In the late 1700s, medical professionals believed that disease was caused by “evil in the air” known as Miasmas. Medical physicians often wore masks during their contact with patients so as not to breathe in the “bad aromas”. The public often closed their windows at night to keep the bad aromas out, since it was believed the aromas were more prevalent at night. In Jane Austen’s novel, Emma, Emma’s father, Mr. Woodhouse, rarely went out at night since he was preoccupied with his health.

Draining of fluid from a sick person was common since it was thought to balance the four bodily fluid elements. Leeches were used to drain the body of blood. Inducing vomiting and the use of enemas were popular. Sea bathing was recommended to reduce stress and cure chronic disease. Ointments were made from honey and mint and were oftentimes successful treatment modalities.

There were four classes of medical professionals. Physicians were gentlemen who had several months of non-patient training. They made house calls to the wealthy;, listening to patient’s lungs and taking their pulses and medical history. They prescribed medication. They did not perform surgeries. Surgeons had no formal training. They did manual work such as bandaging, amputations, and blood letting. Many barbers were surgeons. There was ineffective anesthesia at this time and hygiene was very poor. Antibiotics did not exist. Most patients died of infections rather than the disease itself. The Royal Navy employed surgeons rather than physicians on their ships. Apothecaries were not well respected. Apothecaries treated the poor and servant class. They treated their patients with herbal elixirs. Most medical treatments were trial and error. Medical manuals did not exist. Women were nurses, herbal healers and midwives. They were regarded as the “lowest” level of medical professionals. Midwives were kept very busy by the aristocratic class since most women in this class had at least eight children. (Abstinence was the only form of birth control.) Labor rooms were heated and new mothers were bed bound for weeks on a liquid diet which weakened their immune systems. There was a high rate of mortality during childbirth for mother and child.

Hospitals were very unsanitary. There were separate hospitals for eye ailments, dementia and venereal disease. Hospitals were filled with plagues including tuberculosis (consumption). The wealthy were treated at home, not in hospitals. Common reasons for ill health included obesity, gout, hernias and bone fractures. Contagions included cholera, tuberculosis of the lungs, smallpox, typhoid fever, typhus and yellow fever. (It is believed that Jane Austen had typhus as a child.) Better sewage, hand washing and more living space could have reduced contagion spread.

Florence Nightingale and Ignaz Semmelweiss were heroes during this time. They brought proper hygienic methods, including hand washing to the forefront reducing deaths from infection.

I want to thank Dr. Elizabeth Paquette from the Jane Austen Society of the Palm Beaches for this wealth of information.