When deaths from ‘fever’ began to decline other epidemic diseases carried off men, women and children by the thousand, the Bills of Mortality recording whooping cough, measles, scarlatina, infantile diarrhoea and, later, cholera, among the principal causes of death.33 Even when death did not result and was not expected, illness was often a prolonged trial: wounds were quickly infected and suppurated for days on end; gastric upsets from eating bad food were common; decayed teeth produced permanent septic foci; alcohol and laudanum might relieve pain but surgical operations without anaesthetics were as much to be dreaded as they had ever been; and death was a constant spectre.
‘Bring me the candle, Brown,’ said Keats to his friend when he first realized he was dying of consumption. ‘Let me see the blood … It is arterial blood I cannot be deceived … That drop of blood is my death warrant. I must die.’34
Tuberculosis, both glandular and pulmonary, was a common complaint; and, in the seventeenth century at least, scrofula – a state of constitutional weakness characterized mainly by defective nutrition of the tissues which renders them a ready prey to tuberculosis – seems to have been particularly virulent. It was also known as the King’s Evil since it had been believed from the time of Edward the Confessor that it could be cured by a touch from the sovereign’s hands. Edward III had given public displays of his ability to cure sufferers from the disease; Henry VII had the ‘Ceremonies for the Healing’ inserted in the Service Book; Elizabeth I laid her long white fingers on the afflicted flesh of thousands of her subjects; and James I, although he clearly found the process distasteful, did the same. Charles II is said to have touched nearly 100,000 scrofulous people, over 6000 of them in the year of his Restoration. William III continued the ceremony grudgingly, repeating, ‘God grant you better health and more sense’ after each laying on of his hand and eventually abandoned the practice altogether. It was revived by Queen Anne who insisted on having persons suffering from the disease brought into her presence even when she herself was dying. Samuel Johnson, whose operation for scrofula on the glands of his neck and a later attack of smallpox left him scarred for life, was one of those whom she touched. This was in March 1712 when he was not yet three years old, but he claimed to have a ‘confused but somehow a sort of solemn recollection of a lady in diamonds, and a long black hood’, and he greatly prized the golden touchpiece she gave him, a thin medallion on a white ribbon, which he wore round his neck till he died. Two years after this, when George I came to the throne, the ceremony was abandoned, not to be revived. Belief in the healing power of the monarch survived, however, well into the twentieth century. Before the Second World War afflicted people in Norfolk pressed round George VI in the hope of curing themselves by touching him.
Pulmonary tuberculosis, called by John Bunyan, ‘The Captain of the Men of Death’, also appears to have been widespread in the seventeenth century. Indeed, according to John Locke, writing in 1685, as many as a fifth of all deaths in London were caused by this disease. One seventeenth-century victim was Pepys’s brother, of whom the diarist wrote, ‘About eight o’clock my brother began to fetch his spittle with more pain and to speak as much but not so distinctly; till at last the phlegm getting the mastery of him and he beginning as we thought to rattle, I had no mind to see him die … and so withdrew … Before I came back he was dead.’35
It was a disease usually associated with towns, but country people were not immune, though the distance between villages did inhibit the spread of the disease.36 In the Middle Ages and the England of the Tudors it may have been, as is sometimes suggested, a disease to which the upper classes were more prone than the lower: Henry VII and his son, Prince Arthur, both probably died of it, as did King Henry’s grandson, Edward VI, whose complaint was, no doubt, aggravated by hereditary syphilis. But during the eighteenth century the disease was far more common among the poor than the rich, miners, brassworkers, stonecutters and pregnant women working in industry being particularly susceptible.37 There were, however, numerous victims in comfortable homes such as that of Parson Woodforde where his maid, Molly, died in 1785 ‘in the last stage of a consumption … very sensible of her approaching end and happily resigned to it’.
