Regency Period Medical Care

When Sharpe wasn't being tended by his fellow Riflemen, Harper, one of his wives or a camp follower, he had to rely on the benefits of 19th century medicine and surgeons to heal his heroic battle wounds. By the time Sharpe retired to Normandy after the final defeat of Bonaparte, he had amassed a laundry list of scars from wounds taken both on and off the battlefield. Add to those the myriad of fevers he picked up from Flanders and India to Portugal and Spain and one might think he should have been in his grave many years before. But, whether it was his constitution, the grace of God, British medical care or just plain luck, he had another half to his life to live out with Lucille in Normandy.

Sharpe's War Wounds:

202 lashes (Tiger)
Lance wound to side (Tiger)
Clipped by musket ball on scalp (Triumph)
Gash in left cheek (Fortress)
Sword slash to back (Rifles TV - twice)
Sword slash to knee (Between Rifles TV and Eagle TV)
Bayonet slash to thigh, sword cut to scalp (Eagle TV)
Pistol bullet wound to thigh (Eagle TV; Company TV)
Pistol ball in leg (Company)
Knife cuts to abdomen, arm (Honour TV)
Richochet into shoulder (Gold Book)
Pistol ball to shoulder (Battle TV)
Musket ball crease to skull (Escape Book)
Musket ball wound to abdomen, sword gash to shoulder (Sword TV) , pistol ball wound to abdomen (Sword Book)
Rusty nails fired by shotgun. Wounded in thigh (Revenge TV), shoulder and ear (Revenge Book)
Saber slash to arm (Justice)
Sword cut to abdomen (Challenge)
Punches, kicks and body blows (Every book and TV episode)
Kife wound to shoulder, Rifle ball to upper arm (Peril TV)

History

In the 15th century, gunpowder became an important military tool as mobile siege guns were used to breech city walls. In the sixteenth century, muskets and hand guns were developed for use by individual soldiers. Improved cannons loaded with steel balls, rocks, pieces of metal and glass, nails, and other objects were used against enemy infantry formations. These antipersonnel cannons caused great injury and death. The use of cannon, muskets, and rifles resulted in a major change in the types of wounds that soldiers suffered. Many more injuries to the limbs occurred. Compound fractures, which were rare in ancient times, were common due to the force of the bullet hitting a bone. Opposing armies now inflicted large numbers of non-fatal injuries on each other.

The primary problem was that of infection. Almost all gunshot wounds became infected either due to the injury itself (clothing, dirt, and other contamination was often forced into the wound by the musket ball), from unsanitary conditions following injury, by the surgeon probing for the musket ball or shrapnel with his unwashed fingers, or even from being deliberately introduced by the surgeon in an effort to promote healing. Death from infection rather than from the injury itself was the primary danger to the soldier on the battlefield.

The blunt-force trauma generated by musket balls produced shattered bones, resulting in the need to amputate the injured limb. Amputation often resulted in death from shock or infection.

In the 17th century, European medical knowledge increased greatly. The functions of the circulatory and respiratory systems were understood, the microscope was invented and used to study diseases, and intravenous injections were performed. Discoveries in chemistry and physics were also used to better understand the functioning of the human body. Surgical instruments were made by highly-skilled craftsmen who standardised the design of these instruments. The printing press made another major contribution, this time in the form of medical periodicals.

Although there were advances in medical knowledge, the actual treatment of diseases and infections progressed far slower. Although some military surgeons used Roman ligation procedures to control bleeding from arteries, it would not be until the beginning of the 18th century that major progress would be made in amputation.

A major problem was the failure to use a scientific method of researching medications. All sorts of items were used to treat patients, often being either useless or causing additional harm. A physician, for example, might treat a gunshot wound by applying a mixture of materials to the soldier's rifle. Apothecaries sold salves and powders having no proven benefit to the patient.

In 1718, Jean Louis Petit, a French surgeon, invented a screw tourniquet to control bleeding. The screw tourniquet made thigh amputations possible and reduced the risks associated with amputations below the knee. The screw tourniquet was still in use during the American Civil War. As amputations became safer, military surgeons gave greater emphasis to preparing limbs for prosthesis. Flap and lateral incision amputations became common procedures. The death rate from amputation remained high until methods were developed in the 19th century to control infection and shock.

