Anne de Bourgh, the heiress of Rosings Park in Jane Austen’s popular novel Pride and Prejudice, might have been suffering from a debilitating disease that made her sickly and cross: acute rheumatism, consumption (tuberculosis), tussis (a persistent cough), or a nasty catarrh (in other words, an awful cold). I’ve always thought she might be suffering from the lingering aftereffects of an illness she had as a teenager. Scarlet fever struck me as a likely culprit. Regency doctors had lots of theories about what caused scarlet fever—and many interesting ideas about how to treat it.
Vomiting for Good Effect
Ulcerations in strept throat, which can lead to scarlet fever (Wikimedia Commons CC BY 3.0 — Author: James Heilman)
Dr. William Withering, whose book on scarlet fever was published in 1793, wrote that, after observing many patients with scarlet fever, he favored the good effects of vomiting and especially “early, powerful and repeated vomits.”1 His enthusiasm is seen in his words:
Vomiting seems to be the remedy of nature: it stands foremost in her efforts to throw off the cause of the disease … If we want to dislodge a poison from the fauces [the back of the mouth], and the mucous membrane of the nose, and to prevent its descent to the stomach, how shall we do it so effectually as by emetics?”2
How, indeed. When your patient’s throat is aflame with ulcerations—as shown above for strept throat—and her body is fired by fever, why not add to her misery by regular vomiting? All I can say is, they were hardy people, those Regency patients.
Dr. Withering believed the speed of the cure and the patient’s safety depended upon early and repeated vomiting. In the first attack, a vomit nearly always removed the disease at once, by acting on the nervous system. Emetics opened the gullet (the throat), making swallowing easier, and they also “unloaded the lungs” (whatever that means), which made the patient breathe more freely. He advised a powerful vomit once every 48 hours; in the worst cases, a patient should have a powerful vomit two or three times in 24 hours. His typical emetic consisted of a combination of tartar emetic in a solution with ipecacuanha. His goal was to achieve a “certain violence of action upon the [patient’s] system.”2
Giving Calomel (Mercury Chloride)
A satirical print by Thomas Richardson showing a physician wearing a garland of bottles and pill boxes. The syringe is for giving a clyster or enema. (Wellcome Library, London, image # V0011674 Wikimedia Commons CC BY 4.0)
Dr. Benjamin Rush, a professor at the University of Pennsylvania and a signer of the Declaration of Independence, treated his scarlet fever patients by “giving a vomit consisting of either tartar emetic or ipecacuanha joined with calomel.”3 Calomel is a mineral form of mercury chloride. The combination of calomel and an emetic was designed to discharge a good quantity of bile by evacuating the stomach. In the process, it scoured the throat, thus apparently stripping off the infection in the fauces, while also producing two or three stools. Dr. Rush gave calomel during the entire course of the fever. If calomel failed to open the bowels, then he gave his patient a gentle purge. (Purges cleansed or emptied the bowels.)
Calomel is toxic, which fact was not known during the Regency era. Sometimes it was given in such large quantities that patients’ teeth and hair fell out. (Mercury poisoning still occurs today.)
Applying Gargles and Steams
In his scarlet fever patients, Dr. Rush aimed to keep the throat clean of ulcerations by giving detergent gargles. This was particularly important, he said, in cases where a patient had trouble swallowing or breathing. Dr. Withering likewise found gargles beneficial and typically prepared a decoction of contrayerva sweetened with oxymel of squill. (Squill is a perennial plant.) Sometimes he prepared barley water mixed with the marine acid or used a tincture of roses. (Marine acid was the name for hydrochloric acid prior to the 1800’s.) These gargles were forcibly injected over the tongue and down the throat by the use of a long pipe. Dr. Withering wrote:4
“It was amazing to see the quantity of viscid ropy stuff that was discharged, both from the fauces and nostrils.”
Yes, well … perhaps enough said about that! Dr. Rush used a similar method, for he wrote of administering steams of warm water mixed with a bit of vinegar through a funnel placed into the throat.5
Apothecaries often sold dangerous, deadly compounds, as shown here in “Voyage to Death.” A couple buys some narcotics from an apothecary whose assistant, Death, works with a pestle and mortar in the back room. The caption reads: ‘Don’t worry, I have an assistant who never gets it wrong.’ (Source: Wellcome Library, London, image # V0011779 Wikimedia Commons CC BY 4.0)
Promoting Perspiration
Another strategy Dr. Rush used to cure his scarlet fever patients was to keep up a steady perspiration. Presumably the thinking in this case was that any “infection” or “poison” could be sweated out through the skin. Dr. Rush reported that gentle doses of antimonials, along with diluting drinks made with wine, always brought relief.5 (Antimonials contain the mineral antimony, which today is used mainly in industrial processes like making fire retardants; alloys for batteries and bearings; and semiconductors. In 21st-century medicine, antimony is used to treat leishmaniasis, a tropical disease caused by a parasite transmitted by the bites of female sandflies.)
Dr. Bateman, however, took exception to the practice of using antimonials to stimulate perspiration, believing they did not benefit his scarlet fever patients. Because antimonials increased the heat of the skin, increased thirst and restlessness, and raised the pulse, he advised reducing a patient’s temperature in cases where it was “too high” by applying cold water to the skin.6
Applying Blisters
When the previous treatments failed to work, Dr. Rush advised applying a blister behind each ear or one to the neck. This always worked to good effect, in his opinion.5 This approach was also sanctioned by Dr. Bateman, who suggested applying a blister to the external fauces (that is, on the outside of the neck) when scarlet fever patients had trouble swallowing.7
What exactly is a blister? According to The Surgeon’s Vade Mecum of 1809, a blister is “formed by the continued application of a small blister, or vesicant, to the part, until the scarf-skin (the epidermis) is destroyed.”8 A vesicant is a substance that causes burns and destroys the tissue. So! A scarlet fever patient endured an ulcerated throat on the inside and ulcerated skin on the outside when his Regency-era doctor believed it necessary to apply a blister. Read about blisters and other treatments used on the night President George Washington died.
These treatments were considered standard therapy for scarlet fever during the Regency era. Thankfully, medicine has come a long way since then.
Sources:
1Withering, William. An Account of the Scarlet Fever and Sore Throat; or Scarlatina Anginosa: Particularly as It Appeared at Birmingham in the Year 1778, 2nd ed. (London: G.G. & J. Robinson, 1793), p. 10 (PDF p. 15).
2Ibid., pp. 76-77 (PDF pp. 81-84).
3Rush, Benjamin. Medical Inquiries and Observations, Vol. I. (Philadelphia: J. Conrad & Co., 1805), pp. 144-145 (PDF pp. 161-162).
4Withering, pp. 91-92 (PDF pp. 96-97).
5Rush, p. 145 (PDF p. 162).
6Bateman, Thomas. A Practical Synopsis of Cutaneous Diseases. (London: Longman, Hurst, Rees, Orme, and Brown, 1814),, pp. 78-80 (PDF pp. 115-117).
7Ibid., p. 83 (PDF p. 120).
8Anon. The Surgeon’s Vade Mecum. (London: John Murray, 1809), p. 46 (PDF p. 69).