The Facts behind the Fiction
Bloodletting in 1860, one of only three known photographs of the procedure.[Wikipedia] Hello and welcome to my blog. Writing historical fiction involves an awful lot of research which informs the novel but isn't necessarily included in it. I want to share with you some of the fun facts I've learnt during the course of writing Shakespeare Cliff. SPOILER ALERT!!! If you intend to read the novel when it's published, please be aware that these posts contain excerpts and plot reveals. Given the current Covid situation, I decided that disease, illness and death would be good subjects to start with - morbid, maybe, but topical. Warning: if you're a little on the squeamish side, you may find some of this content disturbing. There are several characters in Shakespeare Cliff who have to put up with illness and it goes without saying that conditions were not as sanitary and treatments not as advanced as they are today. Childbed fever - Elizabeth Crouch The second chapter of the novel opens with Elizabeth Crouch on her deathbed: The doctor had diagnosed childbirth fever. A piece of the afterbirth festered in her womb and she would die within weeks if not days. In the illustration, a woman is being shown her newborn baby for the final time before receiving the last rites. [Engraving by A.H.Payne after C.Piloty - Wellcome Collection.] Known nowadays as puerperal sepsis, a term coined in 1716 by Edward Strother, childbed fever is an infection soon after childbirth caused by a streptococcus bacterium. The disease progresses rapidly with symptoms of abdominal pain, fever and weakness. Elizabeth knows she will die soon. She must put her affairs in order and write a letter to her daughter while she still has strength: At present her symptoms were mild: headaches, a pain in her abdomen, fevers and chills, which woke her at night. But her condition would worsen. The disease also affects lactation. Poor Elizabeth could not even nurse her newborn daughter: She glanced at the crib next to her bed, expecting to see her precious baby asleep, but the wet-nurse had taken her. Elizabeth’s own milk had dried. An understanding of infections and how they are transmitted was in its infancy towards the end of the 19th century. Childbed fever was widespread and feared. It was one of the many causes of death in childbirth. ‘In the 18th and 19th centuries, there were between six and nine cases for every 1,000 deliveries, resulting in a death toll during that span of as much as half a million in England alone.’ 1 [A blog on child birth coming soon.] In Elizabeth’s case it was caused by a torn placenta. The part of the placenta left in the uterus becomes infected a few days after the birth leading rapidly to blood poisoning. But childbed fever was often caused by lack of hygiene when doctors or midwives failed to wash their hands and unwittingly passed on infection from one patient to another. A doctor could come directly from examining a body in the morgue to attending a mother in childbirth without washing his hands. Statistically, you were more likely to get childbed fever from a doctor assisting the birth than a midwife. In Elizabeth’s day, 1881, there was no known cure and death was almost inevitable. Treatment included opium for the pain and bloodletting to reduce the fever: Elizabeth reclined in the chair and closed her eyes, steadying her breathing as the dull pain in her abdomen intensified into something she could no longer ignore. Her forehead felt hot to her touch. Time for more bloodletting soon. But there was no treatment available to kill the bacteria which caused the infection. With modern hygiene and antibiotics, thankfully, the disease is now comparatively rare. Duodenal ulcer – George Crouch Elizabeth meets her future husband, George Crouch at her father’s surgery in Sandwich. She writes in her diary: This was not our first meeting. For months, he has visited surgery. Papa’s reputation for curing complaints of the digestive tract draws patients from far afield. Mr Crouch’s physician will have referred him to Papa, having exhausted other avenues without success. Elizabeth is concerned to know what is the matter with her suitor: And what ails him that he has sought treatment from Papa? He looks in fine form. I hope he has no chronic and debilitating condition. Surely Papa would not affiance me to a potential invalid! Elizabeth’s sister Ellen is also keen to know all the details: Ellen’s eyebrows rose, and her jaw dropped. She wanted to know everything about him. I explained he was one of Papa’s patients whom she would not have met. Eager for gossip-worthy details, she asked what ailed him. Patient confidentiality prevented Papa from answering, but I too longed to know the severity of his condition before taking the courtship seriously. Papa assures