Lives and Legacies

Category: Health

  • Bane of the Washingtons: Deaths in the Next Generation and Amongst the Enslaved

    Welcome back to our 3-Part Blog charting tuberculosis (TB) in the extended Washington Family. If you are new to this series, Part I examined how the disease works, charted its history and explained standard courses of treatments in the 1700s. Part II looked at victims from George’s generation, including his brothers Lawrence and Samuel and brother-in-law Fielding Lewis. You can find those blogs here and here. In our final entry, we will continue to look at individuals who suffered from the disease and see more evidence of how the disease stayed within a family. 

    George Steptoe Washington (1771-1809, aged 37)

    George Steptoe Washington Source: MESDA

    As covered in Part 2, George’s brother Samuel died of tuberculosis, as did several of his sons, including George Steptoe Washington. A product of his father’s fourth marriage to Anne Steptoe, George Steptoe became an orphan at age ten. He and his siblings then fell under the care of their uncle, George Washington. George Steptoe would go on to marry Lucy Payne, the sister of Dolly Madison. Like his father, the point of infection cannot be determined but is likely derived from a family member. George Steptoe certainly faced exposure to TB via his father from the moment of his birth but may have caught it later in life. Regardless, his health experienced a serious decline sometime after 1800, and he ultimately traveled to Augusta, Georgia, in search of health benefits. He died there on January 10, 1809.

    George Augustine Washington (1759-1793, aged 34) & Frances “Fanny” Bassett (1767-1796, aged 29): George Augustine was another nephew of George Washington through his youngest brother Charles and quickly became his uncle’s favorite. He joined the Mount Vernon household in the early 1780s but had already experienced several periods of ill health that forced him to take leaves of absence from the battlefield. A diagnosis of tuberculosis soon came, leading George Washington to take an involved interest in his nephew’s health. Despite having witnessed the lack of improvement made by his brother Lawrence during such ventures, George funded trips to Berkeley Springs, Barbados, and Bermuda for George Augustine. He returned in May 1785 “in better health than when he set out, but not quite recovered.”1

    Fanny Bassett Source: Mount Vernon

    During George Augustine’s absence, Frances “Fanny” Bassett, Martha Washington’s favorite niece, officially joined the household. Upon his return, the two quickly formed an attachment and married on October 15, 1785. George Augustine later became the manager of Mount Vernon, but his health steadily declined, leading his uncle to describe him as “a shadow of what he was.”2 Despite barely being able to ride, George Augustine traveled to Berkeley Springs in October 1791 but would be bedridden and coughing up blood by August 1792. After battling the disease for over ten years, he finally succumbed in 1793. His death “had been long expected,”3 but nevertheless caused his uncle to feel “it very keenly.”4

    The death of her husband left Fanny a young widow with three very young children. Unlike many in that situation, she retained a comfortable lifestyle. As the beloved niece of George and Martha, she always had a home at Mount Vernon and frequently served as an additional hostess. Regardless, she did not remain a widow for long and married Tobias Lear, secretary to her uncle, in August 1795. Sadly, she passed less than a year later, in March 1796, with Lear lamenting, “The Partner of my life is no more!”5 Thought to have died of TB, Fanny likely contracted it from George Augustine during their marriage.

    Charlotte (~1770-unknown, aged 27+): Charlotte served as an enslaved seamstress at Kenmore and later at Betty Washington’s final home, Millbrook. She first appears, aged eleven, in the 1781 probate inventory following the death of Fielding Lewis. Few details about her life exist apart from the record of a son, George, and another baby in a document from 1797. However, Charlotte clearly held an important position within Betty Washington’s household, given the medical records we have.

