18 October 2016

Do you want to know more about disease and medicine in Victorian times?

my Tuesday Talk Guest Katherine Tansley

So if you are interested in Victorian medicine - or indeed,m anything Victorian...
you may be interested in my novel The Doctor of Broad Street, which paints a vivid picture of Victorian London. 

Over to you Katherine:

In those often romanticised days when the young Queen Victoria took the throne, dresses were full, tankards brimmed with porter, life bustled with energy and optimism as the Empire grew and the industrial revolution gained momentum. It seemed the English could conquer the world. However, closer to home lurked dangers which could strike a man in an instant, and from which no stratum of society was immune. Disease stalked the streets and death was an everyday, indiscriminate occurrence.

So what do we know about disease in Victorian times? We know about health in the past from early attempts to record disease patterns. As early as the 1660s, John Graunt published his book Observations on the Bills of Mortality, in which he attempted to analyse the mortality rolls introduced by Charles II to warn of bubonic plague. Analysis and recording of disease took a great leap forward during Victorian times, when William Farr joined the General Register Office to collect official medical statistics in England and Wales. He set up a system for routinely recording cause of death, which has evolved over the decades into the Office for National Statistics. Today ONS collects and collates data about births, deaths and a myriad of other aspects of the human condition.

The Victorian rich had access to physicians, the most highly trained of medical men (and they were all, as yet, men), who had studied in a university, completed apprenticeships in a teaching hospital and passed the examination for the Royal College of Physicians. However, their services came at a cost and the poor relied on apothecaries, who could advise on complaints and dispense medication, or general practitioners who were apothecaries with additional surgical training. The mainstays of treatment were laudanum (a derivative of opium) and emetics or purgatives, poultices, ointments and liquids of varying composition and efficacy. However, in truth, often a visit from the priest was as effective as anything else and the carpenters and grave diggers made a sound living.

So what did the Victorians believe about the causes of disease? Since the days of the ancient Greeks and Galen and Hippocrates, it was thought that disease was caused by an imbalance of four ‘humors’ or bodily fluids: black bile, yellow bile, phlegm and blood, and this belief persisted, largely unaltered, for many centuries. Excesses of humors were derived from inhalation or absorption, and deficits from loss of body fluids. Treatments were aimed at normalising an excess or deficit, by blood-letting or purgatives, or the application of appropriate herbs or diet to restore balance. By Victorian times, the theory of miasma (bad airs) was widely believed.

This stated that miasma was inhaled and this led to generalised constitutional changes in the body which produced symptoms. The poor and morally degenerate were believed to be more susceptible to the effects of miasma. Microbiology was in its infancy and there was no appreciation of the fact that each disease is caused by a different specific pathogen (for example, a bacterium or a virus) which acts directly on body tissues to produce symptoms. To the Victorians, when the miasma was bad, disease could strike. Furthermore there was no concept of transmissibility of disease; they believed that if one person became ill, their neighbour might do so too, by breathing the same miasma.

So what diseases afflicted our Victorian ancestors? Before the days of vaccination, and the appreciation of the importance of sanitation and hygiene, microbes had free rein. Smallpox, tuberculosis, scarlet fever, cholera, typhoid, and diphtheria were all rife, as were what are now considered preventable childhood illnesses like measles, mumps and rubella (German measles). In prisons, gaol fever (typhus), was common. Syphilis and other sexually-transmitted diseases ran riot among prostitutes and their clients.

Most diseases were endemic and the ever present threat provided a backdrop to everyday life. However, some diseases occurred in epidemic, and people lived in fear of terrible outbreaks of fatal disease. This was particularly the case with cholera. The first devastating cholera epidemic in England occurred in 1831-2, when Asiatic cholera swept eastwards through Europe to hit England. This was followed by a second major epidemic in 1848-9 and a third in 1854. London, with its burgeoning population and overcrowding, was particularly badly affected. Each epidemic killed tens of thousands of people, devastating whole streets and communities, before the miasma seemingly moved on and the epidemic waned. The sanitarian movement believed that the way to prevent such epidemics was to improve drainage and sewerage, to remove the noxious smells from the streets. 

Work was undertaken linking open drains and cesspits to sewers, which drained into the Thames.
It is at this point in 1854 that The Doctor of Broad Street (Troubador publishing) is set. It tells the story of one man’s work to discover the cause of a cholera epidemic and it is based on a true story. Frank Roberts is a doctor working with the poor in the squalor of Victorian London, who finds himself drawn into a murder investigation. Before long, his efforts to clear an innocent man are overshadowed as a deadly cholera epidemic sweeps the streets. He works with his friend, the real life anaesthetist Dr John Snow, to discover the cause of the epidemic, as he battles to save his patients and help the accused man. Thoroughly researched and attracting positive reviews, it is a story of tenacity and perseverance. The Doctor of Broad Street is available on Amazon, Troubador, or to order through book shops, and it is also available as an e-book. If you want to feel and understand the terror of cholera in Victorian times, this could be a book for you.

I studied medicine at Oxford and qualified as a general practitioner before training and working in public health medicine, in which John Snow is an iconic figure. I have always loved historical fiction which informs and entertains. I live in Cambridge with my husband and three children.

