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.

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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.