    Bill for Charlotte’s medical treatments

    Charlotte took ill at Millbrook in 1796 with some form of respiratory complaint. Rather than care for Charlotte personally, Betty sent for the doctor seven times over the year. Charlotte underwent throat examinations and notably received treatment with mercury tablets and ammonia liniment for the chest. The former served as a common cure, which “purged” the body of any imbalances, while the latter mimicked early Vicks VapoRub by opening the airways. None of these treatments would have been pleasant, and the mercury certainly did more harm than good, but Charlotte recovered nonetheless. However, Betty Washington Lewis’ death in 1797 prompted the division of her enslaved staff. In an all-too-common occurrence, Charlotte and her son went to different properties (no mention of the baby exists). They likely saw little of each other after this or never met again. At age twenty-seven, we know Charlotte resided on a property owned by Charles Carter in Frederick County, Virginia. After this, she disappears from the record.

    The true nature of Charlotte’s illness remains a mystery. She certainly suffered from a respiratory ailment and received treatment in line with that given to tuberculosis patients. Nevertheless, we cannot conclusively diagnose it as TB or determine if it ever affected her again. Despite this, her story reflects an important aspect of life in eighteenth-century Virginia and a failing of history. An interest in keeping the enslaved healthy enough to work existed, but the actual health of an enslaved individual often went undocumented. We only know of Charlotte’s illness due to the bill sent by the doctor listing dates and treatments. Even this reflects a rarity as the lady of the household generally oversaw medical treatment for the enslaved rather than a physician. Considering the widespread nature of TB, its higher prominence in poor and minority communities, enslaved living and working conditions, and the high death rates recorded amongst Philadelphia’s free Black population in the early 1800s, the disease likely accounted for a high number of deaths within Virginia’s enslaved population. Sadly, we may never know how many individuals died of the disease or its impact on their lives.

    You can read the full details of Charlotte’s treatment and life here.

    Hercules Posey (~1754-1812, aged roughly 64)

    Hercules Posey Source: Mount Vernon

    One Black individual known to have died of tuberculosis was Hercules Posey. Hercules came to Mount Vernon in 1767 after his previous enslaver, John Posey, failed to pay a mortgage owed to Washington. Having served as a ferryman for Posey, Hercules initially took up the same position. By 1786, he had moved on to the position of cook, for which he is best known. Highly skilled in his culinary abilities, Hercules counted amongst the nine enslaved individuals the Washingtons brought with them to Philadelphia in 1790. Early 1797, however, found Hercules working as a laborer at Mount Vernon, and he acted to self-emancipate in February. In doing so, Hercules left behind at least three children, Richmond, Evey, and Delia, who he shared with his late wife, Alice. Due to Alice’s status as a dower slave, none of their children would receive their freedom in Washington’s will.

    After his escape, Hercules made his way to New York City, where he again worked as a chef. He died on May 15, 1812, with the cause given as TB, and his grave lies in the Second African Burying Ground in Lower Manhattan. Given the span of time between his escape to freedom and death, he possibly contracted the disease after leaving Mount Vernon. Then again, it remains entirely possible that he became ill while enslaved in Virginia or Philadelphia. In this case, he either suffered with an active case for many years, with periods of waxing and waning or had a dormant case that reactivated later in life.

    Others: Additional members of the extended Washington family contracted the disease as time went on, and the same goes for the enslaved. However, an interesting aspect of tuberculosis is that far more individuals may have had it but remained unaware. As covered in Part I, TB can go dormant by walling itself off in the lungs. Minor symptoms would have appeared at the time of infection, but those pauses when the disease goes dormant. Depending on how long it remained active and how severe, the TB may have gone unnoticed or been misdiagnosed. If the disease never reactivated, a person could live a full life and never know they had it.

    Today, we diagnose tuberculosis through symptom analysis and testing. Multiple successful treatments additionally exist to help people overcome the disease. For the 1700s, however, symptoms alone provided the diagnosis, and the dormant phase served as the only successful reprieve from the disease. The fact that our modern technology and medical knowledge would have saved many of the people covered in this 3-part blog appears evident. Nonetheless, it remains unclear just how many people in the extended Washington family actually contracted TB. This then raises the question, if TB testing had existed in the 1700s, would individuals such as George and Betty Washington have turned up positive?

