The beginning of the Victorian Era was a time of population growth coupled with primitive medicine and of obsolete science. By the end, comparatively advanced scientific theories had been confirmed; treatment had been improved through the introduction of antiseptic and anesthetic; and the life span of the average human had been increased. In order to understand this transformation, four primary areas of study are examined in detail. The multitude of professions in medicine are detailed, from the prestigious physician to the lowly apothecary, and the arenas in which each works. Current scientific theory prevalent at the time is also described and analyzed in order to understand the treatment practices. Treatment, though very primitive in nature, vastly improved during the Victorian era. Lastly, an analysis of the general health trends that result from the practice, the predominant theories, and the treatment is offered.
Briefs
Medicine was practiced in a wide array of settings. It was practiced by one of a multitude of different practitioners, wielding a variety of licenses. Social class delineated between one practitioner and the next; professional standards were as obscure as female practitioners. Fees ranged from a mere token to a handsome sum wrapped in paper and placed on a nearby table, to allow for discreet collection later. Despite common notions, the Victorian Age was full of medical practitioners, the possible wealth, rank, and social status that were associated with the practice of medicine appealed to many. (Mitchell, Victorian Britain 491)
Victorian scientific thinking evolved from the primitive miasma theory based on odors to an advanced bacterial understanding. Although actions taken to improve health were often founded upon faulty theories, the standard of living was nevertheless improved. By the end of the century Victorians understood the need for antiseptic surgery, anesthetic, and general cleanliness. Through the research and innovation of Joseph Lister, Pasteur, Snow, Budd, and Jenner theories were refined and created to further the cause of medicine.
Promising headway into more effective treatment was made during the Victorian era. Medical practitioners began using opium extensively, as well as laudanum and chloroform. Surgery also became more advanced, and safer through the use of antiseptic. Aside from these new forays into treatment, many people remained reliant on household manuals that prescribed ancient herbal cures and practices.
Although infant mortality decreased and the life expectancy increased during the Victorian era, both measurements indicate terrifying rates. Babies were suspect to disease, infections, and mistreatment (often they were silenced with a mixture of opium and alcohol). The public was susceptible to a wide array of disease, not to mention malnutrition and inhuman working conditions.
Practice
Medicine was practiced in a wide array of settings. It was practiced by one of a multitude of different practitioners, wielding a variety of licenses. Social class delineated between one practitioner and the next; professional standards were as obscure as female practitioners. Fees ranged from a mere token to a handsome sum wrapped in paper and placed on a nearby table, to allow for discreet collection later. Despite common notions, the Victorian Age was full of medical practitioners, the possible wealth, rank, and social status that were associated with the practice of medicine appealed to many. (Mitchell, Victorian Britain 491)
Doctors and physicians occupied the highest rung on the social ladder. Such citizens were considered gentleman because 1) their training did not include apprenticeship and 2) the profession excluded, supposedly, manual labor. Doctors were permitted to dine with the family during home visits, while other practitioners took dinner with the servants. A physician's fee was wrapped and placed nearby, for theoretically gentleman did not accept money for their work. The prestige originated in their education: most often a higher degree from an esteemed school such as Cambridge, Oxford, or Edinborough. A medical degree, however, did not require any clinical experience. Students studied Greek and Latin theory, but they were not obligated to 'walk the wards'. Not all 'doctors', however, attended a medical school. For the majority of the Victorian era no official licensing requirements existed, but the practice did become more professionalized and organized. (Mitchell, Daily Life 196) The doctor that was called in to deal with Mrs. Yeobright's snake bite knew nothing but the old wives tale to neutralize the poison. This doctor most likely had no license, but just practiced the profession based on information handed down from a family member, most likely his father. (268)
Most doctors maintained a room in their residence for treatment and care. This room, dubbed the surgery (even when the practitioner was not a surgeon), was open to patients without appointment during specific hours. (Mitchell, Daily Life 196) Physicians and doctors did not deal with external injuries. They did not set bones, examine patients, or perform surgery. Doctors primarily administered 'physic', or drugs, utilizing a detailed case history provided by another medical practitioner. Doctors were chiefly concentrated in London where they were guaranteed a host of upper class patients. (Pool 249)
Elizabeth Blackwell became the first fully accredited woman doctor in the United States and Great Britain. Accepted as a joke, she diligently acquired all the major qualifications needed to practice medicine. Elizabeth eventually opened her own women's medical training school and an infirmary.
