! Now, I know that after the first 200 years of life birthdays no longer seem so important, but as one of your best friends I wanted to send you a little token of my love and friendship. I first heard this played by Miss Mary Bennet at the Netherfield ball (I believe I told you about THAT fiasco!), but, in spite of Miss Bennet’s lack of talent, I thought the song itself had potential. I bought it for myself and so enjoyed it that I wanted to share the work with you. It is by Handel…I know, I know, a little old fashioned and stuffy, but you must admit that he CAN compose! And it was SO funny to see his face when he found out that his former patron, the Elector of Hanover, was to become the King of England when GF had been lurking about London for years and delaying his return to Hanover. What a hoot! Well, my dearest friend, I hope you enjoy the music…and keep Mary Bennet away from the pianoforte! 🙂
C. Allyn Pierson

To find out what else Jane got for her birthday, just visit the surprise party put on by Maria Grazia at My Jane Austen Bookclub, and and Katherine Cox at November’s Autumn and maybe you will win a present too! I am giving away a copy of Mr. Darcy’s Little Sister and the giveaway is open worldwide!

Jane’s other friends who are at the party:

  1. Sharon Lathan  Blog: Sharon Lathan      Giveaway : Miss Darcy Falls in Love
  2. Emily Snyder    Blog: O! Beauty Unattempted     Giveaway: Letters of Love & Deception
  3. Laurel Ann Nattress     Blog:  Austenprose  Giveaway: signed copy of Jane Austen Made Me Do It
  4. Cindy Jones     Blog: First Draft    Giveaway:  a signed copy of “My Jane Austen Summer” and a package of Lily Berry’s Pink Rose Tea by Bingley’s, Ltd.
  5. Farida Mestek     Blog:  Regency stories set against the backdrop of Regency England     Giveaway: I was Jane Austen Best Friend by Cora Harrison
  6. Marilyn Brant    Blog:    Brant Flakes     Giveaway : A canvas ACCORDING TO JANE tote bag and a pair of A SUMMER IN EUROPE luggage tags.
  7. Prue Batten    Blog: Mesmered’s Blog     Giveaway : Anna Elliot’s  “Georgiana Darcy” (Kindle book)
  8. Erin Blakemore   Blog:   The Heroine’s Bookshelf       Giveaway :  a set of Potter-Style Pride and Prejudice notecards  
  9.  Blog: vvb32 read      Giveaway: Jane Austen’s Little Instruction Book (Charming Petites) By Jane Austen,  Edited by Sophia Bedford-Pierce, Illustrated by Mullen & Katz,  Introduction by  Barbara Paulding
  10. Karen Doornebos     Blog: The Fiction vs. Reality Smackdown    Giveaway: 2 Jane Austen Candles and 2 signed DNMD books plus drink coasters and tea!
  11. Regina Jeffers  ReginaJeffers’s Blog    Giveaway:  An autographed copy of “Christmas at Pemberley “
  12. Alyssa Goodnight    Blog: Alyssa Goodnight   Giveaway: Jane Austen Action figure
  13. Deb     Blog: Jane Austen in  Vermont     Giveaway:  JASNA 2012 calendars from the Wisconsin JASNA Region
  14. Laura Hile,  Susan Kaye, Pamela Aidan, and Barbara Cornthwaite
    Blog: Jane Started It!      Giveaway: One copy of Young Master Darcy: A Lesson in Honour by Pamela Aidan, One set of Frederick Wentworth, Captain (Books 1 and 2) by Susan Kaye,   Two copies of Mercy’s Embrace: So Rough a Course (Book 1) by Laura Hile,   George Kinghtley, Gentleman (Books 1 and 2) by Barbara Cornthwaite.
  15. Juliet Archer     Blog: Choc Lit Authors’ Corner     Giveaway:  a copy of “Persuade Me”  and one of “The Importance of Being Emma”
  16. 18. Jane Greensmith     Blog: Reading, Writing, Working , Playing     Giveaway: a copy of  “Intimations of Austen”, and Sense & Sensibility (Marvel Illustrated)
  17. Jenny Allworthy     Blog : The Jane Austen Film Club       Giveaway:  a copy of Northanger Abbey DVD starring Felicity Jones and JJ Feild (The winner will choose region 1 or 2 DVD)
  18. Sitio Jane Austen     Blog: El Salón de Té de Jane      Giveaway:  – Spanish edition of Sense and Sensibility for the 200th Anniversary + A DVD package with adaptations of Jane Austen
    (It’s only zone 2, but it’s in Spanish and English ) +  blu-ray of the BBC’s Emma with Romola Garai
  19. Kaitlin Saunders     Blog : Kaitlin Saunders      Giveaway: “A Modern Day Persuasion”
  20. Becky Rhodehouse     Blog: One Literature Nut     Giveaway: selection of Austenesque Reads
  21. Patrice Sarath   Blog: Patrice Sarath      Giveaway: A copy of The Unexpected Miss Bennet
  22. Adriana Zardini     Site: Jane Austen Brasil     Giveaway: DVD – Sense and Sensibility (1995) – English / Portuguese subtitles
  23. Jane Odiwe     Blog: Jane Austen Sequels      Giveaway:  a mug with one of  Jane Odiwe’s illustrations and a copy of her “Mr Darcy’s Secret”
  24. Courtney Webb     Stiletto Storytime     Giveaway: Noble Satyr by Lucinda Brant (Regency Romance)
  25. Jennifer Becton     Blog: Jennifer W. Becton     Giveaway: An ebook of the Personages of Pride and Prejudice Collection, which contains all of my Austenesque works: Charlotte Collins, “Maria Lucas,” and Caroline Bingley. The giveaway will be open internationally.
  26. Vera Nazarian     Blog: Urban Girl Takes Vermont      Giveaway: a copy of Vera Nazarian’s gift hardcover edition of her inspirational calendar and diary, The Perpetual Calendar of Inspiration
  27. Abigail Reynolds     Blog: Pemberley Variations      Giveaway:   a signed copy of “Mr. Darcy’s Undoing”
  28. Blog: AustenAuthors     Giveaway:  Georgette Heyer’s Regency World by Jennifer Kloester
  29. Katherine Cox     November’s Autumn     Giveaway :$10 B&N Gift-card (US only)
  30. Maria Grazia     My Jane Austen Book Club     Giveaway : A selection of Austenesque reads