    Emma Schlauder

    Research Archaeologist

    Bibliography

    Anderson, Alicia K. & Lynn A. Price (editors) 2018     George Washington’s Barbados Diary: 1751-52. University of Virginia Press, Charlottesville, VA.

    Budinger, Meghan & Mara Kaktins 2020    Charlotte and the Mercury Pills. Lives & Legacies Blog, The George Washington Foundation <https://livesandlegaciesblog.org/2020/06/17/charlotte-and-the-mercury-pills/&gt;. Accessed April 11 2023.

    Chernow, Ron 2010     Washington: A Life. Penguin Books Ltd, London, UK.

    5 Eliassen, Meredith, Tobias Lear. Digital Encyclopedia of George Washington’s Mount Vernon, George Washington’s Mount Vernon < https://www.mountvernon.org/library/digitalhistory/digital-encyclopedia/article/tobias-lear/&gt;. Accessed April 11 2023.

    1-4 Fore, Samuel K. George Augustine Washington (ca. 1759-1793). Digital Encyclopedia of George Washington’s Mount Vernon, George Washington’s Mount Vernon < https://www.mountvernon.org/library/ digitalhistory/digital-encyclopedia/article/george-augustine-washington-ca-1759-1793/>. Accessed April 11 2023.

    Glen, Justin 2014     The Washingtons: A Family History, Vol 1, Seven Generations of the Presidential Branch. Savas Beatie LLC, El Dorado Hills, CA.

    Lenhart, Chelsea  Hercules. Digital Encyclopedia of George Washington’s Mount Vernon, George Washington’s Mount Vernon < https://www.mountvernon.org/library/digitalhistory/digital-encyclopedia/ article/hercules/>. Accessed 11 April 2023.

    Rankin-Hill, Lesley M.  1997     A Biohistory of 19th-Century Afro-Americans: The Burial Remains of a Philadelphia Cemetery. Bergin & Garvey, Westport, CT.

  • Bane of the Washington Family Part I: The Disease

    Epidemics and pandemics loom large in history. Few have not heard of the Black Death or Spanish Flu, and Covid-19 still affects our lives. Short, two to three-year outbreaks of these diseases kill quickly and in staggering numbers, but what about the diseases that have stuck around throughout history and brought about death in a much slower fashion?

    Tuberculosis (TB) represents one disease that humanity has never managed to shake. A devastating illness marked by a cough and wasting of the body, it has infiltrated all corners of the world, killing more than any other microbial pathogen. The 1700s proved no exception, and the level of contagion associated with the disease meant that once it entered a family, it proved hard to eliminate. Sadly, this became the fate of many members in two generations of the Washington and Lewis families and, undoubtedly others who came in close contact with them. In Part I of this examination of TB in the Washington family, we will examine the disease itself.

    Watercolor of a TB Victim by R. Cooper, ca. 1912 (Wellcome Collection)

    Brief History of TB

    Tuberculosis originated in East Africa, possibly around 3 million years ago, and evolved into our modern strains between 250-1000 years ago. This makes it one of the oldest diseases still in existence. While primarily a disease of the lungs, TB has the potential to infect most tissues and organs. Skeletal deformities caused by certain strains make it identifiable in the archaeological record, which help to date the disease. As humans migrated across the world, they brought the disease with them. Evidence even exists to suggest that TB thrived in parts of the Americas before the arrival of Europeans. Its presence makes it one of the rare diseases that Europeans did not introduce, though encroachment on indigenous groups and confinement of them to specific areas did lead to a rise in cases. Various names have applied to the disease, but in the Western World, the most common historical names include “consumption,” “White Plague,” and “phthisis.”

