In the last Madeira Mondays post, we looked at a really riveting Young Adult novel: Fever, 1793 by Laurie Halse Anderson. If you didn’t catch that post, this great little book is historical fiction, inspired by the outbreak of Yellow Fever in Philadelphia in…1793 (as it says in the title!). For this week’s post, I had planned on diving into the real history behind yellow fever: what it is, how it spread in the 18th century, and what doctors used to treat it. However, I realized that I couldn’t really talk about that without first doing a brief overview of 18th century medical knowledge in general. Which is a really fascinating and complex subject in itself!

So before we zoom in more specifically to yellow fever (which we will do in the next Madeira Mondays) – I wanted to start with the basics. (As I always mention, I’m not a historian, and I’ll link some books and articles below if this is something you’re really interested in and want to look at even further!).

Here are some key things to know about how people thought about health and wellness in the 18th century.

1 – This is a world pre ‘germ theory’

What is germ theory? It’s basically our current scientific understanding of how many diseases spread. Tiny wee microorganisms known as ‘germs’ invade our bodies (or animals’ bodies etc.) and then they grow and reproduce inside us and make us get sick.

This might sound really, really basic (like Elementary School level basic) to you, but if you think back to the 18th, this is NOT how people understood disease. Most people didn’t know about germs. Instead, most people believed in the now obsolete medical theory of miasma aka ‘bad air’. Basically, they thought that bad smells from dirty, decaying matter made you sick. This article from The Science Museum in London explains more about miasma (it’s about the spread of cholera in Victorian London, but the definition still applies):

In miasma theory, it was believed that diseases were caused by the presence in the air of a miasma, a poisonous vapour in which were suspended particles of decaying matter that was characterised by its foul smell. The theory originated in the Middle Ages and endured for several centuries.

So people kept their houses and themselves clean, opened windows, washed floors etc. to prevent miasmas, not to get rid of germs. (And that’s why plague doctors wore those horrifying bird-like masks. Their masks were stuffed with herbs to prevent them from inhaling the bad air).

People did also understand that you could get sick by just being around other people who were sick – not just from inhaling ‘bad air’. They had evidence right before their eyes, after all, that those who spent time with sick people often got sick too! That’s why during times like The Black Death there were quarantines in place and strangers banned from entering plague stricken towns etc. But it wasn’t until the mid to late 1800s when people like Louis Pasteur started making some headway in understanding and identifying microorganisms. By the end of the 1800s, germ theory was basically accepted and able to account for why diseases spread both through the air and through person to person contact.

All this is to say, basically, that during the 1700s people often did things that were ‘right’ in terms of preventing diseases (staying away from those who had them, cleaning surfaces etc.) but they didn’t always do them for the right reasons.

BUT SOMETIMES THEY ALSO DID THINGS THAT WERE VERY, VERY BAD FOR THE BODY…

2 -Balancing the humors

Squeamish readers beware! Blood talk ahead…

The other thing I wanted to mention about 18th century health and medicine is the humors. (Maybe you know where this is going). Basically, people believed that our bodies were made up of four humors: Blood, Yellow Bile, Black Bile, and Phlegm. It was thought that the humors affected our health and our temperaments as well,  so someone who had too much blood was passionate, optimistic, energetic etc. (We still have the word sanguine. In French, coming from the Latin root, sang means blood). Someone who had too much phlegm was more peaceful, calm, cold etc. (see: phlegmatic).

ANYWAYS, a lot of prominent doctors in the 18th century (including Benjamin Rush, who was one of the the best doctors in the American colonies) believed in bleeding patients to get rid of the pestilence in their bodies and to balance out their humors. This is just as grizzly as it sounds. Doctors would cut into patients and ‘bleed’ them. (As a side note, George Washington was famously more or less bled to death, and if you want to read more about THAT grizzly story, you can check out this article).

All of these beliefs – miasmas, the humors – were around in the middle ages too, it just lingered into the 18th century and was really only replaced with new theories and understandings in the 19th century.

3 – The era of home remedies

A third thing to keep in mind, before we talk about yellow fever in the next Madeira Mondays, is that this is a time when people (usually women) were called upon to treat diseases at home in early America. This wasn’t just because physicians were expensive, it was because they were often far away, in the cities, so you just had to do your best out there, wherever you were.

Wealthy women could buy medicine cabinets which were stocked with labeled bottles to treat anything from colds to sleeplessness. (For more on medicine cabinets, see my post about the bedroom in The Georgian House where I volunteer.)  But of course there were also known home remedies passed down through generations, like herbal teas that you might drink for certain ailments, with herbs from the garden.

If you wanted, and if you were literate, you could also get a book like Domestic Medicine: or A Treatise on the Prevention and Cures of Diseases by Regimen and Simple Medicines, with an Appendix containing a Dispensary for the use of Private Practitioners, by William Buchan. This book (which you can read in its entirety here) #1 has an incredibly 18th century title and I love it. #2 Was really popular in the 18th century, in Britain and the USA. Buchan was from Edinburgh (yay!), a site of medical expertise at the time. It provided instructions for housewives to treat their families and their servants. In it, you can find remedies to treat the measles, to treat coughs, to treat various types of fevers, as well as instructions on how to treat the ‘passions’ such as love, fear, grief and ‘religious melancholy’. (The remedy for a lot of these mental ailments, by the way, is: distract yourself!!)

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Okay, so those are the basics. The very, very basics.

As I mentioned, I’m not a historian, and there is so much more to all these topics. I just think these things are so interesting (bodies, health…) and something I want to stress is that these people were doing the best they could with the knowledge they had.

I always cringe a little bit when people talk about the past and smugly mock historical people for their ‘backwards’ ways (‘Hah ha! The fools!‘). I don’t like this because I’m so conscious of the fact that in 50, 100, 300 years we will be those fools, and our understandings of medicine, science, technology will seem woefully silly and backwards. So, just a reminder that they were doing their best. And even without our modern technology, they often figured out treatments and things that worked well (for instance: people knew about the benefits of exercise and how that improved your mental and physical health!). And their physicians were doing research and gathering information that would lead to some of the medical knowledge we have today so…thanks guys.

Next week, we’re gonna zoom in on Philadelphia and yellow fever. Until then, I hope you have a nice week and are staying safe, warm, and healthy.

Did any of these beliefs (miasmas, humors) surprise you? What topics within early modern health would you like to know more about (smallpox? sanitation? hospitals? birth?)? 

Recommended Further Reading:

• Domestic Medicine by William Buchan (an 18th century home medicine guide). Read it here on Google books.
• Revolutionary Medicine: The Founding Fathers and Mothers in Sickness and in Health by Jeanne Abrams (also featured in the wonderful podcast Ben Franklin’s World, Episode 5, here)
• ‘Five Things You Should Know about 18th-Century Medical History’, from Colonial Williamsburg
• ‘A Taste of Early Modern Medicine’ from the University of Cambridge, a short article about an exhibition of 17th century home remedies books

‘Madeira Mondays’ is a series of blog posts exploring 18th century history and historical fiction. Follow the blog for a new post every other Monday and thanks for reading!