Health & Medicine
Medical knowledge, venereal disease, and the hospitals of Georgian London
Medical knowledge, venereal disease, and the hospitals of Georgian London
Health and disease were always present concerns in eighteenth-century London. In a city with primitive sanitation, no knowledge of germs, and medical practices that often did more harm than good, disease was always a constant companion to life in the city. For the women described in Harris's List, the health concerns of venereal disease and the like were an integral part of the definition of their existence, and the publication itself often describes disease, health, and wellness in its portrayals of the prostitutes.
The medical community of Georgian London was divided into three classes: physicians, surgeons, and apothecaries. The physicians, educated and certified by the Royal College of Physicians, were the most prestigious of the medical community. They diagnosed disease, prescribed treatments, and charged exorbitant fees that only the rich could afford. The surgeons, apprenticed and organised under the Company of Surgeons, later to be called the Royal College of Surgeons, performed operations and treated wounds and external diseases. The apothecaries sold medicines and increasingly functioned as general practitioners for the middle and lower classes, offering diagnoses and treatments at lower prices.
Outside these licensed practitioners, there existed a huge unregulated marketplace of quacks, mountebanks, and patent medicine salesmen. Quack doctors were advertised in the press and on handbills touting cures for all ailments. They were particularly prominent in the treatment of venereal disease, the shame and stigma of which forced sufferers to seek discreet treatment rather than a regular practitioner.
Venereal disease, which includes syphilis and gonorrhoea, although eighteenth-century medicine did not distinguish between the two, was a common problem in Georgian London. It was referred to by contemporaries as "the pox," "the French disease," "a certain distemper," or simply "the disorder." It was a problem that carried huge social stigma, but the fact of the matter was that venereal disease was a widespread problem across all social classes.
Syphilis was the most dreaded of the venereal diseases. It caused lesions during the initial stages. If left untreated, the disease could cause serious damage to the nervous and cardiovascular systems. The disease was spread through sexual contact and could also be passed on by the mother during pregnancy or childbirth. Gonorrhoea, while not life-threatening, was accompanied by severe symptoms and could cause serious complications, including infertility.
For the women described in Harris's List, the risk of venereal disease was an occupational hazard of the most serious kind. It could spell the end of her working life, ruining the physical appearance upon which her livelihood depended. It could also cause death, although death from syphilis took a long time, even decades, as the disease went through its various stages.
The standard medical therapy for syphilis throughout the eighteenth century was mercury, applied as an ointment rubbed into the skin, as pills taken by mouth, or as a fumigation in which the patient was enclosed in a box and exposed to mercury vapors. The therapy was a brutal one. The patient suffering from syphilis was subjected to a 'salivation cure.' Mercury poisoning caused the patient to salivate profusely; the patient could produce as much as several pints of saliva a day. The 'salivation cure' was a lengthy process that left the patient weakened and disfigured. Nevertheless, mercury was the main therapy for syphilis because nothing else was known to work. The spontaneous remission of syphilis, which was a feature of the secondary stage of the disease, was attributed to the mercury therapy.
The quack doctors presented a range of alternatives to the 'salivation cure.' The patent medicines included 'Velnos Vegetable Syrup' and 'Leake's Patent Pills.' The quack doctors promised their patients a painless and discreet cure for syphilis without the need for mercury therapy. Many of these patent medicines contained mercury, sometimes in unpredictable doses. Others were based on guaiacum, a New World wood; on sarsaparilla; or on various concoctions of herbs. None of them were successful against the treponema bacterium responsible for syphilis, although some of them may have provided relief from symptoms.
The eighteenth century was the age of hospital founding in London. The great voluntary hospitals of Westminster (1720), Guy's (1721), St George's (1733), the London (1740), and the Middlesex (1745) were all founded through charitable subscription to treat the "deserving poor." However, the majority of them explicitly excluded those suffering from venereal disease on the grounds that they were undeserving of charitable help.
The Lock Hospital, founded in 1747 on the site of a medieval leper hospital near Hyde Park Corner, was different. It was the first and only hospital in London specialising in the treatment of venereal disease. It admitted men as well as women. The Lock Hospital provided the mercury cure under medical supervision, which was safer than the home treatment or the quacks' versions of it. It was always underfunded and could only treat a small minority of those suffering from the disease.
The Foundling Hospital, established by Captain Thomas Coram in 1739, was designed to deal with another, although somewhat different, problem — abandonment. The Hospital took in children of mothers who could not or would not care for them and provided them with food, clothing, and education. Many of the children admitted to the Hospital were the children of prostitutes, and the Hospital records are an important source of information about the circumstances of their mothers' lives.
Pregnancy was always a risk for the women described in Harris's List, and the means of contraception available at the time were few and ineffective. The use of condoms, made from the intestines of animals (usually sheep), was possible. They could be obtained at shops and street stalls in London. Their use was not widespread, although they were sold as a means of preventing the spread of venereal disease. Other forms of contraception included coitus interruptus, pessaries, and herbal remedies, which were thought to have an effect on pregnancy.
An unwanted pregnancy could be economically ruinous. Lying-in hospitals, such as the British Lying-In Hospital (1749) and Queen Charlotte's Hospital (1752), provided care for pregnant women, but only if they were married. Single pregnant women were not admitted, or were admitted reluctantly.
Harris's List deals with health issues in several ways. The publication often discusses the state of health of the women it describes, sometimes cautioning the reader about the risk of disease, and sometimes assuring them that the subject of the advertisement is "healthy" or "sound." While these references to health issues have no medical value, they point to the central role of disease anxiety in the world of Harris's List They also remind us that, despite the flippant tone of the publication, there was a world of pain and suffering, caused by bad medicine, insufficient charity, and the harsh realities of life in eighteenth-century London.