    Highly contagious, the disease could strike anyone, with those living in cramped and unhygienic conditions experiencing a higher risk of infection. Cities, therefore, had more cases than the countryside. However, the true rate of infection for the 1700s remains unknown as the recording of disease cases did not start until the early 1800s. Once this practice got underway, TB ranked as the leading cause of death in places such as Philadelphia, where it accounted for nearly 15% of all deaths in two separate periods (1807-1826: 7,972 deaths or 15.04%; 1831-1840: 6,093 deaths or 14.23%). From statistics such as this, estimates for previous eras can occur with TB likely causing 25% of all deaths in Europe from the 1600s-1800s and similar numbers occurring in North America.

    With such a high rate of infection, and its tendency to spread within families, some came to interpret the disease as inherited, while others continued to support the theory of miasma. A more radical thought blamed vampires, leading to several periods of panic in New England during the 1800s. Today, we understand germ theory, but this would not become mainstream until late 1800s and early 1900s—nevertheless, suggestions of TB’s true contagious nature date to at least 1546. German scientist Robert Koch put the debate to rest when he identified Mycobacterium tuberculosis as the causative agent behind the disease in 1882. The rod-shaped bacteria thus gave the disease its common name. This discovery helped lead to the realization that several strains and forms of the disease exist. While M. tuberculosis spreads via the air and droplets, the zoonotic form of the disease, Mycobacterium bovis, thrives in cattle and their relatives before jumping to humans. This occurs through the consumption of contaminated dairy products and produces a near identical infection to M. tuberculosis.  

    Mycobacterium tuberculosis (NIH)

    Despite the pathogen’s deadliness, though also in part of it, TB took on a romantic and fashionable nature. Many a character would suffer from the disease in 19th-century literature, with it running as rampant in the novels of the Brontë sisters as it did in their family, and Lord Byron once lamented his good health since a case of TB would make his appearance more interesting to women. The pale, slim, feverish appearance of the infected fit the ideal female body image that emerged between the late 1700s and mid-1800s. On the extreme end of things, some individuals purposefully exposed themselves to the disease in the hopes of achieving this appearance. A more manageable level saw fashion attempt to mimic the symptoms with corsets and skirts creating the illusion of slim waists while makeup lightened the skin and tinted the cheeks.

    Sickness

                As with every disease, the onset, severity, and progress of the infection varies depending on the health of the infected individual. For instance, tuberculosis could burn through very young children before anyone identified the disease in the 1700s. Likewise, someone with a stronger immune system might fall ill for a longer period before all the symptoms came to together to provide a diagnosis. Nevertheless, TB has several key identifiers.

    The disease develops in two basic forms, pulmonary and extrapulmonary. The former sees the infection restricted to the lungs and serves as the most common manifestation. Typical symptoms included a cough, which produces blood at a progressed stage, extreme weight loss, decline in appetite, sweats, fever, fatigue, and paleness. The disease can occur over several attacks, interrupted by brief respites, which worsen with time. As the disease progresses, it leaves holes in the lung tissue giving it an appearance akin to Swiss cheese. Extrapulmonary cases pertain to TB that has spread to an organ or tissue outside of the lungs. The standard symptoms remain in addition to physical indications in the impacted areas. This may include enlarged lymph nodes, sores, and spinal deformities that develop over time. Two forms include Pott’s Disease, TB of the spine, and Scrofula, TB of cervical lymph nodes.        

    While TB can affect all age groups, historically, it has most often struck the young. In Ancient Greece, Hippocrates noted, “phthisis makes its attacks chiefly between the age of eighteen and thirty-five.”1 Higher rates of death amongst those in their twenties and thirties added to the tragedy of the disease, though hope of relief did exist. TB has a unique ability to go dormant during which it walls itself up in the lungs or simply pauses in other parts of the body. While this latent state can reverse at any point, meaning a victim could have years between symptoms and still die of it, the disease may never reactivate. In this scenario, a person would test positive under modern examinations, but suffer no impact to their health or prove contagious to others.  