Specialized medical instruments for removing musket balls were developed (but were still not sterilized before use); locking forceps made their first appearance; wound dressing and bandaging became a skilled art; styptics were used to stop minor bleeding; pressure sponges, alcohol, and turpentine were used to treat minor wounds.

John Pringle, Physician General to the British forces in 1740, identified jail fever, ship fever, and hospital fever as being one disease, now known as epidemic typhus.

Pierre-Joseph Desault, a military surgeon, developed the debridement technique for treating traumatic wounds in which only the necrotic tissue was cut away to remove a source of infection. Pringle wrote the first English text on military medicine in 1752. In it, his purpose was clear: "My chief intention was to collect materials for tracing the remote causes of military distempers, in order that whatsoever depended upon those in command, and was consistent with the service, might be fairly stated, so as to suggest proper measures for preventing in any future campaign."

Percival Pott, also a military surgeon, reduced the risk of infection in head wounds by extracting blood from extradural and subdural spaces by cranial draining.

Physicians and surgeons began to introduce thoughtful publications about the health of armies, military medicine, and camp diseases. In 1764, Richard Brockelsby, an English physician, wrote a book on controlling contagious diseases in military hospitals. In 1794, John Hunter, a military surgeon from Scotland, published his treatise in which he argued against the normal practices of enlarging gunshot wounds and blood-letting.

At the beginning of the century, the pattern of military medical care remained essentially as it had been in the previous century. By mid-century, however, all major armies of the period had moved considerably closer towards establishing institutionalized systems of military medical care in which providing paid medical care to all soldiers became a recognized function of the national government. This included the provision of food, shelter, and clothing needed to maintain the health of the troops.

Physical Examinations: Armies encouraged voluntary enlistments for limited periods of military service. Large numbers of marginally healthy adults with poor sanitary habits entered the military service, leading military officials to introduce physical examinations for recruits. At first, the recruit was provided only a cursory examination by his commander. In 1726 the French army began regular medical examinations for recruits. By 1764 each French recruit was examined by a regimental surgeon for physical fitness. In 1788 Prussia required medical officers to conduct physical examinations of all soldiers on a regular basis. In 1790 mandatory medical examinations were instituted in the British army.

Rations: The standard military ration greatly improved the general health of the soldier. Most soldiers ate better in the military than they had in civilian life. Rations were provided to the soldier at government expense. Unfortunately, the quality and quantity of food was often less than promised. Armies relied on a contract supply system which led to fraud, theft, and pressure to reduce expenditures by reducing the quantity or quality of food purchased for troops in the field.

Barracks: In addition to providing troops with regular meals, the military began providing soldiers with buildings specially designed for soldiers to live and sleep. Barracks replaced the old practice of billeting troops with the citizenry or in rented inns. Moreover, the new barracks made control over desertion easier. The first British barracks were introduced in Ireland in 1713 due to a shortage of barns and inns. The first military barracks constructed in England proper were built in 1723.

Uniforms: Regulation uniforms were issued to make it easier to identify friendly units in the smoke of the battlefield. Uniforms were designed without considering the effects on the health of the soldier. They were often made of cheap cotton which did not provide sufficient warmth in cold climates and rain. Tight stockings restricted blood circulation in the legs and did not provided sufficient padding to the bottoms of the soldiers' feet. The shoes provided little protection from frostbite and trench foot. Tight buttons and belts often restricted the soldier's breathing. Heavy headgear added to the soldier's load without providing protection from shell fragments and bullets or even rain.

Military Hospitals : During the 18th century a number of improvements took place in the establishment and organisation of military hospitals, especially with the wide-scale introduction of mobile field hospitals that accompanied the armies on the march. Although every army had a hospital medical organization to provide treatment and administration, these organizations were seldom fully staffed and there was a notorious lack of coordination between hospitals. Mobile hospitals were often little more than rapidly constructed huts in the field. These remained unsanitary and disease continued to be the major threat to military manpower. Few armies had any organized and dedicated transport to move the wounded to the rear-area hospitals. It often took several days for the casualty to reach the rear hospital and it was not unusual for a third of the patients to die in transit from the front to the rear hospitals.