The normal price for a Doctor's home visit near the turn of the century was five shillings, although most doctors charged only 1s. 6d. when they were aware of a patient's inability to pay. Many physicians saved one morning a week to work charity cases, otherwise, the gentleman charged a guinea per visit. (Mitchell, Daily Life 179) Highly successful medical establishments were known to take in more than 10,000 pounds a year. Even moderate success netted at least 700 pounds. (Mitchell, Victorian Britain 489)
Surgeons represented the next step down from doctors in the social hierarchy. The paramount difference between physicians and surgeons is training. Surgeons were apprenticed in their middle teens; their parents paid for the boy to watch a surgeon in his practice, read his books, and later act as the surgeon's assistant. Such pupils were infamous for their rowdiness. Surgeons set bones, stitched wounds, and pulled teeth. (Mitchell, Daily Life 204) Surgeons were often qualified as apothecaries as well. An apothecary typically sold drugs, advice, and performed basic medical tasks such as initially examining a sick patient. (Mitchell, Victorian Britain 774) The title apothecary-surgeon came into use when the trade was regulated. In 1815 the apothecaries act provided for licenses for those practitioners who first 'walked the wards' of a medical establishment for six months. As time wore on, however, the line separating apothecary-surgeons and doctors became less distinct, until finally the professions merged into one, general practitioner. (Pool 250)
Nursing was first popularized by Florence Nightingale; she portrayed it as I dignified and glamorous profession. Nightingale led the first women nurses, ten of them, into the Crimea, and afterwards, British society awarder her with enough funding to found a nursing school. Despite the glorious connotations, however, nursing required perpetual work and care. Nurses cooked meals for patients, cleaned, were on call day and night. The pay, a shilling per day, was fairly good for the times, and the women earning it were well respected. Often a year as a probationer, a position between maid and nurse, was required of nurses before they received their qualifications. Typical shifts ran from 7:00 am until 9:00 pm, with two hours of recreational and mealtime breaks in between. Qualified nurses were able to earn up to 50 pounds per year, with free meals and board. (Mitchell, Daily Life 199)
Victorian scientific thinking evolved from the primitive miasma theory based on odor to an advanced bacterial understanding. Although actions taken to improve health were often founded upon faulty theories, the standard of living was nevertheless improved. By the end of the century Victorians understood the need for antiseptic surgery, anesthetic, and general cleanliness. Through the research and innovation of Joseph Lister, Pasteur, Snow, Budd, and Jenner theories were refined and created to further the cause of medicine.
Three primary theories prevailed in Victorian medical and scientific thinking. The miasma theory was based on the concept that internal diseases were caused by miasmas, or noxious odors. (Mitchell, Victorian Britain 492) Although this theory is obviously flawed, actions based upon the miasma notion benefited health in the cities. Sewers were constructed and improved to prevent the foul odors. Garbage piles and sewage was tended to in order to make the city smell better, and therefore the Victorian were inadvertently removing bacteria, the true cause of the diseases of the time. However, in some cases removing the sewage only complicated the situation further. Often the sewage was flushed directly into the local water supply, which increased any bacteria problem.
In 1849 William Budd and John Snow introduced an opposing concept, the bacterial theory, by explaining that cholera, for instance, was a living organism that multiplied in the intestine. This radical view was rejected at the time.
When Louis Pasteur published his Germ Theory in 1861, which was along the same lines as the bacterial theory, it too was not accepted. Most people simply could not fathom the concept of diseases being caused by organisms, which they could not see. Also, men famous for their sanitary campaigns that improved conditions had popularized the miasma theory with the general public. Some people, however, recognized value of the germ theory, and adapted their practices. Joseph Lister began antiseptic surgery in the late 1860s. Other practitioners followed his example, boiling and scrubbing instruments before and after operations. The post-operative complications that still surfaced after cleaning the instruments are thought to have been caused by certain types of bacteria, unaffected by the antiseptics used, that thrived in the hospital setting. (Mitchell, Daily Life 195) By 1890, though, enough scientific research existed to convince most sensible people of the existence of germs, and the miasma theory became obsolete. Microscopes had been used to identify the bacteria responsible for the most infamous diseases of the era. (Mitchell, Victorian Britain 492)
In 1852 a prominent English surgeon, Lister,was assigned to the task of reducing hospital infections. Joseph Lister devised the first way to effectively study bacteria: the mysterious growth that was invisible yet deadly. Lister realized that carbolic acid inhibits bacteria growth on the tissues, and therefore protects them during operations. (Traux 239) At first, he attempted to disinfect an entire area using evaporated carbolic acid to purify the air. Meeting with failure, Lister then turned to applying the acid directly onto the wound. (Reed 272) Lister boiled and scrubbed all instruments, tools, hands, and anything that would come into contact with the wound. Lister realized that his carbolic acid technique was feasible only in the few well-equipped hospitals of the time. Therefore, he was perpetually seeking different, simpler disinfectants. (Traux 240) Not until 1870, however, did the antiseptic idea firmly catch; prominent doctors had ridiculed it publicly until then. (Mitchell, Victorian Britain 492) In 1877 Lister demonstrated that surgery using antiseptic reduced the mortality rate by fifty percent. Lister was made baron by Queen Victoria and is the namesake of Listerine. (Reed 272)
Edward Jenner, an English countryside doctor, is credited with perhaps the most relieving medical discovery of the time period. He discovered that by "introducing cowpox matter to the bloodstream gave protection without the risk imposed by the current practice of variolation (inoculation with the small pox virus)." His vaccine spread quickly across the country, and led to the mandatory vaccine which was eventually imposed by the government. (Mitchell, Victorian Britain 833)
Treatment
Promising headway into more effective treatment was made during the Victorian era. Medical practitioners began using opium extensively, as well as laudanum and chloroform. Surgery also became more advanced, and safer through the use of antiseptic. Aside from these new forays into treatment, many people remained reliant on household manuals that prescribed ancient herbal cures and practices.