    All active cases, however, lead to a decline in the sufferer’s immune system and leaves them open to secondary infections. Cases of pneumonia, as well as meningitis, prove common. A letter from a Fredericksburg woman, dated March 1867, perfectly illustrates the disease. Her son, who had just passed, suffered an “attack of Hemorrhage of the Lungs” first in 1865 and again in “the summer of ’66.” She reported that he recovered from both attacks, but became ill with the mumps in February of 1867 followed by “the symptoms of fell consumption being clearly developed.”2 The boy ultimately lost the strength to rise and found himself confined to a makeshift bed a few months prior to his death.

    Treatment

    No cure or successful management plan for tuberculosis existed in the 1700s. As such, roughly 66% of cases resulted in death within the first five years of infection. However, lack of success did not stop doctors from prescribing a standard course of treatment that originated in ancient times. To anyone familiar with medical practices of the eighteenth century, the use of emetics, such as mercury and bloodletting, will come as no surprise. Both treatments aimed to purge the body of an affliction, and doctors applied this to nearly every ailment. In truth, these “cure all’s” did more harm than good, with mercury poisoning the patient and bloodletting weakening them. Still, other prescription medicines may have brought some symptomatic relief or, at the very least, not harmed the patient further.

    Other forms of treatment involved lifestyle changes in the form of diet and exercise. Viewing items such as meat and alcohol as harmful in large quantities or too difficult for the body to process, doctors instructed TB patients to eliminate them from their diet. Instead, they should consume plenty of milk, preferably from a donkey, and vegetables. On top of this, the patient should increase fast-paced exercise or travel, such as horse riding, to the extent that their strength allowed. This would ideally force clean air into the lungs. While well-intentioned, neither change could treat a bacterial infection.

    Other changes involved relocation. Some may be familiar with the phrase “taking the waters” The belief that natural springs, particularly hot ones, provide health benefits dates to prehistory and exists in multiple cultures. Some truth lies in this, but no spring could cure TB beyond the warm waters and steam providing some relief to a weakened, cough-ridden body. Nevertheless, doctors frequently instructed patients to visit springs, giving rise to Berkeley Springs in Colonial Virginia. A destination for wealthy Virginians starting in the mid-1700s, some visited for general health benefits and the social scene, while others went specifically for TB. If none of these treatments worked, doctors would prescribe a course of action that everyone knew served as a last resort: relocating to a warmer climate. In Colonial America, some patients went to the southern colonies while others elected to try the Caribbean (Figure 6). They found no cure in these locations, but the belief in springs and warmer or dryer climates providing relief for TB victims would continue into the 1900s.  

    Bane of the Washingtons

                All forms of tuberculosis mentioned above existed in the 1700s, but which one did the Washingtons have? Parts II & III of our Tuberculosis Blog will closely examine individuals connected to the Washington and Lewis families that had the disease, but we can make a few conclusions. Regarding contraction of the disease, the number of people afflicted, and their close relations to one another, it remains highly probable that they passed it to each other. Of the eight people identified across two generations, none developed a spinal deformity, and no mention of enlarged lymph nodes appear. This implicates pulmonary TB as the likely suspect in all cases.

    Nevertheless, we cannot forget M. bovis. With no knowledge of the disease or methods of pasteurization, the frequent consumption of dairy products and presence of cows on farms made it a key source of potential exposure. The Probate Inventory taken in 1743 after Augustine’s death records an inactive dairy building at Ferry Farm. Whether the Washingtons ever used it for dairy remains unknown, but they certainly obtained and consumed dairy products regularly. We will never know what vector the disease took in entering the Washington Family or when each individual first contracted it, but we can piece together how it affected their lives and ultimately ended them. Stay tuned for Parts II and III: The Victims.

    Emma Schlauder

    Research Archaeologist

    Bibliography

    Barberis, Ilaria, Nicola Bragazzi, Lucia Galluzzo, & Mariano Martini 2017     The History of Tuberculosis: From the First Historical Records to the Isolation of Koch’s Bacillus. Journal of Preventive Medicine and Hygiene 58: 9-12.

    Brown, Kathleen M. 2009     Foul Bodies: Cleanliness in Early America. Yale University Press, New Haven, CT.