Dettingen Agreement:

As the 19th century began, medical practices differed little from those of the 18th century. Practitioners believed in the Age of Enlightenment's philosophy of 'natural law'. In this rational system, the body was a machine, and all disease was one disease - an overstimulation of nerves and blood. The cure for overstimulation was 'heroic' medicine: bleeding, blistering, purging, and vomiting to restore the natural balance.

Bleeding was usually the initial treatment. It consisted of venesection (opening up a vein), scarification (Using a spring-loaded instrument to produce a series of small cuts), or cupping (placing a warmed glass cup over a cut which filled with blood as the pressure inside dropped). Blistering involved placing hot plasters onto the skin to raise blisters, which were then drained. The most common purgative was Calomel, a form of mercuric chloride which worked as a laxative in small doses, but usually was prescribed in large doses to purge the system.
University of Toledo Libraries. From Quackery to Bacteriology: The Emergence of Modern Medicine in 19th Century America.

General Observations on Blood-letting.

"We are now, gentlemen, approaching a subject of paramount interest and importance - one which merits, and I doubt not will receive, your closest attention. I mean, the use of blood-letting, as well for the prevention, as the removal of disease. From the earliest times this remedy has been extensively employed; and at no period, perhaps, has it been held in higher estimation, or more frequently resorted to, than in the present day: one might naturally expect, therefore, that a pretty general agreement in opinion would found among practitioners with regard to it. This, however, is far from being the case; opinions are still vague and unsettled on the subject, and, in some respects, contradictory; while the merits of the practice, as far as I am able to judge, are by no means justly or sufficiently appreciated. I know of no greater service that could be rendered to the healing art, and consequently, to society at large, than the assigning, with tolerable certainty and precision, the various circumstances that ought to influence us in the use of this herculean remedy."
"The importance of blood-letting , as a medicinal agent, in comparison with other means of cure, is shown in various respects...it is the least equivocal of remedies: its good effects, when properly administered, are, in most cases, so immediate and striking as not to be mistaken...In short, blood-letting is a remedy which, when judiciously employed, it is hardly possible to estimate too highly."
"Blood-letting may be considered in three points of view--as curative, as palliative, and as preventive; and in all these respects it is important.

When the circulation of the blood was first discovered, it was expected, and not without reason, that the mode of acting, as well as the effects, of blood-letting, would be clearly understood: but it turned out far otherwise; insomuch that it is a matter of doubt whether the subject did not become involved in greater obscurity than before. The effects of blood-letting were judged of upon mechanical and hydraulic principles; as if the blood were moving in inanimate, or, at least, in simply elastic tubes. The contractility of the vessels, a vital property, and nearly allied to muscularity, if not identical with it, was wholly overlooked, although, without reference to this, it is impossible to comprehend a variety of phenomena that present themselves in the movement and distribution of the blood."

On the different Modes of Blood-letting

"Different methods are in use for taking away blood from the system, for therapeutic purposes; as, 1st by phlebotomy, or venesection, where the blood is drawn from one or more of the larger external veins that are conveniently situated for the purpose; secondly, by arteriotomy, or the puncture of an artery, which is sometimes resorted to; thirdly, by scarification of the superficial vessels, with or without the aid of the syringe, or cupping-glass; fourthly, by leeches, which are likewise in frequent use. These different modes of abstracting blood from the system have their respective advantages and disadvantages, which require discussion, the one mode being often applicable, where the others are less appropriate."