As I set off for home to get my bag, I could not help my gut clenching in fear at the prospect of the cholera returning to our shores.”
Dr John Snow

11 October 2016

1066 re-enacted

The14th October 2016 is the 950th Anniversary of the Battle of hastings (which was actually fought seven or so miles from Hastings at a place which, back then, was merely a nameless hillside meadow  bordered by thick woodland on one side and deep marsh on the other, and the track from the coast to London marcging up through it. 
Today, the place is called Battle...
The Place of Battle...
A Re-enactor's View of The Battle of Hastings 
    by re-enactor Man At Arms Phil Berry

I reenact 15th Century battles. The Hundred Years War, and War of the Roses etc. But as a Man at Arms, I'm interested in all historic combat, including that not insignificant Battle of Hastings, which took place quite near where I live! Until the advent of effective modern firearms, the basic elements, i.e. weapons and tactics, with occasional modifications, remained the  same.   While helping my Dark Age friends, at the annual 1066 Battle of Hastings re-enactment, I naturally take great interest in all things martial.

Saxon, Viking, and Norman re-enactors are scrupulous about their accurate living history standards, and the quality displayed in their camp set-up, and equipment, is very high.  On one occasion  my job was to assist my friends to don their mail hauburks, helmets, and weapons.  Armour has always been heavy, and mail armour is no exception. My friends in this instance carried a  heavy load. Their mail, depending on whether it was a full length hauburk, or a shirt, could  be as heavy as my 15th century plate armour ( 5/6 stones) when worn over a padded gambeson. A full length hauburk would need to be additionally supported at the waist, otherwise the full weight would be born on the shoulders of the warrior.

Next, belt on a sword, seax (long knife) and strap, so that his shield may be worn on his back if necessary. My Saxon friends bore kite shaped shields, in which respect they differed little from their Norman counterparts. There is some speculation that the few round shaped shields depicted on the Bayeux Tapestry may have been trophies from the recent victorious battle by the Saxons over the Vikings, at Stanford Bridge. So at this point, with heavy mail armour, shield, weapons (a spear is very handy too) and helmet, our warrior is going to know all about the uphill walk to the battlefield!

The photo of me, on a photo shoot for Pevensey Parish Council, representing a Saxon housecarl, with light mail (minus a gambeson - it was a very hot day on the beach!) 

photo shoot for Pevensey Parish Council
The second pic is of my friend Adrian Pinn, who is much more authentic, and is dressed appropriately as a Norman lord. He will be leading his men at the 1066 re-enactment. As you can imagine he is carrying considerable weight.

As part of the support team I wound my way up, with my friends, to the site of the re-enactment, below Battle Abbey, passing on the way a very impressive troop of Norman cavalry, resting under the trees. Half way up to the battlefield, on a small grassy knoll, a group of foot soldiers were engaged in practice swordplay (which held my attention for a bit!). A good ploy, if you work with an axeman, and the opposition has shields, is for him to hook a shield down with his axe, and expose the man behind to your sword, or spear.

Good move!
I blocked the Norman spear thrust, and had this been
 for real would have taken his arm off! 
So with my band of sweating soldiers, we emerged into the area that the public get to see - the battlefield, and living history encampment. Sited just below the abbey, and above the battlefield, the living history encampment is always a fascinating place to look around, so are the traders.

Given what I have already said about the heavy load of a warrior (or in this case a re-enactor) the Normans had to advance up the hillside to meet the Saxons which made this effort even harder. Not so bad for their cavalry though. Speaking to a Norman cavalry man, on a particularly wet and muddy occasion, I was surprised to learn that the slippery hillside presented no problem to him, as the horse's hooves sank into the mud, and gave it grip. Not so my shoes! I had been reading up on medieval cavalry prior to this occasion, and discovered that a warhorse in the medieval period was typically only 14 1/2 hands, which, I am told, by today's standards is pony height. What made it special was it's powerful, muscular build, and I saw a pair being led into the paddock, which fitted that description perfectly. I didn't have time to ask just then, but someone had obviously taken authenticity to a commendable length.

although the Exmoor
 is not the right height for 1066 mounts,
they do give an idea of the stocky, sure-footed mounts
used by the Norman cavalry
It is hard not to view the Battle of Hastings without preconceptions, except that I know that if we accept the Saxons occupied the high ground, there are self evident forms of attack the Normans must make. In order to show the Norman cavalry in action to the public, in the close confines required for a re-enactment, they normally make a frontal assault. This may work on level ground, but uphill, they  would take a lot of casualties trying to break through the Saxon shield wall, not least from spears and other missiles thrown with the advantage of being uphill, so it is unlikely. Given the fact that the battle lasted all day, I would say the Norman cavalry must have probed the Saxon flanks continuously, and repeatedly assaulted the shield wall on foot. The Saxons were famously lured into chasing the fleeing Normans (a feint) [Helen: I disagrees, I don't think it was a feint, I think they were fleeing - but William took advantage of it.] and thereby breaking ranks, and the Norman cavalry  exploited it. This may well have been the beginning of the end. [Helen: I don't agree with this either - more men would have been arriving during the day to re-inforce the shield wall] 

It  was a grueling battle, as evidenced by the fact that most later medieval battles were over in one to three hours, and this one took all day. Fighting in armour on foot is hard work. Even for the most skilled and fit. Three minutes of full-on effort against an opponent is taxing. It must have been one of the advantages of the shield  wall, that as long as it held, the effort was shared.

It is often said, that in a battle situation you must endeavour to kill your opponent in three moves, or risk being killed, whilst occupied, by one of his friends. But in truth the Norman advantage must have been the maneuverability of their cavalry, and the static formations of the Saxons.

The annual 1066 re-enactment is well worth seeing, and this year's event - October 15/16th - is the 1066 950th anniversary, so it should be special! 

(Titled I Am The Chosen King in the US)

Helen: unfortunately for the first time in about ten years I will not be there at Battle. Instead, I will be at Waltham Abbey for King Harold Day on 8th October (at the Museum in Sun Street) and on 14th October I will be celebrating the 950th anniversary live on Radio Devon with David FitzGerald!

Harold is crowned King
Halley's Comet
what if Hardrada had won?