Opium and Morphine
By the 1820s morphine was a popular anodyne, or soother. Morphine was also, however, a prime method of Victorian suicide. Morphine was six times as potent as opium. It was commercially available, and it was sold using a standardized measure of strength, allowing for accurate doses. Despite the merits of morphine, the newer drug; opium still remained popular among doctors. Dr. Jonathon Pereira, author of standard-setting works on therapeutics, maintained that opium was still the most important drug because its effects are "immediate, direct, and obvious; and its operation is not attended with pain or discomfort." Opium's chief advantage was the lack of ostensible side effects, at least short term. Many doctors were aware of the addictive properties of opium, but they ignored this fact and declined to inform patients. Many upper and middle class patients purchased morphine from doctors and injected themselves daily with newly developed needles. This 'morphinism' was unbounded by legal or social guidelines, and many morphine addicts were unaware of there addiction. Despite the ramifications of morphine as a leisure drug, it allowed for longer and more effective surgery, and for tremendously more efficient battlefield treatment. (Booth 70)
Laudanum is a liquid made from opium and alcohol. Laudanum was a common sleeping medicine. The drug also acted as a painkiller, and a cough suppressant; laudanum also prevented loose bowels. As with opium, doctors neglected to inform patients on the addictive properties of laudanum; and many people of the upper class took nightly doses. Laudanum was also used to quiet babies. (Mitchell, Daily Life 202)
Drug Restrictions
The sale of drugs was not bounded whatsoever until 1868. 'Patent' medicines were sold through grocers, chemists, and other vendors. Other medicines were often purchased by mail. Almost every medicine contained large amounts of alcohol. Mrs. Yeobright in The Return of the Native was administered brandy before anything else was done, to dull the pain and discomfort. (268) " J. Collis Browne's Chlorodyne, advertised as a cure for coughs, colds, colic, cramps, spasms, stomachache, bowel pains, diarrhea, and sleeplessness-contained morphine, chloral hydrate, and cannabis. (Mitchell, Daily Life 202)
Surgery is often considered the one area in which Victorians made he most notable advances. Before Victorian times, the lack of anesthetic and antiseptic translated any wound that tore the skin into a terminal infection. Amputation and then cauterization was the only way to prevent a deadly infection. Any intentional incision into the body was therefore ludicrous until the practice of scrubbing hands and instruments became standard in the 1890s. Joseph Lister first championed antiseptic surgery in the 1860s, but not all doctors followed his example. After chloroform became widespread, surgery increased, as did doctors understanding of the need for cleanliness. Even when doctors were cleaning their hands and the instruments, however, bacteria was rampant, and it led to cases of 'hospital fever'. Regardless, the former low ranking surgeon was becoming the most skilled and respected practitioner by the turn of the century.
The majority of people in the Victorian age depended upon traditional remedies, herbal cures, and homemade prescriptions. Health advice was passed along by either a household manual or through word of mouth. Elderly women and certain servants had enough simple medical knowledge remedy most minor ailments. Following Mrs. Yeobright's snake bite in The Return of the Native, a classic home cure was applied. Sam came up with the old remedy of rubbing the adder sting with the fat of other adders, which is obtained by frying a fresh adder. Sam recalled this remedy from his father's own experience with an adder; a prime example of home cures being passed down from generation to generation. Even Olly Dowden, who is apparently a trained nurse, is aware of such a cure. (268)
Even on the estates of the rich, at least one of the servants would be versed in herbal medicine. Such a servant would make poultices, lance boils, and sooth coughs. This servant's knowledge and confidence served as a substitute for professional care. The household manuals however were often obsolete even when compared to the limited medical knowledge of the era. Almost any minor illness was immediately dubbed a cold and treated as such. Common causes of colds (for women), as described in the time, included sitting in a room without a fire and standing about in evening dress. Nearly all manuals blamed the majority of illnesses on bad air and bad smells. Although bad smell or bad air was often indicative of nearby, yet undiscovered, germs, this generalization proved more a hindrance to public health than help. Still, some of the best advice from manuals and doctors alike was a change of air. The seaside was often recommended to those patients who could afford it. Devotees of these manuals chose dwellings on higher ground, flushed sewers as often as possible and sealed windows to keep out the bad air. The trouble with flushing sewers was that they flushed directly into the nearby water supplies, further spreading any germs or bacteria. Furthermore, by shutting windows against night air, contaminated indoor air was trapped. Tuberculosis was spread chiefly in this fashion. (Mitchell, Daily Life 202)
Florence Nightingale penned a critique of this practice in her writings, Notes on Nursing, by Florence Nightingale (1859).
