If you were lucky enough to escape a thorough bleeding, taking medicine often wasn’t much fun either. Commonly prescribed drugs throughout this period included highly toxic compounds of mercury and arsenic, while naturally occurring poisons such as hemlock and deadly nightshade were also staples of the medicine cabinet. The Pharmacopoeia Londinensis, a catalogue of remedies first published in 1618, offers a fascinating insight into what used to be considered “medicinal” in seventeenth-century England. It includes eleven types of excrement, five of urine, fourteen of blood, as well as the saliva, sweat and fat of sundry animals. Other items you could routinely find in an apothecary’s shop of the time included the penises of stags and bulls, frogs’ lungs, castrated cats, ants and millipedes.
Perhaps the most bizarre items were discarded nail clippings (used to provoke vomiting), the skulls of those who had died a violent death (a treatment for epilepsy) and powdered mummy. The latter was prescribed for a variety of conditions including asthma, tuberculosis and bruising, and the premium stuff was imported from Egypt—although a cheap imitation could be prepared at home by dipping a joint of meat in alcohol and smoking it like a ham. Every bit as effective as the real thing, and a decidedly superior sandwich filling.
None of these odd remedies survived much beyond 1800, unsurprisingly, although all were perfectly orthodox in their day. As old medicines fell out of favor and new ones took their place, doctors frequently reported their experience with the new drugs in the professional journals. While some were deemed effective and gained general acceptance, others fell by the wayside. It is often the accounts of these failed remedies that make for the most entertaining reading—treatments that not only seem ridiculous today but were ridiculous from the moment they were conceived.
DEATH OF AN EARL
On a warm August afternoon, a man in his fifties is enjoying a game of bowls in the affluent English town of Tunbridge Wells. Suddenly he passes out and falls to the ground, apparently dead. If this scene were unfolding today, an ambulance would probably arrive in a few minutes, and paramedics would attempt resuscitation before whisking the poor man off to a hospital for urgent treatment. But what might have happened three hundred years ago? Thanks to an extraordinary document from the Bodleian Library in Oxford, reproduced in the Provincial Medical and Surgical Journal in 1846, we have a pretty good idea.
In 1702, the doctor Charles Goodall was staying with friends in Tunbridge Wells when his professional services were unexpectedly requested. Dr. Goodall, a celebrated medic who a few years later would be elected president of the Royal College of Physicians, described the tragic events in a letter to an eminent colleague, Sir Thomas Millington:
The most considerable accident which happened this season was the most sudden and surprising death of that great and eminent peer, the Earl of Kent, the true and full history of whose case is the following.
The deceased was Anthony Grey, the 11th Earl of Kent, then aged fifty-seven.
His Lordship came very well to Tunbridge Wells, and continued so for about twelve days. He used no manner of exercise while he stayed, but only walking after morning prayers, for one hour or two, and sometimes after evening prayers, or on the bowling green at Mount Sion. On his Lordship’s last and fatal day, I walked with him from the chapel two or three turns on the walks; he then made an appointment to meet at five in the evening to play at bowls, which he had not done before, nor drunk the waters during his continuance with us.
In the early eighteenth century, most people who stayed at Tunbridge Wells were there to take the famous mineral waters. They were discovered—according to tradition—in 1606 by Dudley, Lord North, a dissipated young nobleman who recovered from a “lingering consumptive disorder” after drinking from a spring he had stumbled across in the woods. Dr. Goodall was himself at the spa for therapeutic reasons: His daily regime involved taking the waters and playing bowls for two hours every evening.
I went at the time appointed, and found my Lord on the green before I got thither, engaged in bowls (if I mistake not), with the Lord George Howard, Lord Kingsale, and Sir Thomas Powis.
A suitably aristocratic foursome.