    Buchan, William 1772     Domestic medicine; or, The family physician: being an attempt to render the medical art more generally useful, by shewing people what is in their own power both with respect to the prevention and cure of diseases. Chiefly calculated to recommend a proper attention to regimen and simple medicines. Evans Early American Imprint Collection, University of Michigan < https://quod.lib.umich.edu/cgi/t/text/text-idx?c=evans;cc=evans;q1=Gout;rgn=main;view=text; idno=N09695.0001.001>. Accessed 11 April 2023.

    CDC History of World TB Day. CDC < https://www.cdc.gov/tb/worldtbday/history.htm#:~:text= Johann%20Schonlein%20coined%20the%20term,%E2%80%9Cschachepheth%E2%80%9D%20in%20ancient%20Hebrew.>. Accessed 11 April 2023.

    CDC Symptoms of Pulmonary and Extrapulmonary TB Disease. The Division of Tuberculosis Elimination, CDC < https://www.cdc.gov/tb/webcourses/Course/chapter4/4_ diagnosis_of_tb_ disease_4_clinical_practices_symptoms_of_pulmonary_and_extrapulmonary_tb_disease.html>. Accessed 11 April 2023.  

    2 Conway, Mary Catherine Washington Henry 1867     “Letter to Jane ?, Cabin Mill – March 22, 1867.” Access granted by Suzanne Leigh Peake (owner) and Wyatt Falcone,                        

    1 Daniel, Thomas M. 2006     The History of Tuberculosis. Respiratory Medicine 100: 1862-1870.

    Mackowiak, Philip A., Vera Tiesler Blos, Manuel Aguilar, & Jane E. Buikstra 2005     On the Origin of American Tuberculosis. Clinical Infectious Diseases 41(4): 515-518.

    Mullin, Emily                                                                                                                                            2016     How Tuberculosis Shaped Victorian Fashion. Smithsonian Magazine, Smithsonian < https://www.smithsonianmag.com/science-nature/how-tuberculosis-shaped-victorian-fashion-180959029/&gt;. Accessed 11 April 2023.

    Nardell, Edward A.  2022     Extrapulmonary Tuberculosis (TB). Merck Manual < https://www.merckmanuals.com/ professional/infectious-diseases/mycobacteria/extrapulmonary-tuberculosis-tb>. Accessed 11 April 2023.

    National Jewish Health  2013     Tuberculosis: History. National Jewish Health < https://www.nationaljewish.org/ conditions /tuberculosis-tb/history>. Accessed 11 April 2023.

    Otis, Edward O.  1909     The Great White Plague. Thomas Y. Crowell & Co., New York.

    Palmer, Mitchell V.  2011     Bovine Tuberculosis and the Establishment of an Eradication Program in the United States: Role of Veterinarians. Veterinary Medicine International. 

    Rankin-Hill, Lesley M. 1997     A Biohistory of 19th-Century Afro-Americans: The Burial Remains of a Philadelphia Cemetery. Bergin & Garvey, Westport, CT.

    White, Tim D., Michael T. Black, & Pieter A. Folkens  2012     Human Osteology, 3rd edition. Elsevier Inc., Burlington, MA.

  • Winter Ailments (and how to endure them in the eighteenth century)

    As spring approaches in the Middle Atlantic and Northeastern states, we welcome the chance to spend more time outdoors in the fresh air instead of cooped up in our houses – getting sick.  Ailments such as colds and flu are contractible anytime, but we usually associate them with the wintertime as that’s when they seem to be more prevalent.

    Ferry Farm during winter storm

    With modern medicine, we can easily treat and overcome these and other more serious illnesses that rise up during the colder months.  People living in the eighteenth century, however, did not have the luxury of our scientific knowledge of modern medicines, and so what is easily treatable today could be, and often was, deadly during their lifetime. They had to deal with serious diseases, such as dysentery, measles, mumps, smallpox, rickets, typhus, typhoid, tuberculosis, and yellow fever, without the benefit of antibiotics. 