: 1. "Venesection, or phlebotomy.--The various purposes of blood-letting, as a medicinal agent, are, upon the whole, much more effectually answered by venesection, than by any of the other modes of drawing blood. If, for instance, the object be to take away blood so rapidly as to make a great and sudden impression on the system, with the view of producing actual syncope or fainting, for any particular purpose, venesection is the most sure and effectual means we possess of so doing. If, on the other hand, we be desirous of obtaining a large quantity of blood, in order to produce a more lasting effect, without inducing syncope,-- in this, as well as in the former case, venesection is still the preferable mode; because it is almost always in our power to regulate the velocity with which the blood flows from a vein; at the same time that we are pretty sure of obtaining the desired quantity. By dexterously opening one or more of the larger external veins, either in the upper or lower extremities, or in the neck, (the external jugulars, which are both large in size, and of ready access), it is in general an easy matter to obtain blood, both in quantity, and with all the rapidity, that can be required."
2. "Arteriotomy.-- There are but few places where an artery can be safely opened, or, at least, where the opening would not be followed by more or less of inconvenience. The temples, indeed, are almost the only part where arteriomtomis now practised; and here the branches of the artery are in general so small in size, as to make it by no means an easy matter, at all times, to obtain blood in quantity sufficient for our purpose; and still less in the way that is required to make a sudden and general impression on the system; while, in order to restrain the bleeding after the operation, it is often necessary to have recourse to so much compression of the external vessels of the head, as is likely to disturb in some degree the circulation of the brain."
3. "Scarification, with aid of the syringe, or cupping-glasses, ranks next to venesection, in point of efficiency, though still greatly inferior to it as a general remedy; because it is seldom that the blood can be so quickly obtained by mode of drawing, as to produce a sudden effect, for the purpose of counter impression, in urgent cases of disease, though a sufficient quantity of blood may often thus be procured for ulterior and more durable objects." Simple scarification is sometimes practiced with advantage, as a topical remedy, on parts where the vessels run superficially, and are easy of access. As, for example. in the tonsils, and other parts within the mouth; the inner nostrils. It is not altogether foreign to our purpose to remark here, that cupping without scarification or dry cupping, as it is termed, is an agent of no small importance, and applicable in many instances where loss of blood is objectionable. It acts powerfully as a counter-irritant; as is proved by the pain attending the operation, and by the increase of action it excites in the vessels of the part, and to some distance around. Dry-cupping alone is a useful means of producing counter-irritation on a variety of occasions, and is less resorted to than it deserves to be."
4."Leeches, furnish another mode of drawing blood that has its advantages, as being applicable on some occasions, where other means cannot be conveniently resorted to. Generally speaking, however, as in regard to the other modes of local or topical bleeding, the blood drawn by leeches is discharged too slowly to have much effect on the general system, in the way of counter-impression. Infants, however, are sometimes quickly and powerfully affected, even to fainting, by the application of two or three leeches, which, so far, in them, may answer the purpose of general blood-letting, producing all the effect of venesection in the adult. There is one objection, however, to the use of leeches in children, which deserves attention; namely, the terror they sometimes occasion, with a continuance of angry feelings for an hour or two, while the operation lasts. This is a cause of aggravation in many brain affections of children, where the sensibility and irritability of the system are already greatly in excess. In such cases, therefore, scarification with cupping is often preferable to leeches; and, still more, venesection, if it be practicable, as it often is, either in the arm or neck. By this, not only is the irritation here spoken of avoided, but the disease itself more effectually relieved."

Leeches used in bloodletting

When the application of Leeches is judged expedient, the part on which it is intended they shall fix, should be as clean as possible: it should therefore be first washed with soap and water, and afterwards with water alone; which will be more necessary, should any liniment or embrocation have been used.

Leeches are commonly affixed by inverting a wine-glass containing as many as may be required, upon the part affected. The great disadvantage of this practice is, that some of them frequently retire to the upper part of the glass and remain at rest, defying all attempts to dislodge them, without incurring the risk of removing those that may have fastened.

Some little dexterity is requisite to make the Leech attach itself at the first point of contact, or it often happens that it will pass over a great extent of surface, without evincing the least disposition to bite. In this case, puncturing the part with a lancet offers the only chance of success.

The Leech, when filled, contains from half an ounce of blood; when a Leech quits the part to which it was affixed, and the blood continues to flow longer than is required, the application of a slight compress will usually restrain it; but should this at any time prove ineffectual, we must have recourse to a compress steeped in some styptic, as brandy or spirits of wine.