Upcoming event: Jane Austen’s birthday!

Don’t miss Jane Austen’s birthday Friday, December 16, 2011. Maria Grazia of My Jane Austen Bookclub and Katherine Cox of November’s Autumn have planned a surprise party for our dear friend Jane! Many Austen bloggers will be sending Jane gifts at their sites, so stop in and see her presents and comment- you might win a present too! Each site will have a complete list of participants for your reading enjoyment.


Austen Fans gather in Fort Worth!

The Jane Austen Society of North America (JASNA) is holding its Annual General Meeting (AGM) in at the Worthington hotel in Fort Worth, Texas from October 13-16. The AGM has guest speakers, breakout sessions, and a grand finale with a Regency Ball. In addition, on Sunday, October 16, there will be an author booksigning event from 8 am to 10:30am open only to the attendees of the meeting. Many authors, both fiction and nonfiction, will be attending the AGM and there are booksigning events outside of the AGM venue, as well.

On Friday, October 14, Laurel Ann Nattress, Carrie Bebris, and Janet Mullany will have a booksigning at Barnes and Noble at Sundance Square. The event begins at 6:30 and runs until 8pm.

On Sunday, October 16, seven Austen Authors writers will have a booksigning at the same Barnes and Noble, beginning at 1pm and ending…whenever they run out of fans! Authors present will be C. Allyn Pierson, Sharon Lathan, Abigail Reynolds, Cindy Jones, Karen Doornebos, Mary Simonsen and Susan Mason-Milks.
Both of these Barnes and Noble events are open to the public and are an opportunity to meet your favorite authors and maybe find some new favorites!

Overview of English medical practice between 1700 and 1850

Except in obstetrics, medical care did not change in any fundamental way during the 150 years between 1700 and 1850.  There were inventions, such as the stethoscope invented by the French physician Laennec in 1819, which altered how patients were examined, but until the acceptance of the concept of infectious disease in the second half of the 19th Century, the theory of medical treatments remained essentially unchanged.  This stagnation was worsened by the Napoleonic Wars, which significantly decreased travel in continental Europe by English physicians and so limited the transmission of medical knowledge from Paris and Vienna, major centers of medical advancement of the time.

Physicians were trained in England at medical schools; the only requirement for admission was the ability to pay the tuition and learning was limited to attending lectures.  There were few or no practical or hand-on teaching sessions as physicians did not perform any procedures or surgeries.  In some cities in Scotland and on the Continent a medical diploma could be obtained by mail order.  This separation of medical and surgical treatment was the result of societal mores which prevented “gentlemen” from working with their hands, a situation that began in the middle ages (when the only surgeons were barbers, who had the sharp knives).