I gave him an account of some news of which he had not heard, which occasioned some discourse betwixt us; then he went to his bowls, and played (I suppose) two or three games. I went to the other end of the bowling green, and played one game and part of a second, when on the sudden there was a cry, “A Lord is fallen! A Lord is fallen! A surgeon! A surgeon!” upon which I left my bowls, and ran up to his Lordship, and found him dead on the ground, he having neither pulse nor breath, but only one or two small rattlings in the throat, his eyes being closed.
“Neither pulse nor breath” seems pretty final: respiratory and cardiac arrest. Today any competent first-aider would administer CPR, but this is a surprisingly modern technique, first described as late as 1958. I at first assumed that an eighteenth-century medic would realize the case was hopeless, but Dr. Goodall was not so easily defeated.
He was bled immediately on both arms to the quantity of ten or twelve ounces, as computed.
Slightly more than half a pint.
In the meantime I put up the strongest snuff and Spiritus Salis Armoniaci into both nostrils, and ordered two ounces of Vinum Benedictum to be brought with all speed. The apothecary (Mr Thornton) sent for three ounces, which he poured down his throat, not spilling one drop.
“Spiritus salis armoniaci” (sal ammoniac) is a solution of ammonium chloride, an expectorant often used to treat chest complaints. The highest-quality sal ammoniac came from Egypt and was manufactured from camels’ urine. “Vinum benedictum” is antimonial wine, wine adulterated with the toxic metal antimony and used as an emetic. The doctor’s plan, quite orthodox for the time, was to shock the earl back to life by provoking an extreme reaction: sneezing, coughing or vomiting.
As soon as this was done we carried my Lord (in a chair) off the bowling green through the dancing-room into a very sorry bedchamber, one pair of stairs. I supported his Lordship’s head (which otherwise would have fallen on one side, or backwards, or forwards) with my hands and breast, till he was placed on a bed in a little room; when this was done, I cried out for a surgeon to apply six or eight cupping glasses to his Lordship’s shoulders with deep scarification; but no surgeon or apothecary (although one of the former and one of the latter were present) had any, neither was there any to be had on the walks, (as was answered by the surgeon or apothecary present), nor could have been procured if the Queen’s life had lain at stake on Tunbridge Wells.
Scarification with cupping was a mild form of bloodletting: Small incisions were made in the skin, and the cupping glasses drew out a modest volume of blood by suction.
When I found myself thus unhappily disappointed, I ordered his head to be shaved, and a large blister to be applied to capiti raso,* as also another to the breadth of neck and shoulders.
A blister was just what it sounds like: A harsh inflammatory substance was applied to the skin, usually on a plaster, in an attempt to provoke blistering and force toxins out of the body. The doctor also administered several spoonfuls of buckthorn syrup, a laxative. He was then joined by a colleague, one Dr. Branthwait, who had heard the news and hurried to offer his assistance. He suggested giving the dying man a “proper julep” (a refreshing infusion of herbs). The two medics certainly intended to be thorough. But the treatment was about to get rather more extreme:
Then Dr West came, who advised a frying pan made red hot to be applied to the head . . .
This sounds like desperation, and probably was.
. . . however there appeared not the least breath, pulse, or life in my Lord (though one or two physicians thought that there was some little umbrage* thereof), so that in short we had very slender hopes of his Lordship’s case, or little or no encouragement from any application used.
At this point, Dr. Goodall became frustrated that the room was
“crowded with lords and gentlemen,” and asked them all to leave. One, the Bishop of Gloucester, went to break the news to the earl’s daughter, who lived a mile away.
She was (as must be imagined) upon the hearing of this news in a very great passion, crying out, “Is my Lord dead? is my Lord dead? tell me, my Lord, plain truth”; which being owned by the Bishop that his Lordship was dead, and of an apoplexy, she asked him whether cupping-glasses had been applied, and resolved to go to her dear father.