In London the increase in the death rate from pulmonary tuberculosis appears to have culminated in about 1800 and thereafter to have fallen slowly. In industrial towns the death rate probably remained high slightly longer.38 Yet, during the first five years after the introduction of death registration in 1838 about 60,000 people were listed as having died from the disease; and in the early 1850s there were still over 50,000. Consumption, in fact, killed more people in nineteenth-century Britain than smallpox, typhus fever, scarlet fever, measles and whooping cough put together.39 There was no recognized cure, and many patients considered it useless to consult a doctor. One of these was Emily Brontë whose sister, Charlotte, wrote:
I told you Emily was ill in my last letter … A more hollow, wasted, pallid aspect I have not beheld. The deep, tight cough continues; the breathing after the least exertion is a rapid pant; and these symptoms are accompanied by pains in the chest and side … In this state she resolutely refuses to see a doctor. She will give no explanation of her feelings; she will scarcely allow her feelings to be alluded to.40
A few years before Emily Brontë’s death, a Warwickshire doctor, George Boddington, had published his Treatment and Care of Pulmonary Consumption; and in 1843 he had established a small hospital for consumptives at Sutton Coldfield. But while it was generally agreed that the balanced diet and rest he advocated for his patients might do them good, his insistence that they should also be allowed into the fresh air as often as possible was ridiculed, and he felt obliged to give up his project. Other sanatoria were soon afterwards opened, however, and fresh air, good food and rest became the recognized treatment. Although there were never enough beds for all sufferers from the disease, the incidence of tuberculosis began to fall at the end of the century; but, even so, it was not until the advent of pasteurization, tuberculin testing, mass radiography, modern anti-tuberculous drugs and Bacille Calmette-Guerin vaccinations, that the disease was finally brought under control.
Cholera was conquered more quickly. Endemic in India, it did not reach Britain until October 1831 when cases of a ‘new disease’ were reported from houses on the quay in Suriderland. The disease spread rapidly. Twenty-two thousand people died before the beginning of June 1832 and by the end of that year cholera had visited most parts of England. In Staffordshire nearly 700 people died within two months at Bilston, and at Tipton in a family of fourteen only two survived. The most frightening aspect of the disease was the suddenness with which its victims perished. An attack of violent diarrhoea and vomiting was followed by agonizing cramps in the limbs and abdomen, thirst and fever. After three to twelve hours, the symptoms advanced with rapidity, the skin became dry and a dusky blue or purple in colour, the eyes sank in their sockets, the features were pinched, the pulse at the wrist imperceptible, the voice reduced to a hoarse whisper. Death often took place within a day, sometimes within a few hours.
There was another outbreak in 1848–9 in which there were at least 50,000 deaths in England and Wales and probably as many as 70,000, about 14,000 of them in London, 180 of these in an orphanage in Tooting. Other crowded cities, mainly the poorer quarters of them, also suffered severely, notably Liverpool and Wolverhampton. There were a further 10,675 deaths in London in 1854 and in 1866 more than 5000 people died within three weeks.41
Some medical authorities held that the disease was caused by aerial poison produced by the putrefaction of corpses or rotting vegetables. In 1849, however, a pamphlet was published with the title On the Mode of Communication of Cholera. This suggested that the infection from the sick could be transmitted to food and that it might also be carried by water. Its author was John Snow.
