Before I picked up some sort of virus that has had me down for the count for the better part of the last week, I’d been bandying about several ideas for a post. But then I finally went in to the doctor yesterday, and watched them perform a rapid strep test. The nurse swabbed the back of my throat, put the swab in a test tube with some liquid, and minutes later the doctor came back to see the results.
It was negative, as I knew it would be. I had strep so many times as a kid – once it even developed into scarlet fever – that I can tell when I have it now as an adult. It got me to thinking, though, how far medicine has come since the Regency era. Strep throat, caused by streptococcus bacteria, is cured these days with a rapid test and a round of antibiotics. In Jane Austen’s time, a throat or skin infection caused by streptococcus that devolved into scarlet fever could easily turn deadly, and outbreaks often caused multiple deaths in a village. So if I’d lived 200 years ago, it’s pretty possible I could have been one of those many children who died before reaching adulthood.
I find myself using readers’ modern knowledge of basic medicine to create irony in my stories, because for some reason it’s just irresistible to me. From a woman washing her hands before delivering a baby not because of fear of infection but because it’s important they be clean when she touches the mistress of the great house, to a physician chastising a woman that she ought to be drinking beer and wine rather than water distilled from sea water, there’s something enjoyable about deploying what I’d call modern medical irony.
Perhaps it’s a bit mean of me to mock physicians’ lack of medical knowledge back then, but then again, physicians were of higher rank in society than surgeons, but surgeons actually saved more lives. After all, there’s all the blood-letting, the theories of humours, the belief that disease is caused by miasmas or bad air, basically the generally wrong science behind the medicine these physicians practiced. Yet that may be painting physicians’ ineffectiveness with a rather broad brush. After all, by this era effective vaccination for smallpox was possible, and the forceps had been in use for many decades, likely saving countless lives during childbirth. The causes of malaria (disease-carrying mosquitoes) and scurvy (lack of vitamin c) may not have been known, but they could be effectively treated with Jesuit’s bark (containing quinine) and fruits or vegetables (usually lemon or lime juice at sea, although sauerkraut has also come up in my readings!). Although again, lack of underlying understanding of the disease and the cure meant that Jesuit’s bark was used not only to treat malaria, but pretty much anything else they could think of.
There is, though, evidence that there was at least some understanding of infection, which I hadn’t realised until I reread Frankenstein, published in 1818. There’ll be more on this book in a later post, but for now, this excerpt shows clearly an understanding that one person can infect another with scarlet fever:
Elizabeth had caught the scarlet fever; but her illness was not severe, and she quickly recovered. During her confinement, many arguments had been urged to persuade my mother to refrain from attending upon her. She had, at first, yielded to our entreaties; but when she heard that her favourite was recovering, she could no longer debar herself from her society, and entered her chamber long before the danger of infection was past.
Perhaps the most so far in my series, I’ve been drawing on modern medicine (including some google image searches not for the faint of heart) in A Season Lost. With multiple births occurring within the span of a very long book, it’s almost unavoidable, and I actually read Thomas Denman’s book on midwifery, which would have been commonly referenced by accoucheurs (also known as “man-midwife” physicians) and other physicians during that time, portions of which are even less for the faint of heart than my google searches. It’s not one of those births I’ll leave you all with as an excerpt, however, but instead an event that takes us back to what I began with…streptococcus. It’s mildly spoilerish in terms of what one of the plotlines will be in the book, but probably more cliffhangerish than spoilerish. In it, the Darcys are visiting Kent because Mr. Darcy wants to investigate water-cress, then being cultivated commercially in that county, and staying at Rosings:
As it turned out, Elizabeth liked the water-cress very much. She assumed Rosings’s cook had been warned in advance by Lady Catherine that a French water-cress soup must be put on the table that evening. It was, and was praised by both Mr. Darcy and Mr. Collins, although Mr. Collins’s praise was substantively more extensive and exuberant than Darcy’s was.
Elizabeth liked the soup well enough, but what she found she really preferred was the sallad. She had never favoured rich or heavy foods, and here was something of a very pleasing lightness and mildness. She liked it so well she asked Darcy to serve her more of it, and he gave her a sceptical look in return.
“I do truly like it,” she murmured in protest.
“Mrs. Darcy, Mr. Darcy, what are you speaking of?” asked Lady Catherine.
“I was just telling Mr. Darcy how much I liked the sallad, Lady Catherine. If your cook does not mind, I would like to get the directions for how it was dressed before we leave.”
“Oh yes, yes, of course. Cook minds what I tell her to mind, and you shall have your directions.”
“It is a most elegant sallad,” said Mr. Collins, who having not touched what little of it he had endeavoured to put on his plate, now attacked it vigorously. “I would not have thought to dress a vegetable in such a way, but it is a statement of your cook’s superiority, Lady Catherine, that she should do so.”
“Mr. Collins, are you well?” asked Elizabeth, for he seemed – even in the candlelight – to be very flushed.
“Mrs. Darcy is kind to ask, but I am quite well.”
“Your cheeks do have a little of the look of scarlet fever,” Elizabeth advanced, hesitantly. “We had an outbreak of in our neighbourhood, when I was young – two of my sisters had it.”
“Scarlet fever!” exclaimed Lady Catherine. “What nonsense! Scarlet fever is a wintertime disease.”
“True,” said Elizabeth, “yet I think our present weather is more like winter than anything else.”
“It is not scarlet fever,” Lady Catherine said, firmly. “Mr. Collins, do you have a sore throat?”
“I do not, your ladyship. My throat feels in perfect health, and I am honoured that your ladyship should condescend to inquire about it.”
“Scarlet fever always begins with a very bad sore throat. Now let us see your hands.”
Mr. Collins duly held out his hands, one of which showed a horrific rash.
“Scarlet fever!” Lady Catherine scoffed. “Mr. Collins has been out in his garden, and very likely got at some tansy, or something else which has clearly irritated his hands. He must have touched his face with his hands, and that became irritated as well. We have a salve from Dr. Gibson that will be just the thing; Mrs. Jenkinson can retrieve it for you after dinner.”
“Ah, yes, you are correct as always, Lady Catherine. I recall scratching it while I was working on the roses, and I had been pulling some tansy. Your ladyship is so insightful to have realised it so quickly – I am always telling Mrs. Collins that there is none so perceptive as your ladyship.”
Elizabeth did not press the subject any further, for Lady Catherine’s explanation did seem far more plausible than her own, particularly given the lack of a sore throat. But she remembered that horrible blotchy redness of Jane’s and Catherine’s faces, and could not think with certainty that Mr. Collins’s countenance did not match it. She stayed as far away from him as she could for the rest of the evening, and was glad Darcy did the same.