(History & Special Collections Division, Baltimore).

Biopharm Leeches Homepage

Maggots

Even traditional medicine knows the value of using leeches to improve circulation on severely injured extremities. Maggots help by eating dead tissue, preventing gangrene poisoning, which battlefield experiences confirm. Blow Fly maggots go a step further by secreting healing agents. Maggots are simply the larvae from fly eggs.

The medicinal benefits of maggots were observed in World War I .Those wounded soldiers who were left in open field or trenches (sometimes for days) had their wounds "cleaned" by maggots (which consumed the dead tissue that bacteria, etc would normally feed on) and were able to heal (and keep) their damaged appendage. Soldiers brought back to field hospitals frequently died or lost the damaged appendage due to massive infection. Maggots play an antiseptic, antimicrobial role in wound healing and should not be feared as causative agents of infection.

Troubled Times: Leeches & Maggots

War and Surgery

Surgery was the last resort because it was often fatal and always painful. Performed with no regard for cleanliness, doctors wore filthy coats - often directly from the autopsy room to the operating room - with pride. This practice spread deadly infections like septicemia or gangrene. The only anaesthetics were opium and alcohol.

Disease was the greatest killer. Two soldiers died of disease (dysentery, diarrhoea, typhoid, and malaria) for every one killed in battle. Soldiers from small rural areas suffered from childhood diseases such as measles and mumps because they lacked immunity. Outbreaks of these "camp and campaign" diseases were caused by crowded and unsanitary conditions.

Second to disease as a cause of death was battlefield injuries. The overwhelming number of wounded created problems in removing them from the battlefield.

To discover and collect the wounded on a battlefield, especially after dark, was a great problem. At Salamanca a large part of the field was grown over with shrubs, and the ravines were full of nearly ripe corn, where many a wounded soldier died in concealment before he could be found. On the slope of one hillock about two hundred men had crept or been collected, and were waiting to be removed when Commissary J. E. Daniell saw them, "each man wrapped in his blanket, by which they might be distinguished from the dead lying about". After a major battle wounded men sometimes remained for several days on the field. Some crawled by degrees to the nearest village, and peasants, like those around Vitoria, would bring them into a military dressing station or hospital, yet hundreds still lay on the field without food or attention.

When the fighting was over, troops from individual regiments were sent all over the contested ground in search of wounded comrades, with hospital wagons in tow. During the battle the buglers and bandsmen were responsible for carrying those who had been hit to the regimental surgeon, using either a wooden stretcher or blankets. Sometimes a blanket would be tied between two sergeants' pikes; but more often a hole had been worked at each corner of the bandsmen's blankets, and through these two poles could be run, thus forming a litter carried by four men. In lieu of blankets, the wounded might be carried on branches, on great-coats, even on bed sheets taken from nearby houses.

One officer of the Sherwood Foresters, having been shot through the leg, was carried to a house from the field of Bussaco by four Portuguese in one of the bearers they used for burying their dead.

In a skirmish on 23 July 1810 Rifleman Edward Costello of the 95th received a shot under his right kneecap. With a tremendous effort he dragged himself back over the Coa bridge and then, faint with loss of blood, he persuaded a comrade to help him up the hill to a chapel which had been converted into a temporary hospital. Here the surgeons soon dressed his wound. Having no mules or waggons, they advised anyone who could move to make his way to Pinhel as quickly as possible. Accordingly about seventy disabled soldiers set off, helping one another hobble along. Costello had a couple of rifles as crutches and in this way reached the nearest village, at which point the magistrate had the worst of the wounded placed in bullock carts. It was torture for wounded soldiers to travel to hospital either sitting or lying in these crudely-constructed Portuguese carts, with small solid wooden wheels revolving on unoiled axels and drawn by a pair of bullocks, yoked at the head. On narrow stony tracks the jolting often tore off bandages and opened up wounds. It was believed that the Portuguese never greased the wheels because the dreadful squeaking frightened away the Devil.