The son of a Yorkshire farmer, Snow was better known as an anaesthetist than as an expert on cholera. His attention had been drawn to the properties of ether
which had been recently introduced in America as an anaesthetizing agent. Having made improvements in the methods of its administration, Snow had demonstrated its use in the dental out-patient room at St George’s Hospital, and in 1853 had administered chloroform to Queen Victoria during the birth of Prince Leopold. But he had also been interested in the problem of cholera ever since he had served as an unqualified assistant during the epidemic of 1831–2; and in the epidemic of 1854 he was able to confirm his belief that cholera is a water-borne disease. In the outbreak of that year over 600 deaths occurred in the Broad Street area of London, the inhabitants of only twelve of the forty-nine houses in Broad Street itself escaping death. Snow traced the source of the infection to a pump which provided water for the area, and after he had persuaded the Vestry of St Paneras to remove the handle from the pump, the incidence of cholera in the district fell sharply. Even so, it was some time before Snow’s contentions were generally accepted; but in the 1866 epidemic, which occurred when London’s main drainage system was almost complete, three quarters of the deaths were in the East End, many of them in those areas from Aldgate to Bow as yet unconnected to the system. These districts were supplied by the East London Company from Old Ford Reservoir whose waters, grossly polluted, were supplied without filtration. ‘The area of intense cholera was almost exactly the area of this particular water supply,’ declared the medical officer for health, ‘nearly if not absolutely filling it and scarcely, if at all, reaching beyond it.’ These outbreaks of cholera and the work of John Snow and of William Budd, a Bristol doctor who had simultaneously come to conclusions similar to Snow’s, emphasized the urgent need for a pure water supply and for further sanitary reform.42
39 Operators and Tooth-drawers
Few complaints were more common or more troublesome than toothache; and in the eighteenth century the methods of treating, extracting and replacing bad teeth had improved very little since the Middle Ages when tooth-drawers, wearing necklaces of teeth round their necks and sewed into their belts, would declaim their skill at fairs, promising painless extractions and giving rise to the adage, ‘to lie like a tooth-drawer’. John Gay described the most commonly resorted to of dentists, the barber, whose sign and inscription, ‘Shaving, bleeding and teeth drawn at a touch’, can be seen hanging next door to the Rummer Tavern in Hogarth’s Night:
His pole with pewter basons hung
Black rotten teeth in order strung,
Rang’d cups, that in the window stood,
Lin’d with red rags to look like blood,
Did well his threefold trade explain,
Who shav’d, drew teeth and breath’d a vein.1
But teeth were treated and pulled out not only by barbers but also by blacksmiths, hairdressers, apothecaries, farriers and even by cobblers, watchmakers, jewellers and wood-turners.
Several of those in dental practice were women. In the middle of the eighteenth century among those practising in London were a Mrs Silvie of Porter’s Street, Newport Market; Hannah Crippen who continued ‘her late husband’s business as Dentist and Phlebotomist’ in Baldwin’s Gardens; Mme Rauxcourt who had acquired her knowledge from ‘the most famous Monsier Caperon of Paris, dentist to the King of France’; Signora Foggioni who could cure toothache by placing a finger on the affected tooth, and, to prove that there was no trickery involved, washed her hands in full view of the patient; and Catherine Madden of West Smithfield whose cures were so efficacious that she guaranteed ‘no recurrence of the trouble’. Mrs Lewis of Bath attended ladies in their own homes; and Mrs de St Raymond of York was not only a ‘Dentist and Operator’ on teeth and gums, but also filled hollow teeth, made loose ones firm, straightened children’s irregular teeth, supplied efficacious dentifrice at 2s 6d the box, and bored holes in ladies’ ears for rings.2 It was a doctor who extracted several teeth from the Rev. Francis Kilvert’s acquaintance, William Hulbert, but he was no gentler nor more expert than the ordinary itinerant tooth-drawer:
And whilst the doctor was pulling out the [seven] teeth, [so Kilvert said] he felt three tumours (he called them ‘knubs’) in Hulbert’s head. These he insisted on cutting out on the spot, and Hulbert brought the whole lot, ‘snags’ [stumps] and ‘knubs’ home in his pocket. ‘It made I sweat,’ he said. ‘It was all over in ten minutes, but the place was like a butcher’s shop and once I should have liked to knock the doctor through the door.’3