"Another extraordinary fallacy is the dread of night air. What air can we breathe at night but night air? The choice is between pure night air from without and foul night air from within. Most people prefer the latter. An unaccountable choice. What will they say if it is proved to be true that fully one-half of all the disease we suffer from is occasioned by people sleeping with their windows shut? An open window most nights in the year will never hurt any one. (Nightingale)
Hypnosis
Hypnosis was used particularly in the beginning of the Victorian era. Hypnosis stacks up surprisingly very well to the alternate anesthetics of the day. Hypnosis is painless, is associated with no side effects and does not alter the heart rate of the patient. The famed surgeon Jules Croquet performed an operation to remove a cancerous breast from a woman who was under hypnosis. The operation was perfect and painless. The obvious downsides to hypnosis are 1) not everyone can be hypnotized and 2) few people can be hypnotized into a deep enough sleep for a major operation. (Curtis 14)
Placebo Effect
Every prominent Victorian medical institution taught students that ninety percent of practicing medicine is comforting and relaxing the patient while nature takes its course. Books published in the time, such as Taylor's Holy Living and Dying described prayers, forms, conduct, and attitudes necessary to provide patients with confidence and inspiration. Often, the placebo effect, sometimes referred to as the sugar pill effect, was employed as the chief strategy in curing an illness. Queen Victoria herself had been known to touch the ill on their forehead, ridding them of illness, at least in their own minds. A popular Victorian tale describes a doctor approaching a very ill child every day with a candied peach. Always, after administering the candy to the ill child, the doctor would describe the magical effects of his all-curing medicine. The child was rid of disease. Victorian doctors mastered the art of placebo to such a great extent that even now medical students study famous Victorian 'placebists'. (Doyle 1)
Health Trends
Although infant mortality decreased and the life expectancy increased during the Victorian era, both measurements indicate terrifying rates. Babies were subject to disease, infections, and mistreatment (often they were silenced with a mixture of opium and alcohol). The public was susceptible to a wide array of disease, not to mention malnutrition and inhuman working conditions.
Infant Mortality Rate
The infant mortality rate is a sensitive measure of the Victorian Age. Generalizations about poverty, housing, sanitation, medical care, and public health can all be made with specific knowledge of the infant mortality rate. In the upper-class areas Liverpool England, 1899, 136 newborns out of 1000 would die before they reached the age of one. Working class districts maintained a rate of 274 infant deaths per 1000 births, and impoverished slums had a horrifying 509 infant deaths per 1000. Even as these rates improve towards the end of the Victorian Age, infant mortality remained at over ten times the current rates in industrialized nations. Alexander Finlaison reported that one half of all children of farmers, laborers, artisans, and servants dies before reaching their fifth birthday, compared to one in eleven children of the land owning gentry. (Mitchell, Victorian Britain 142) Children suffered from multiple influenza outbreaks, diphtheria, scarlet fever, measles, whooping cough, polio, tetanus, and typhoid. Merely keeping sanitary was difficult until the later ages of piped water. This combined with the lack of vaccinations for diseases produced an extremely high infant mortality rate in all classes. (Mitchell, Daily Life 192)
Life Expectancy
A second important indicator of a community's physical condition is the life expectancy. During the middle of the Victorian age, rural people lived longer than city dwellers, the rich lived longer than the poor, and men lived longer than women. Women died younger not only due to childbirth; women suffered from inactivity and from inferior food consumption. It was also primarily women who were responsible for nursing the sick; which inevitably led to their own sickness. Men participated in outdoor exercise, which had just recently taken hold in a movement dubbed the "games mystique". Society had delicate expectations for women, and as a result, it was not ladylike to have a heart appetite or abundant energy. Customarily the finest food was given to the men and boys of the family. In the lower classes, both men and women were debilitated by the age of forty. Long hours, poor nutrition, and premature full-time employment all contributed to a short life expectancy. (Mitchell, Daily Life 189)
The life span slowly increased within the Victorian age, as treatment became more advanced, surgery more effective, and knowledge more extensive. The average life span in 1840, in the Whitechapel district of London, was 45 years for the upper class and 27 years for tradesman. Laborers and servants lived only 22 years on average. (Mitchell, Victorian Britain 492)
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