Elizabeth that Mr Crouch is cured but she still has her doubts: Tea this afternoon was nerve-wracking. Eager to impress Mr Crouch with my culinary skills, I presented soft cod’s roe on buttered toast to start. He consumed a single slice. He is a neat eater. I wondered if his abstemiousness arises from his medical condition, though Papa has assured me he is cured. Perhaps he is not fond of cod’s roe but was too polite to decline. I suppose that is one challenge of embarking on an intimate relationship—getting to know each other’s likes and dislikes. I hope Mr Crouch doesn’t suffer too severely from indigestion. George has been suffering from a duodenal ulcer, another disease caused by bacteria, though not usually fatal. The symptoms include abdominal pain a few hours after eating and at night, bloating, blood in the faeces, sometimes nausea or vomiting. Nowadays duodenal ulcers can be investigated by endoscopy and treated with a range of sophisticated drugs but in the 1880s the treatment was confined to dietary advice and the use of antacids such as milk of magnesia. Drinking alcohol exacerbates the condition. As Elizabeth discovers after she is married, George now and again enjoys a drink too many. A growth on the lungs – George Crouch George recovers from his ulcer and lives to the ripe old age of 80 before dying of lung cancer. His daughter, Sarah, and he are estranged and she hears the news of his illness from a sister-in-law she bumps into in the town: “I met my sister-in-law in town, my brother Walter’s wife, and she said my father’s seriously ill. They’ve moved into the cottage to care for him. They don’t think he’s got much time left.” Since he’s clearly on his last legs, Sarah decides to visit him with her daughter Annie: “How is he?” Ma asked. “Well,” Walter said, “the growth on his lungs means his breathing’s not up to much. But you know Father—he’s a tough old boot. There’s no telling how long he’ll hang on.” “Is he in pain?” Annie asked. “He’s having laudanum for the pain,” Walter’s wife said, “so he’s drowsy much of the time. He’s due another dose soon. See him now, if you want any sense from him.” On entering the parlour, Annie heard stertorous, laboured breathing, like a saw rasping through hard wood. The sickroom was stuffy and dim, with a fire burning in the grate and the curtains drawn. A whiff of ammonia from the unemptied chamber pot permeated the room. Grandpa Crouch was lying on his back, the covers pulled up to his chin. Disturbed by their entrance, he stirred and turned his head towards them. Leon Michel Gambetta on his deathbed. Etching by Charles Renouard, 1883. [Wellcome Collection] George shows symptoms of advanced lung cancer – wheezing, shortness of breath and fatigue: He fell back on the pillow and panted, as though he had rushed up a flight of stairs. The conversation had exhausted him and he took a while to regain his breath. Annie listened to his rasping and watched his chest rise and fall under the covers, as he struggled to fill his lungs. She wanted to get away. Obviously, modern treatments of chemotherapy were unavailable in 1919 when George was suffering from this disease. They were developed in the 1940s. Radiotherapy was begun in 1900 but was not widespread until mid-century. Surgery to remove a tumour was one option. Although anaesthetics, introduced in the 1840s, meant surgery was less painful, most patients were not cured by it. A surgical operation to remove a malignant tumour from a man's left breast and armpit in a Dublin drawing room, 1817. Watercolour, 1817. [Power, Robert F. Credit: Wellcome Collection.]
For George, opiates to dull the pain were the only treatment. He dies a couple of months after this final meeting with his daughter and granddaughter in February 1920. Enough of this gruesome topic for the time being - more characters and their illnesses in the next blog. Good health to you all! Adrienne. Footnote: 1. Emily Baumrin, William Corbett, and Amita Kulkarni, Dartmouth Medical School, 2010 Sources: 1.The Attempt to Understand Puerperal Fever in the Eighteenth and Early Nineteenth Centuries by Christine Hallett PhD. 2. Childbed fever: A Nineteenth-Century Mystery by Christa Colyer School of Science University of Ontario Institute of Technology 3. A comprehensive history of cancer treatment by Nigel Hawkes.
2 Comments
A. Sandomirsky
12/10/2020 08:09:17 pm
Thank you for the riveting descriptions of the health issues faced by previous generations, and the "cures" that many faced. I find your writing style very enjoyable to read. Your words paint pictures. Looking forward to the publication of the first book in this series.
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Adrienne Terblanche
12/11/2020 02:53:30 pm
Thank you for your encouraging comment.
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