    Medical treatments for dealing with illnesses in the eighteenth century were primarily herbal remedies and traditions passed down over the centuries in medical books or as local knowledge. People like the Washington family probably relied on local healers, apothecaries, physicians, or midwives in the Fredericksburg area to prepare the medicines and treat their illnesses.  It is also very likely that Mary Washington would have had the knowledge herself to oversee the formulation of cough syrups, laxatives, and other tinctures using the herbs and flowers in her own garden. Betty Washington Lewis, Mary’s daughter, owned a copy of Eliza Smith’s 1739 The Compleat Housewife: or, Accomplished Gentlewoman’s Companion, a cookbook, in which are explicit medicinal recipes for dealing with hysterics, the vapours, pain from stones, the plague, upset stomachs, a cancerous breast, consumption, and for ‘preserving the lungs,’ among other things.[1]  The chances are pretty good her mother Mary also had access to this same recipe book.

    We do not have any historical information on the childhood diseases or winter ailments that were present in the Washington home, but here are two that they might have experienced.

    Pneumonia

    Anteroposterior chest x-ray revealed right upper lobe pneumonia. Credit: Public Domain Files

    Pneumonia, a bacterial infection of the lungs, also known as ‘Winter Fever’, was a great concern in colonial Virginia.  Although it was not known as a disease in and of itself but rather a symptom of other illnesses until much later, the presence of this respiratory ailment was noted by colonists. 

    Pneumonia and many other such illnesses were prevalent in the winter months when conditions forced people inside with closed windows and doors.  Prior to modern home climate-control technology, windows and doors were opened in good weather to create a breeze that cooled down a house but also served to air it out.  Additionally, many activities we perform indoors today took place outside, such as laundry and food processing, which got people out in the open more.  When the weather turned cold, however, people were stuck inside with little ventilation and essentially stewing in their own germs.  As such, pneumonia spread rampantly throughout the winter, and with no antibiotics, it was often deadly especially for the young and elderly. 

    An ill man who is being bled by his doctor. Credit: Wikimedia Commons

    The commonly incorrect assumption at the time was that many illnesses resulted from bad smells or miasma. Bloodletting, laxatives, and emetics were justified treatments for almost anything wrong with you because it was essential to purge and expel the bad blood and humours from one’s body.  In general, these treatments did more harm than good and, in some cases, killed the patient.

    In addressing the symptoms of pneumonia (fever, cough, inflammation of the lungs), a mixture of treatments would have been proscribed for the patient.  Cough syrups recipes were many and concocted from a wide variety of aromatic herbs infused in flavored waters, honey, or liquor. Opium in the form of poppy leaves was also a common ingredient.  Additional treatments included bloodletting “8 to 10 ounces if strong 12 ounces” and applying ‘blisters’ on the back of their neck to promote sweating and to help with a headache.[2]  Blistering was an aggressive treatment to the skin and essentially created pain in one spot to counteract pain elsewhere. A blistering agent, such as mustard, capsicum, or Spanish Fly, was applied in a poultice to the skin, causing redness and, in extreme cases, a raised pus-filled blister.[3] The cure might have been worse than the disease!

    Scientists have since made great breakthroughs in treating pneumonia, including the invention of penicillin by Alexander Fleming in 1928.  Yay science!

    Rickets

    Three children displaying signs of rickets. Credit: Wellcome Collection

    Bowed legs, thickened wrists and ankles, low weight, and deformities of the skull and pelvis are all signs of Rickets, a common disease of the 18th century and prevalent during the winter months.  Rickets is caused by a lack of Vitamin D in a child’s diet, leading to soft, weak bones that don’t mineralize properly. The symptoms of rickets usually appear between the ages of 3 to 18 months, and if caught early, the disease is reversible by ensuring a proper diet of Vitamin D-rich foods (fatty fish, egg yolks, fish oil) and exposure to sunlight.