Conditions in the hospitals were appalling. In 1810 Sergeant Cooper, 7th Fusiliers was in Celorico in an unventilated room with eleven other men who were either unconscious or bawling out incomprehensible jibberish. "There was not a single chamber utensil. A blanket was spread on the floor instead. Some made use of the window for every purpose. I saw neither basin, soap, nor towel." In 1811 Celorico was so overcrowded two patients occupied each bed. When one died, another was brought in to fill his place "to share in mind as well as body the infection of his disease." (Cornet Francis Hall).

Cooper wrote of his treatment in the hospital in Elvas: "Shirt unchanged and sticking to my sore back; ears running stinking matter; a man lying close on my right hand with both his legs mortified nearly to the knees, and dying. A little sympathy would have soothed, but sympathy there was none. The orderlies were brutes."

Risks from surgery were great. Doctors in the field hospitals had no notion of antiseptic surgery, resulting in extremely high death rates from post-operative infection. Surgeons ignored anaesthesia, instead relying on the "surgical shock" of battle, when the patient's heart rate was greatest, to amputate.

Amputation of a wounded arm or leg was the most common operation, due largely to the ammunition used during the war, causing gaping wounds filled with dirt and pieces of clothing. Because of the severity of the wounds and the overwhelming case load, surgeons usually elected for fast and easy amputation over trying to remove the bullet and save the limb. This was done without anaesthetic, except sometimes a gulp of rum, and with the patient only on rare occassions requiring to be held to the operating table.

: "The door through which Lawford had been carried was opened and a soldier dragged out a corpse. It was not the Colonel. The body, pulled by the heels, left a jellied slime of bloodied mud on the tiles. The door was left open and Sharpe crossed to it, leaned on the post, and stared into the candle-bright charnel house. He remembered the soldier's prayer, morning and evening, that God keep him from the surgeon's knife. Lawford was on the table strapped tight, his uniform cut away. An orderly leaned on his chest, obscuring the face, while a surgeon, his apron stiff with blood the colour of burnt ochre, grunted as he pushed in the knife. Sharpe saw Lawford's feet, still encased in the boots with the swan-neck spurs, jerk in the leather straps. The surgeon was sweating. The candles guttered in the draught and he turned a blood-spattered face. 'Shut the bloody door!'

Sharpe closed it, cutting off the view of severed limbs, the waiting bodies." (Sharpe's Company p49).

From the windows of one convent amputated arms and legs were flung down into a square among wounded soldiers who lay waiting their turn to go before the surgeons, if they lived long enough. Vimeiro churchyard after the battle contained unpleasant evidence of surgery: a heap of legs that had just been amputated, and a large wooden dish filled with severed hands. After Ciudad Rodrigo, when George Napier had his arm cut off, Surgeon Guthrie took a long time to do the job, at least twenty minutes, so blunted were his instruments from the number of amputations he had already performed.

"A little farther on, in an inner court, were the surgeons. They were stripped to their shirts and bloody; - curiosity led me forward; a number of doors, placed on barrels, served as temporary tables, and on these lay the different subjects upon whom the surgeons were operating; to the right and left were arms and legs, flung here and there, without distinction, and the ground was dyed with blood." (Liieutenant William Grattan).

The dead cart used to go around the hospital at Elvas three times a day laden with naked corpses, which were tumbled into a hole outside the town. The men who died, mostly of fever, were buried between eleven o'clock and midnight, without any religious service or military honours.

John Moore, seroiusly ill with fever, was taken in error to the dead-house and laid on a plank with his feet tied together, ready for burial that night. A sentry on duty, hearing a noise, called for the corporal of the guard. They opened the door and found that Moore had fallen off the plank and was trying to untie his feet. Moore recovered and rejoined his company and friends.

The medical machinery usually worked more smoothly whenever a battle was fought near a large town or city, because the surgeons could find much better accommodation in which to operate and house the wounded. Also, the energy and resources of the local population became available. On 22 July 1812 many inhabitants of Salamanca came out, carrying with them tea, coffee and other refreshments, while carts laden with fresh fruit, provisions and containers of water squeaked their way to the scene. Women back in the city had already prepared a large quantity of lint and rags for binding up wounds, and many Spanish girls were to be seen that evening supporting from the battlefield those among the wounded soldiers who were able to walk. They also carried their knapsacks and muskets. The local doctors, too, came out by torchlight with jackasses laden with bandages and other stores in order to dress the wounded - or some of them at least - on the spot.

