Regency Medicine Part 2

Part 2

Medical Practice

Most doctors in the Regency era were surgeons of the older sort, those who had learned their craft through apprenticeships and hands-on experience. They served villages and towns, and in most areas of London too.  However, “physicians” would be the medical professionals sought after by the ton for their greater training and expertise (and price).

The life of a physician back then was considerably different than experienced today. For one thing, a medical career didn’t put a doctor squarely in the elite as it might today. A few were knighted, mostly for doctoring the royal family or for coming up with some important medical advance.  But few physicians would be invited to ton parties, except those perhaps who tended to the duke or the countess and might be needed in a crisis.

He could make an adequate living, equivalent perhaps to that of a seacaptain (300 pounds a year), or if a specialist or “consulting physician” earn considerably more, up to 2000 pounds after the Regency. But physicians didn’t become wealthy then, for theirs was a mostly retail practice—housecalls to sick patients, holding “surgery” for those able to walk in to the office. Payment was generally by the incident (sometimes with barter of farm goods or other services). But some physicians had something of a “subscription practice,” what we’d now call “concierge medical treatment,” where the richer families paid a fee per annum to keep him on retainer.

A slightly later (mid-century) account of a young physician’s practice can be found in

Middlemarch, where the promising young doctor Mr. Lydgate is thought to have married “up” when he weds the daughter of minor (untitled) gentry.  As he was just starting his practice in a new town (rather than taking over his father’s or uncle’s or mentor’s practice, which was more common), he has to woo the landed families in the area, sometimes seducing them away from established physicians. Though Middlemarch takes place a few decades after the Regency, its account of a village surgeon tells of a life similar to that of Regency practicioners.

Physicians and surgeons did have privileges (as now) in hospitals. However, most hospitals were in the cities, and seldom used by the majority of the populace. In fact, they were long considered sources of contagion. Just superimpose a Google map of hospitals in London over the map of old London. Most hospitals are, even now, outside of where the old City gates would have been, because they were where plague, TB, and other infectious patients would be sent.

Most doctors in the Regency era practiced in villages and towns, and seldom visited a hospital. Many did try to keep up with medical advances, such as they were in that time before the “age of miracles,” before medicine became a science.

Medical Learning on the Job

The great 17th Century doctor William Harvey famously told his students, “Don’t think, try.” This advice demonstrates how doctors in the centuries before the great modern advances still managed to practice good medicine and even cure diseases.

The network of physician correspondence and medical journals of the period shows the Regency patient or physician was not relegated to leech applications and mustard poultices. In fact, without ringing the Walgreens to order up a Cipro prescription, a Regency-era physician had plenty of tools at his disposal (yes, they were almost all “him,” but there were women nurses, midwives, and healers then).  Just remember, though, that medical knowledge was mostly inductively attained then, through experience, observation, and experimentation.

“Inductive” means making conclusions from evidence.  For example (going ahead a couple decades), Florence Nightingale used the evidence of many battlefield hospital deaths by infection to start an experiment of “clean water and clean hands”.  Just that technique cut deaths from 42% to 2% in four months, an outcome striking enough, and visible enough, to get her discoveries published and promulgated. However, she would probably not have been the first health care worker to have noticed this. So yes, a Regency doctor could certainly wash his hands between patients. He might not know exactly why, but he’ll know it helps save lives.
Another example, reported by Robert and Nancy Mayer, is the treatment of scurvy by ships’ surgeons in the Royal Navy. Some ship surgeons noticed how sufferers craved green vegetables, and correctly supposed that filling up on fresh produce during landfalls would cure the disease. Other surgeons, trying to figure out how to maintain health during long voyages, settled on citric juice and crystals as easily preserved nostrums.  They didn’t have to know much about vitamins to observe the health benefits of fruits and vegetables.

Physicians of this pre-modern period were always observing and sharing realizations and revelations in the Regency-equivalent of an internet list, the formal journals put out by medical societies and the informal networks of posted letters and reports. For example, the letters of Edward Jenner (the small pox guy) show that he was constantly sending and receiving letters from other doctors speculating about medical issues and reporting on observations. In one letter, Jenner anticipated (in the 18th century!) modern cardiology when he traced heart problems to arterial narrowing. Many of these informal physician correspondences are collected in medical school libraries and the Royal College of Physicians.

Medical journals were also sources of information and research for doctors in the Regency period. However, these journals could be expensive, so poorer doctors might share a subscription and post the issues back and forth. A scanned copy of the very first (1809) issue of the Journal of the Royal Society of Medicine “Medico-Chirurgical Transactions” can be found here at the NIH’s Pub Med Central, which has been digitizing millions of pages of medical journals. This includes an article titled “A case of violent and obstinate Cough, cured by a preparation of Iron“.  The Royal Navy surgeons, who were responsible for the health of a hundred thousand seamen, had several journals for reading and reporting. Even more common was the circulation of surgeons’ logs and private journals. Accounts of these have been collected in the British National Archives.

Doctors also learned by experimenting, sometimes to the detriment of the current patient.  Stephen Maturin, the ever-curious physician in the Patrick O’Brian “Aubrey” series (a must read) once reported to his captain about a “successful” surgery where he and another surgeon had tried out a new technique in opening up and stitching together a wound. Captain Aubrey said gladly, “Mr. Brown came through, then.” But Stephen shakes his head. Well, no, the patient died—but the operation was still a success, because they’d learned from it.

In fact, earlier medicine tends to come to the right conclusions for the wrong reasons—keep that in mind when you want to have the physician explain his miracles. The medieval concept of “bile,” for example, turns out not to be so determinative, but the physicians then were certainly correct that certain bodily fluids could transmit disease.  Use this “right for the wrong reason” to help your doctor soothe his patients. For instance, the novelist Umberto Eco has two madhouse doctors discussing a profoundly hypochondriac patient. These doctors believe in the late 19th C magnetism therapy, where a steel rod is placed against the flesh of a patient to “attract” the disease away from the body.  Of course, we would think of this as a big scam, but guess what? It worked. Why? Those doctors didn’t know what the “placebo effect” was, but the “double-blind placebo” has always been a solution to some mental illnesses. If both the doctor and the patient believe this will work, well, why not try it?  Maybe the “cure” is psychological, but maybe the illness is too.

Go to Part 3.