Surgeons in the Georgian Era had long been separated from barbers, but they continued to be a completely separate branch of medical care from the physicians.  Surgeons were not required to go to medical school, but were trained by apprenticeship like any other trade.  For this reason, professional surgeons have always been called “Mr.” in England, unlike physicians, who are called “Dr.”  This has translated in modern practice to an English surgeon attending medical school and being called “Dr.” until he finishes his surgical training, at which time he goes back to “Mr.”  As the 18th Century progressed, more and more surgeons attended lectures in medical schools and gradually became more professional about their field, but until the development of anesthesia (ether) and sterile technique in the second half-centurythey were limited in what they could do.

Most of the practice of surgeons was in setting bones, removing bullets, stitching up wounds, and bleeding patients.  An important part of the practice in the first half of the 18th Century was in obstetrics; when a midwife gave up on a difficult case and either the mother or child was going to die the surgeon was called in to try and save one of them.  Not surprisingly, the association in the minds of the public between surgeons and obstetrics was that of death.

Apothecaries, or pharmacists as they are now known, were not legal practitioners of medicine, but they were the people who had the drugs and common usage in the 18th and 19th Centuries was for people who did not have a physician, or who could not afford a physician, to ask the apothecary for advice.  As time went on he was called to peoples’ houses to prescribe for those who were ill, and many upper class households used an apothecary for the servants and a physician for the family.  The apothecary could not legally charge for his advice, but only for the drugs which he prescribed.  It was not until 1815 that a law was passed requiring licensing of apothecaries, but the law was universally despised by medical practitioners and was rarely enforced because of the great confusion of responsibility for the enforcement of the law.

Midwives, until the second half of the 18th Century, were almost always women who gained some experience delivering babies and who gained their job by default of other practitioners.  Then male surgeons, who were already considered tradesmen, began infringing on this all-female monopoly and brought medical science (such as it was) into the practice of what is now known as obstetrics.  This change was largely brought about by the demands of the gentry and peers for healthy heirs to their estates.  This was so important in the smooth inheritance of vast amounts of English land that the man-midwives, or accoucheurs, were actually accepted into the upper echelons of society in a way that no other surgeons had been.  No accoucheur would have been invited to dinner by the haute ton, but one, William Knightley, was knighted for his service to the crown (he was the Prince Regent’s personal practitioner at the time) and was actually given a post as advisor to the Regent in government matters.  Clearly, he was seen by the Regent as a man of acumen and wisdom.

Austen Authors first anniversary bash

Austen Authors, that grab bag of Austen fans whose writing is inspired by Jane Austen’s classic works, will be celebrating our first anniversary for six days, September 5 through 10!  It all began when veteran writers Sharon Lathan and Abigail Reynolds began tossing around the idea of a group blog when they met at writers conferences.  After a couple of years they decided to make their dream a reality, and Austen Authors was born!  Today there are 25 members of Austen Authors who each bring their own views and experiences to the blog.

So, join us in our celebration! Virtual champagne will be provided to all celebrants, as well as virtual dark chocolate from Belgium with 85 % cocoa, and melted to the perfect temperature for dipping fresh strawberries.   Well…perhaps that is a bit of exaggeration, but the party is not! Click the Anniversary badge to the left and find out how you can join the fun!


The history of opium in medical practice.

Poppy photo courtesy Shaun Dovey

Pain relief has been one of the primary goals of medical care since humankind began and physicians have been debating the best way to accomplish this goal since ancient Egyptian physicians first wrote down their treatments and discussed them with their colleagues.  Opium, derived from the sticky sap in the immature seed pods of the opium poppy, was the most widely used medication in the Georgian, Regency, and Victorian Era for two very good reasons: it relieved pain and it was inexpensive.

Laudanum, a strong tincture containing 10% opium contained all the alkaloids of opium, primarily morphine, was widely used and could be obtained without a prescription.  It was very potent and was used for both pain and to quiet “nervous” disorders, which we would now call anxiety disorders.  It was also the only medication available to help people sleep.  Morphine and its derivatives work by binding to receptors in the brain which normally bind natural endorphins, produced by the body to relieve pain.  The action of morphine is much stronger than endorphins and will override the action of the endorphins.  Not surprisingly, most households of the gentry and upper classes would have this useful drug in the house in case of need.