Hydropathy

The hydropathic system had three treatments: the general application of water by bath, the application to a particular part of the body, and internal cleansing by drinking or injecting.

Hydropathy had no adverse effect on those who prescribed to it, and produced some benefits. It promoted frequent bathing when most soldiers rarely had the luxury of bathing and helped to prevent the spread of disease. Hydropathy treatment was followed by walking in the open air, and as such promoted exercise at a time when frailty was the norm.

The water cure was used for the ague in the Peninsular war. George Peach of the 9th Dragoons was made by a surgeon to get into water during every hot fit and repeat the operation several times. "This getting into water in a fever makes one shudder almost as much as if told to get into a furnace."

At Elvas in 1809 William Green of the Rifle Corps was quartered in the town, and when off duty he and his companions took turns to sit with the sick until about midnight, when they took fever patients out of bed and led them to a flight of steps. As the sick wore no shirts in bed they were naked, so two buckets of cold water were poured over each. "They were so deranged they knew nothing about it. I have put my finger into their hand, when they would jump out of bed, follow me, and sit quietly while we poured the contents of the buckets over them, and would be led by the finger back again to bed, and never utter one word." The regimental officers and doctors believed this mode of treatment had a beneficial effect, and no doubt it did for some of the afflicted. Costello, also of the Rifle Corps, was one of them. He recovered after six weeks, thanks to a strong constitution and, so he believed, the doctor's cure of frequent drenching in cold water.

Scurvy

A vitamin C deficiency results in an underhydroxylation of proline and lysine in collagen which results in a lower melting temperature of the resulting collagen fibres which causes a breakdown of the protein collagen needed for connective tissue, bones and dentine, the major portion of teeth. Collagen is a cementing material that binds cells together, and is an essential connective tissue protein in the body. Whenever the body is wounded, collagen glues the separated tissues together to form a scar.

A lack of collagen causes the walls of the body's blood capillaries to break down and haemorrhaging occurs in cells throughout the body. When capillaries lose the 'glue' that holds them together, symptoms of scurvy appear.

An affected person becomes weak and has joint pain. Internal haemorrhages cause black and blue marks to appear on the skin. At the first visible signs of scurvy, raised red spots appear on the skin around the hair follicles of the legs, buttocks, arms and back. When the tiny capillaries of the hair follicles haemorrhage, the hair-producing cells do not receive the nourishment needed for the hairs to grow normally. Consequently, the skin becomes flecked with small lesions that begin to appear on the body after about five months on a diet deficient in vitamin C. These lesions were the 'spots' that James Lind observed on the skin of his sick men. Gums haemorrhage and their tissue becomes weak and spongy. Dentine, which lies below the enamel and is part of the root of teeth, breaks down. Teeth loosen and eating becomes difficult and painful.

In 1747 as the HMS Salisbury sailed from England to the Plymouth Colony, the ship's physician, James Lind, performed a simple experiment to determine what might be effective as a cure for scurvy. Scurvy was described as early as 1500BC in the Ebers papyrus and other descriptions appeared in Greek and Roman writings. It struck the crew of Magellan's around the world journey in 1519-22 and a British report in 1600 indicated that in the previous 20 years some 10,000 mariners had been destroyed by the disease.

On the 20th of May, 1747, Lind divided his 12 ill men into six groups of two each. All 12 shared a common diet for breakfast, lunch and dinner but each group received a different supplement as follows:

quart of apple juice daily
25 drops of exlir vitriol (sulfuric acid and aromatics)
two spoonfuls of vinegar three times a day
concoction of herbs and spices
half-pint of sea water daily
two organges and one lemon daily

The two men who ate the oranges and lemon recovered immediately. One was fit for duty in six days and the other was also well in six days and was appointed as nurse to all the others. The two men who drank apple cider improved but were not well enough to work. None of the others showed any improvement.

