#roupell cup | Explore Tumblr Posts and Blogs

thethirdromana · 5 months

Text

Given how relevant it is to the current epoch, I did a bit of reading into treatment of typhus in the 1840s. TL;DR: oh god, poor Marian.

Content warning: discussion of grim historical medical practices.

The Woman in White was written in 1860 and set in 1849-1850, which is right at the beginning of germ theory. It was only widely accepted by the 1880s. All the doctors in the Woman in White most likely believe in miasma theory; they aren't aware that typhus is a bacterial infection.

Mr Dawson prescribes a "saline" treatment. A Short Treatise on Typhus Fever, by George Leith Roupell in 1840, recommends "saline substances" and refers to "their agency in rendering the blood florid, and duly stimulating the heart and other organs." In practice:

Salts are the combination of acids with salifiable bases; those recommended by Huxham, are carbonate of potassa or sesquicarbonate of ammonia with lemon juice and nitrate of potassa

I don't really have enough medical knowledge to judge but this doesn't seem obviously harmful? Or even if it is... not compared with some of the alternatives below.

The History, Diagnosis, and Treatment of Typhoid and of Typhus Fever by Elisha Bartlett in 1842 runs through the treatments available.

Dr Jackson of Boston suggests complete bedrest, an emetic and enema, and if "vomiting and purging" aren't followed by great relief, bloodletting. Tartarised antimony (a strong emetic) should be given every two hours in increasing doses and the bowels kept open. If the patient has diarrhoea, they should be given opium. However, if the patient has advanced to the second week of the disease, none of this will be effective. Food should be very limited and bland.

Dr Nathan Smith thinks no treatment should be given if the disease seems to be running its course naturally. (Phew). There should be bloodletting of up to half a litre of blood only in severe cases of uncommon pain in the head. He would also recommend emetics only in cases of nausea and only the use of gentle laxatives. Mercury shouldn't be used. However, the most effective thing is to uncover the patient's body and sprinkle it with pure, cold water.

Chomel in Paris mostly favours refreshing drinks, emollients, sponging the body with vinegar or water, "mucilaginous injections" several times per day, and moderate bleeding at the onset of fever. In cases of severe pain, he suggests leeches. But if the disease is severe or inflammatory, the patient should not be allowed any food (even in liquid form) and there should be more bleeding and more leeches. He also suggests "cinchona, wine, camphor and ether", thinking that cinchona is better than quinine.

(I think this suggests that Fosco is right about experts recommending "brandy, wine, ammonia and quinine".)

Louis says much the same as some of the others. He doesn't think bloodletting is particularly effective but recommends up to half a litre "once or twice" anyway. He is in favour of quinine.

Bouillard is also in favour of bloodletting:

The number of his bleedings varies from one to five or six, of from twelve to sixteen ounces each; and nearly or quite an equal quantity of blood is taken from the patient by means of leeches or cups.

Unless "ounces" means something wildly different here (and the British fluid ounce, US fluid ounce, and ounce of blood by weight aren't that different), this means a maximum blood loss of 96 ounces or... 2.8 litres?? That's about what was taken from Byron when he died, and in all likelihood it contributed to killing him.

All this leaves me with no idea what message we're supposed to take from this chapter. Mr Dawson's approach does seem to be old-fashioned compared with what Fosco proposes. Some contemporary doctors would agree with the new physician, but others would think him dangerously hands-off. Maybe we're just not supposed to know what the correct approach is.

But from the perspective of medical knowledge that there's no way Wilkie Collins could have had, Marian is lucky to be alive.

#woman in white weekly #historical context

4 notes · View notes