Distraught, the young woman asked for her father’s body to be brought back to his own apartment. Dr. Goodall agreed,
it being my judgment that the motion of the coach, with the warmth of my Lord’s servant, who kept his body in an upright erect position by grasping him round the waist, might conduce to the operation of the vomit and purge which had been given him some hours before, if there was the least warmth or life left in his stomach or bowels, which might be so, though indiscernible to us.
This was surely a forlorn hope: It sounds as if the poor man had died within minutes of his original collapse. Nevertheless, the earl’s corpse (presumably) was propped up in a coach and taken to his own lodgings. Even now the treatments continued:
As soon as his Lordship was put into his warm bed we ordered several pipes of tobacco thoroughly lighted to be blown up the anus, which we thought might be of use, when we could not have the advantage of tobacco glysters.
A “glyster” is an enema. A liquid preparation of tobacco, which was known to be a stimulant, was routinely injected through the anus to treat a variety of conditions. On this occasion, however, they did not have any enema paraphernalia to hand, so instead resorted to blowing smoke up the dead man’s bottom. Though this may sound an eccentric thing to do, it was a standard resuscitation technique, often employed in cases of drowning.* When even this failed to work, the doctors were at their wits’ end. They tried one last desperate method, an attempt to warm the patient up:
After this was done, upon a suggestion of Sir Edmund King’s, the bowels of a sheep killed in the house were applied to his Lordship’s stomach and belly, but all without the least success, though we were reasonably encouraged to make use of all proper remedies in so great a case, many apoplecticks having come to life a considerable time after they appeared dead to all human sense.
An “apoplectick” is one who suffers apoplexy—what we would call a stroke or cerebrovascular accident (CVA). Stroke patients do indeed sometimes lapse into a coma and later recover, and three hundred years ago, medics often had great difficulty telling the difference between coma and death. Without a stethoscope, it was impossible to be absolutely sure that the heart had stopped beating; in some cases, it was safe to declare that death had occurred only once rigor mortis had set in. In that context, Dr. Goodall’s perseverance in his resuscitation efforts is quite understandable.
The letter concludes with a lengthy discussion of the possible cause of death. Dr. Goodall’s colleagues believed that the earl had died from an abscess or a “syncope”—the latter meaningless as a diagnosis, since it means simply “loss of consciousness.” An abscess is also unlikely, since one could be expected to produce signs of infection before the patient’s final collapse. There are in fact numerous things that might cause sudden death: a heart attack, cardiac arrhythmia or a burst aneurysm, for instance. But Dr. Goodall was strongly of the opinion that the fatal event had been a stroke, pointing out that when these are very severe
the patient is (as it was) planet-struck, or knocked down by a club, or butcher’s axe, never more to move hand or foot after.
Just such a blow, he argued, felled the unfortunate Earl of Kent.
THE TOBACCO-SMOKE ENEMA
Samuel Auguste André David Tissot was an eminent Swiss physician of the eighteenth century, the author of one of the first scholarly studies of migraine, and also remembered for his much-cited work on the evils of masturbation, L’Onanisme. In 1761, he published Avis au Peuple sur sa Santé, a little book aimed at the general public and translated into English six years later.
One of the early readers of this work was John Wesley, the founder of Methodism, who was fascinated by medicine and even had a small practice as an amateur physician, giving free care to those who could not afford a proper doctor. In 1769, he published his own version of Tissot’s work under the title Advices with Respect to Health. Although much of its guidance remains valid today, other sections are, well, a little outdated. Take, for instance, Tissot’s advice on first aid in the event of near-drownings, which begins sensibly enough:
Whenever a person who has been drowned has remained a quarter of an hour underwater, there can be no considerable hopes of his recovery: the space of two or three minutes in such a situation being often sufficient to kill a man. Nevertheless, as several circumstances may happen to have continued life beyond the ordinary term, we should not give them up too soon, since it has often been known that after the expiration of two, and sometimes even of three hours, such bodies have recovered.
