Medicine and medical therapy during the Regency era fascinate me. Perhaps that isn’t surprising, considering that I have worked with physicians and physician-researchers throughout my career. Unlike Jane Austen and everyone else of her era, however, I have enjoyed the curative powers of modern medicine. I believe, for instance, that penicillin saved my life when I was a teenager, and when I fell ill with the Hong Kong flu while in college, two little white pills broke my fever of 105 degrees, thus preventing any serious consequences. Good fortune, indeed. People living during Jane Austen’s day were not so lucky.

A representation of the cholera epidemic, 1831 (Source: Wikimedia Commons)

A representation of the cholera epidemic, 1831 (Source: Wikimedia Commons)

Miasma Trumped “Disease Seeds” in the 16th Century

From the time when humans huddled in caves, right through the Regency and into the Victorian era, there was no germ theory of disease. As a result, there was no real understanding of what caused disease and how to cure people of what ailed them. For centuries the belief that poisonous, foul-smelling air or miasma caused disease was firmly entrenched, being especially popular during the Middle Ages. Even in the 1850’s the spread of cholera in London and Paris was blamed on miasma.

Portrait of Girolamo Fracastoro by Titian (Source: Wikimedia Commons)

Portrait of Girolamo Fracastoro by Titian (Source: Wikimedia Commons)

The idea that diseases could be transmitted by tiny “seed-like entities” was first proposed by the 16th-century Italian physician and scholar Girolamo Fracastoro. In his 1546 treatise on contagious diseases and their cure, he wrote that tiny particles could cause disease either directly or indirectly and over long distances. He believed that clothing and linen bedcovers and the like, while not contaminating themselves, could promote the “essential seeds” of contagion. (He is also credited with giving a name to the “French Disease”: syphilis.) Sadly, Fracastoreo’s remarkable idea did not gain traction for some three hundred years, when Louis Pasteur began his experiments in the 1860’s.

“Animalcules” in the 17th Century

Antonie van Leeuwenhoek also met with skepticism. A Dutch draper by training and scientist by inclination, van Leeuwenhoek (1632-1723) is known as the Father of Microbiology. He fashioned his own microscopes (he made more than 500) to study microorganisms (bacteria and protozoa)— what he called “animalcules” — in pond water. He also studied bees, lice, blood vessels, sperm cells, muscle fibers and mold. His early correspondence with England’s Royal Society garnered some credibility, even though he had no formal scientific training, but when he wrote of his observations of animalcules, his findings were met with ridicule and scorn. Such is the progress of science. His descriptions of minuscule animalcules stunned and startled because nobody had ever seen such creatures before.

van Leeuwenhoek once said: “All the people living in our United Netherlands are not as many as the living animals that I carry in my own mouth this very day.”1 No wonder his fellow scientists were aghast: they had never imagined invisible critters thriving in their mouths. Today, of course, his contributions to the advancement of science are widely recognized.

Sketches of van Leeuwenhoek's microscope, 1756 (Source: Wikimedia Commons [PD-1923])

Sketches of van Leeuwenhoek’s microscope, 1756 (Source: Wikimedia Commons [PD-1923])

Miasma in the 18th Century

The idea that “animalcules” might cause disease carried no weight in Jane Austen’s day. Rather, the prevailing theory of disease contagion was miasma — the centuries-old belief that disease was caused by polluted air arising from the rotting of decaying organic material such as corpses, cesspools, swamps and garbage dumps or from noxious air breathed out by sick people. During the Regency era most medical practitioners believed that diseases were spread by miasmas.2

Seeking to read what Regency doctors thought about the causes of disease, I turned first to Dr. William Buchan’s 1811 edition of Domestic Medicine. His opening volley stunned: “almost one-half of children born in Great Britain die under twelve years of age.”3 Only think of it! What an awful, incredible statistic.

Buchan’s ideas were modern in some ways — for example, he promoted a good diet and regular exercise in wholesome fresh air for children and adults alike. Nothing to criticize there. But he also believed most diseases in infants arose from “the heat of their humors.”4 Thus, he advised preventing infants from getting too hot, which could distress the lungs and eventually lead to coughs, consumption and diseases of the breast. Nor should infants be wrapped in swaddling clothes or rollers. Rollers were lengths of fabric, sometimes eight to ten feet long, that were wrapped around newly-born infants. He believed these practices restricted the infant’s circulation and deformed its body, sometimes causing convulsions and death.5

James Gilroy's sketch of the gout, 1799 (Source: Wikimedia Commons [PD-1923])

James Gilroy’s sketch of the gout, 1799 (Source: Wikimedia Commons [PD-1923])

Bertrand Russell’s quip that children should choose their parents wisely comes to mind when reading what the good doctor wrote about parents. Buchan warned that diseased, unhealthy, intemperate parents risked passing awful diseases like gout, the scurvy or the King’s evil (scrofula) to their children. Today we know scurvy results from a lack of sufficient vitamin C in the diet, not intemperate or diseased parents. Scrofula (or tuberculosis cervical lymphadenitis, as it is known today) is caused by mycobacteria. Gout, we now know, arises from a combination of both dietary and genetic factors, so it might be possible for a child to inherit a genetic tendency for this condition from a “diseased” parent.

In short, most of what passed for medical therapy in Jane Austen’s day was really only medical moonshine. Of course, Regency era doctors and surgeons were not to blame. They acted on the knowledge available to them. When we look back at that time we think, “How primitive, how stupid and cruel were most of their therapies.” It’s worth noting that in 2216 — two hundred years from now — people will be thinking the same of us!


1Fenster, Julie M. Mavericks, Miracles, and Medicine. New York: Carroll & Graf; 2003, p. 63.

2Strathern, Paul. A Brief History of Medicine from Hippocrates to Gene Therapy. New York: Carroll & Graf; 2005, p. 283.

3Buchan, William. Domestic Medicine (Boston, 1811), p. 31.
(Note: William Buchan was a Scottish physician. The first edition of his book was published in Edinburgh in 1769; later editions were published in England and the U.S. colonies. I tend to use the 1811 edition because it is the closest in time to my novels, even though it was published in Boston.)

4Ibid., p. 40.

5Ibid., pp. 36-38.