Instruments used were pliers which might prove effective with a loose tooth; keys with claws that engaged over the crown and were rapidly twisted in the mouth to dislocate the tooth from its socket; pelicans which had claws resembling the bird’s beak and dragged more recalcitrant teeth out sideways; and tools which, by twisting the teeth round sharply, dragged out the roots. A skilful practitioner might perform these operations without too much agony to the patient but a clumsy, heavy-handed one might – as Ambrose Paré, the expert surgeon to the French court, had warned – dislocate the jaw or even bring part of it away. Certainly, rough use of the pelican could result in good teeth being pulled out with the decayed: Paré recorded the case of a poor countryman who had three sound teeth removed by a tooth-drawer’s bungling apprentice and was warned by the youth that if he complained his master would charge him for taking out three teeth instead of one; so the man hurried off with his drawn teeth in his pocket and his painful one still in his mouth.4
All kinds of powders and tinctures were used to preserve teeth and thus avoid the pain of losing them, and all sorts of preparations were recommended to prevent the bad breath resulting from decay. ‘To take away the stinking of the mouth,’ one early seventeenth-century authority proposed, ‘wash mouthe with water and vinegar and chew masticke then washe mouth with the decoction of Annis seeds, mints and cloves sodden in wine.’5 It was recommended that the teeth should be picked clean after meals, not with the point of a knife but with a wooden stick, that they should be rubbed with a cloth or sponge – brushes were rarely used until the middle of the nineteenth century – and that the mouth should be rinsed out with some such homemade preparation as a mixture of honey, myrrh, juniper root and rock alum. Roasted turnip parings were also said to be efficacious when placed behind the ear. Ladies with bad teeth or bad breath found fans extremely useful in disguising the one and discreetly wafting away the fumes of the other.
Numerous patent powders and tinctures were advertised in the newspapers. In December 1717 the Daily Courant advertised a tincture which ‘infallibly fastened loose teeth to admiration and caused the flesh to grow up to the teeth again when almost quite eaten away’. The same issue of this paper carried an advertisement for a powder which made the teeth as white as ivory, ‘tho’ never so black or yellow’:
It effectually preserves them from rotting or decaying, continuing them sound to exceeding old age. It wonderfully cures the scurvy in the gums, prevents rheum or defluxions, kills worms at the roots of the teeth, and thereby hinders the tooth-ach. It admirably fastens loose teeth.6
As late as 1821 readers of The Times were assured that
A Discovery has lately been introduced which bids fair to supersede the necessity of a dentist. Hudson’s Botanic Tooth Powder is a certain remedy and preventative for all disorders of the Mouth. It not only cleans and beautifies the Teeth, but preserves them from decay to the latest period of life. It makes them white, fastens such as are loose, prevents those decayed from growing worse, removes the tartar, and cures the scurvy in the gums, leaving them firm and of a healthy redness. It is an antidote for gum-boils, swelled face, and that excruciating pain called tooth-ache; and so certain and undeviating in its effects, that there never was an instance of any person who used it ever having the tooth-ache or tooth decay; and though so efficacious an antiseptic, it is so innocent that the contents of a box may be swallowed by an infant without any danger.7
Another advertiser recommended a cure for toothache guaranteed to banish the pain for at least fifteen years, to keep teeth firm in their sockets and to prevent decay. This was a cure
, ‘effected in three seconds’, ‘by fumigation or steam from foreign herbs which destroys the nerve without causing any pain to the patient’.
When such prophylactics proved ineffective a visit to the tooth operator could no longer be delayed; and perhaps, if the painful tooth was not too far gone, it might be saved by cutting out the decay and filling the cavity. Gold leaf had been occasionally used as a filling material since the fifteenth century; but in the eighteenth molten lead or gutta percha were more usual materials, and in the early nineteenth a dangerous amalgam of mercury and silver scrapings. But filling was rarely practised. A bad tooth was generally pulled out, the patient sitting or lying on the floor, before chairs came into common use, with his head held between the operator’s knees and his limbs perhaps bound with leather straps to limit the inconvenience of struggling. Good teeth were cleaned with metal scrapers and sticks dipped in aqua fortis which, while undoubtedly making them white, eventually destroyed them.
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