    Eighteenth-century physicians knew about the disease and discussed the symptoms and possible remedies in their medical books, but they didn’t understand the actual cause (Vitamin D deficiency) and, therefore, how to cure it. And although Rickets is often associated with children living in poverty with limited diets or restricted to sunless living and working conditions, it affected children of all socio-economic levels.

    Mother holding a child with symptoms of rickets in Christ at the Pool of Bethesda by William Hogarth (1697–1764) Credit: Barts Heritage

    John Freke, in his 1748 book “An Essay on the Art of Healing,” felt that the diet of the children affected by Rickets was “in general too luxuriant” and should be scaled back to a more austere diet than ordinary.[4]  “Care should be taken to send this sort of Children into a sharp Air,” and “rousing their Blood by shaking and tossing them often, giving them now-and-then a little red Wine, and dipping them every Morning in cold Water.” He was spot on to suggest letting them play outside in the sun, but restricting their diet would certainly have had a deleterious effect on the patient.

    The 1710 Book of Physick was a recipe book of natural remedies using plants and minerals to cure the everyday ills and complaints of the sick.[5] The first step incurring rickets was to administer a “purge,” which was a drink that flushes everything out of your digestive system by either vomiting or diarrhea.  Purgatives were seen as a cure-all for many diseases because the prevailing thought was you had to expel whatever was making you sick out of your body.

    The recommended purge was made of a long list of plants, including liverwort, speedwell, and yarrow, mixed with fruits such as figs and raisins, all slowly simmered together in water. Dosage was three spoonful’s every morning and night for 14 days.

    Next on the list was bloodletting, of course! Just a prick on the ear would do the job, or leeches behind the ears! What is interesting is that this instruction was immediately followed by a reference to the page on how “to staunch bleeding.”

    Not all remedies had to come from physician’s books but could be found in publications geared towards laymen.  The Servants Directory, Improved; or House-Keepers Companion, published in1762, was an instruction manual on all things household, ranging from how to kill rats, clean furniture, wash silk stockings to the best way to cook parsnips.   Included in a chapter on the care of small children was a cure for a Rickety child.  The first suggestion was to give the child three doses of a gentle physic, or purge, similar to the 1710 Phisick book.  Next, rub the child with a concoction of smashed garden snails and liquor every day for a month.  Outside exercise was also recommended, thank goodness![6]

    If the 18th century rickety child could survive multiple purges, bloodletting, a restrictive diet, vigorous body rubs with bug juice, and occasional sun exposure, who’s to say which treatment was the one that was most effective (Just kidding)!  Progress in studying the causes and treatments of Rickets culminated in the early 20th century when it was clearly shown the benefits of using sources of Vitamin D, such as cod liver oil and sun exposure, in curing rickets.[7]

    If you are interested in medical history see our other blog posts on mercury, patent medications, Civil War medicines, Civil War hospitals, bad medicines, homemade medical remedies, dental care and smallpox.

    Judy Jobrack

    Staff Archaeologist

    Mara Kaktins, Archaeologist

    Ceramic & Glass Specialist

    [1] Eliza Smith, The Compleat Housewife: or, Accomplished Gentlewoman’s Companion, J. and J. Pemberton, 1739, pgs. 240-250.

    [2] A Book of Phisick. Made June 1710, p. 46. Wellcome Collection. Public Domain Mark

    [3] Souter, Keith. Bleed, Blister, Vomit and Purge. July 23, 2015. https://westernfictioneers.blogspot.com/

    [4] Freke, John. An Essay on the Art of Healing, p. 247-248. 1748. https://play.google.com/books/reader?id=H_o1AQAAMAAJ&pg=GBS.PA246&hl=en

    [5] A Book of Phisick, pg. 92-93.

    [6] The Servants Directory, Improved; or, House-Keepers Companion. H. Glass. Fourth Edition, 1762. Reprinted 2001 by United States Historical Research Service.

    [7] O’Riordan, Jeffrey and Olav Bijvoet. Rickets before the discovery of vitamin D. Published online 2014 Jan 8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3899557/