James Lind's observation that citrus fruits contained something that counteracted the ravages of scurvy was followed by his development of a method for the concentration and preservation of citrus fruit juices for use at sea. In 1795, the British Royal Navy provided a daily ration of lime or lemon juice to all its men. English sailors to this day are called 'limeys', for lime was the term used at the time for both lemons and limes. Captain Cook carried citrus fruits on his sea voyages.
(History & Special Collections Division, Baltimore).

Mental Health

In the early 19th century care for the mentally ill was almost non-existent: the afflicted were usually relegated to prisons, almshouses, or inadequate supervision by families. Treatment, if provided, included bloodletting and purgatives.

'Moral treatment' was the predominating philosophy to cure the insane. This system was developed in late 18th century Europe. It challenged the demonic explanations for insanity and emphasised the role of environment in determining character: improper external conditions could induce derangement. The 'moral treatment' system was optimistic that an appropriate environment could facilitate cure, especially for those with acute (not chronic) afflictions.

Essential to this theory was a physiological basis for mental disorder: insanity was caused by brain damage. The brain's surface was soft and malleable and physically altered by outward influence. This idea was closely related to phrenology which assigned specific faculties to sections of the brain.

Phrenology

Phrenology was not a cure, but a way to interpret the mind and body to better understand both. Founded by Franz Josef Gall (1758 - 1828) in Vienna, phrenology centred on the physiological basis of the mind. The movement claimed a person's character was made up of 37 faculties which could be 'read' on the cranium at the site where each was located. The size of the brain in these locations would reveal the strength of that particular faculty. They believed there were "connexions and relations which exist between the conditions and developments of the brain and the manifestations of the mind." Phrenology was even applied to art as sculptors and painters did phrenological profiles of their subjects to insure their art would reflect the traits of the subject.

Disease and Housing

Typhus epidemics devastated Europe in the early 19th century because of overcrowding, poverty and filth which promoted typhus transmission by lice.

Catharine Beecher noted a connection between poor air quality in European slums and the spread of disease. She advocated open fireplaces and improved home ventilation, stating the "first and most indispensable requisite for health is pure air, both by day and night." She felt windows should be kept open and bed chambers kept cold to improve resistance to disease. She researched cooking and heating stove design, and strongly opposed closed furnaces because they removed moisture from the air and could leak poisonous gases. Other advocates for clean air included William Alcott, who wanted to change the architecture of school houses to improve ventilation and add outside playgrounds where students could breathe healthful air.

Women

Women were especially vulnerable to inadequate diagnoses and treatment in the 19th century. It was commonly believed that most physical ailments of women were caused by their sexual organs or mental disorders, resulting in painful, sometimes lethal treatments. Despite these malpractices, some advances were made in the field of obstetrics and gynaecology.

Non-surgical cancer treatments included injections of Castile soap suds for the treatment of ovarian cancer and taking emetics to clear the body of breast cancer. a plaster of extract of clover was to be placed on any exposed cancerous sores following the purging, a treatment considered a 'simple, safe and generally effectual remedy."

Childbirth during this period was marked by concern for pain in delivery and the cause of puerperal fever, which appeared mysteriously after deliveries and often led to quick death. Physicians were finally able to combat puerperal fever in the 1880s when they connected unclean instruments and doctor's hands with the high mortality rates. Ether and chloroform were used to alleviate the pain of childbirth, despite vigorous opposition by religious zealots who claimed anaesthesia during birth was sacrilegious because it conflicted with God's dictum:" In sorrow shalt thou bring forth children." Birth pain, they said, was a curse upon women and suffering was necessary to induce maternal love. Some doctors agreed.

Female mental health problems were generally viewed as pathological. The Victorian view of females as weak, fragile, and childlike served as both cause and effect, creating generations of repressed, suffering women made worse by harsh treatment. Surgical cures for mental illness in women were also common.

Contraception: Coitus interruptus, sponging and abstinence were the most common. Methods employed in terminating pregnancies included jumping off tables, rolling on the floor, massaging the stomach, taking abortifacients (discreetly sold as patent medicine cures for 'female problems'), and using blunt instruments.