This sounds extremely unlikely. Seven minutes underwater is usually enough to cause fatal brain damage, and after half an hour, the chances of survival are virtually nil. Extremely cold water can increase this theoretical maximum, since hypothermia reduces the body’s oxygen requirements and also triggers physiological mechanisms that effectively slow the metabolism. Even so, there are only a handful of cases in which people are known to have survived as long as an hour underwater, let alone two or three.
Tissot lists several measures that should be taken in order to improve the chances of recovery.
Immediately strip the sufferer; rub him strongly with dry coarse linen; put him as soon as possible into a well heated bed, and continue to rub him a considerable time together.
Before the advent of CPR, rubbing the body was thought to be the best way of restoring the circulation, even if the heart had stopped. Artificial respiration, on the other hand, was already known in the eighteenth century:
A strong and healthy person should force his own warm breath into the patient’s lungs; and the smoke of tobacco, if some was at hand, by means of a pipe, introduced into the mouth.
Imagine a paramedic giving mouth-to-mouth resuscitation while smoking a cigarette, and you’ll get the general idea. Tissot, like many eighteenth-century doctors, believed that the primary cause of drowning was not necessarily inhaled water but the froth it created with gas inside the lungs. The theory behind this intervention was that tobacco smoke would dissolve this froth, causing the air to recover its “spring” or pressure—a technical term borrowed from the experimental writings of Robert Boyle. Bleeding was, naturally, another vital component of emergency treatment.
If a surgeon is at hand, he must open the jugular vein, and let out ten or twelve ounces of blood. Such a bleeding renews the circulation, and removes the obstruction of the head and lungs.
And why stop at blowing tobacco smoke into the patient’s lungs? Two orifices are better than one.
The fumes of tobacco should be thrown up, as speedily and plentifully as possible, into the intestines by the fundament. Two pipes may be well lighted and applied; the extremity of one is to be introduced into the fundament; and the other may be blown through into the lungs.
Tissot even recommends using a pipe attached to a bladder for this purpose, much like the bag-mask ventilators used today by paramedics. Blowing tobacco smoke up the rectum was not some eccentric idea of his own: As we’ve already seen, the technique was employed in the failed attempt to revive the unfortunate Earl of Kent, and it was widely used in eighteenth-century Europe. It was known as Dutch fumigation, but the practice is believed to have been the invention of Native American tribes centuries earlier.
Tissot’s book was published just before the emergence of the humane societies, organizations dedicated to the study and practice of resuscitation. The first of these, the Society for the Recovery of Drowned Persons, was fo
unded in Amsterdam in 1767; others soon followed in Germany, Italy, Austria, France and London. Dutch fumigation was believed to be so valuable a technique that tubes and bellows for blowing tobacco smoke “into the fundament” were installed in public places such as coffee shops and barbershops—just as defibrillators are today. But it was not just smoke that might be used:
Any other vapour may also be conveyed up, by introducing a cannula, or any other pipe, with a bladder firmly fixed to it. This bladder is fastened at its other end to a large tin funnel, under which tobacco is to be lighted. This contrivance has succeeded with me upon other occasions, in which necessity compelled me to apply it. The strongest volatiles should be applied to the patient’s nostrils. The powder of some strong dry herb should be blown up his nose, such as marjoram, or very well dried tobacco.
It’s a wonder the patient had any space left in his airways for oxygen, with all these substances being inserted into them.
As long as the patient shows no signs of life, he will be unable to swallow. But as soon as he discovers any motion, he should take within one hour, a strong infusion of carduus benedictus, of camomile flowers sweetened with honey; and supposing nothing else to be had, some warm water, with the addition of a little salt.
Carduus benedictus, also known as Holy Thistle, was believed to be a panacea by early modern medics: In Much Ado about Nothing, Margaret says to Beatrice: “Get you some of this distilled carduus benedictus and lay it to your heart; it is the only thing for a qualm.”
The Mystery of the Exploding Teeth and Other Curiosities From the History of Medicine Page 9