Another formulation containing tincture of opium was paregoric.  This was a complex mixture first formulated by Jakob Le Mort in the early 18th Century for the treatment of asthma, and contained “honey, licorice, flowers of Benjamin, opium, camphor, oil of aniseed, salt of tartar and spirit of wine.” By the 19th Century, paregoric was primarily used for gastrointestinal disorders such as diarrhea and the intestinal cramps associated with it (usually called abdominal colic at that time).  In this case, a side effect of the opium was what provided the relief:  opium and all of it’s relatives (including heroin, oxycodone, hydrocodone and codeine) cause the intestines to stop their peristalsis, the rhythmic progression of contractions which move the  ingested food through the length of the intestines, promoting breakdown and mixing of food into a form which could be absorbed into the rest of the body.  Cramping during a bout of diarrhea is caused by lack of coordination or spasm in these muscles, resulting in pain and expulsion of the waste products before the colon can absorb the excess water and make stools of a normal consistency.

The downside to this very effective class of pain relievers is constipation (also from suppression of peristalsis), drowsiness, and the potential for addiction. With the ready availability of laudanum and paregoric, addiction was a significant risk for users.

Both laudanum and paregoric are still available in the US and England (although by prescription only) but they are rarely prescribed since the development of non-narcotic anti-diarrheal agents such as loperamide in the mid-Twentieth Century.

18th Century medicine: how a poisonous flower became a life-saver

Common foxglove (Digitalis purpurea)

As the 18th Century gave way to the 19th, the list of medications available to treat patients was very limited and many diseases were treated with non-pharmaceutical methods, such as bleeding and poultices.  Physicians generally practiced in cities where they could command a steady income, and apothecaries (pharmacists) treated those who did not have access to trained physicians.  In addition, there were often women who had learned traditional lore about herbs and their actions and would treat patients.  Not surprisingly, the trained physicians regarded these herbal healers (sometimes called witches) with disdain and discounted the ability of their possets and extracts to treat patients.  This is the story of what happened when a physician was open-minded enough to see what occurred  when an elderly herbalist treated one of his patients who was afflicted with congestive heart failure.

William Withering (1741-1799) was a traditional practitioner who had studied at the prestigious Edinburgh Medical School and was eventually named physician to Birmingham Hospital.  One of the frustrations of medical practice was the inability to treat dropsy, a now archaic term for edema, or swelling, and caused by heart failure, liver failure or kidney failure.  Cardiac dropsy, now called c0ngestive heart failure, was caused by the heart weakening and being unable to move the fluid load of the body as well as is necessary for health.  This failure would also limit how well the kidneys could excrete excess fluid as not enough blood was reaching them.  Patients would develop swelling in their ankles, which would become worse and worse until the heart failed completely or developed an irregular beat and the patient died.

When Withering’s patient was treated by the herbalist, he noticed that the patient improved.  He talked to the herbalist and found that she was using a concoction containing 20 different herbs for the dropsy.  He was an inquisitive physician, and tested the various ingredients alone until he deduced which one was actually active in cardiac dropsy:  an extract from the leaves of the common foxglove (digitalis pupurea).

Foxglove is a common and attractive garden flower, and was well-known to be highly poisonous if ingested; consuming just one of the upper leaves was enough to kill an adult human.  Withering carefully studied the dosage and action of the extract of foxglove leaves (called digitalin or digitalis) and found that it induced the heart to beat both more steadily and more strongly.  This improvement in the efficiency of the heart action helped reduce the swelling in patients and allowed them to return to a more normal life.  William Withering is thus credited with one of the major breakthroughs in medical therapeutics in 1785, but the road to medical history was not without a few bumps.  One of the patients that Withering had studied was referred by Withering’s friend Erasmus Darwin, and Darwin jumped in ahead of Withering in the publication of the results of the digitalis tests.  Fortunately, Withering had submitted his paper to the College of Physicians in London two months earlier, so he is given credit for the study.  Not surprisingly, his friendship with Erasmus Darwin did not survive.

As is well known in modern medicine, any medication can be toxic if taken in excess.  The dose that is high enough to be effective and low enough to not be toxic is called the therapeutic window.  Unfortunately, the therapeutic window for digitalis is very narrow so the dose must be very tightly controlled to produce the physiologic effect needed without harming the patient.  One of the difficulties with using digitalis that was extracted from foxglove in the 18th and 19th Centuries, was that the amount of the drug contained in the plant would vary with age of the plant and soil and weather conditions, so it had to be used very cautiously, and many herbalists avoided it.

Digitalis is still used to treat weak and irregular heart function and the activity of the medication is now standardized, but it must still be used with great caution.  Signs of overdose include nausea, vomiting, severe headache, diarrhea, hallucinations and other cerebral dysfunctions (included an unusual visual disturbance which causes everything to appear more yellow than normal).  The heart rate can be increased or decreased in an overdose, depending on how high the blood level is.  Newer medicines that have a more favorable therapeutic window are usually used today, but digitalis still has a place in the physician’s armamentarium.