(I highly recommend the last one, Mary Berry’s new show, for anyone writing in the British historical romance chronotope. Big house parties are the theme, and the first episode begins with Highclere Castle—or, as you likely know it, Downton Abbey!)
In case you were wondering, we did win our game of Pandemic. I mean, we cured all four diseases, which is all you need to do—not actually heal the infected. It all feels very 2021.
For slightly more festive posts from Christmases past, check out the links below. And, whichever holiday you celebrate, if any, everyone at Little Brick Books wishes you a safe, healthy, and happy one.
My favorite stuffed animal as a child was a weird-looking turtle named Snoozie. My bedtime stories were mostly Snoozie skits—half-Muppet Show, half Lion King—as written and performed by my father. When my beloved Snoozie tore a seam, my father stitched him up. The surgeon of the house did all the sewing. My father also removed my splinters with the tip of an eight-inch butcher’s knife. Since I could not stand to look at the knife, I watched his face as he concentrated. He never missed one, and it never hurt.
As I grew older, I loved to hear tales of my father’s training in medical school, like when he had to draw his own blood because his partner had passed out. He filled the syringe and handed it over when the other guy woke up. Another classmate devoted only one line in his notebook to each day’s lecture. Later, if anyone had a question about what was said a month ago in physiology, this fellow would look up the right dated line and reprise the professor’s entire hour-long talk verbatim, even the bad jokes.
Despite this steady diet of stories, my father did not believe in pressuring his only child to follow in his footsteps—not that it was much of a choice for me after college. I am a bit embarrassed to admit that I did not take a single laboratory science course after high school, and that omission would have been a problem on my application—in the 1990s. In the 1890s, not so much. Harvard Medical School accepted nearly all applicants. Well, all male applicants. The president of the university considered coeducation “a thoroughly wrong idea which is rapidly disappearing.”
Fortunately, coeducation did not disappear and, also fortunately, other medical schools at the time did accept women, including Ohio Medical University, where my next heroine, Liddy, will be trained. She will be one of about three women in her class of forty-nine. (My father went there too. By the 1960s, it was known as the Ohio State University College of Medicine. Go Bucks!)
Liddy will be unusual because she will have a bachelor’s degree when she starts medical school—something only eight percent of American medical students had in 1894, when she began. Typically those eight percent probably came from the bottom of their respective college classes. Scholars with promise went into teaching or the clergy. Physicians were considered “coarse and uncultivated . . . devoid of intellectual interests.” There was a real danger that too much science would “overcrowd” their limited minds. There were no written examinations at Harvard Medical School. None. In fact, that would have been impossible, one professor complained, because half of his students “could barely write.” He was not making a joke about doctors’ poor penmanship.
How could this be?
The Humoral System (Pre-Gilded Age)
Let’s talk first about what we know about what makes us sick. For far too long—from the ancient Greeks to the middle of the Victorian age—the European system of medicine described the human body as a balance of four substances called humors. If you had too much blood, the first of the four, it made you sanguine—courageous, hopeful, even amorous. Too much yellow bile turned you choleric, or hot-tempered. Black bile produced melancholic scholars, Shakespeare’s favorite. Too much phlegm slowed you down, made you apathetic. Your “sense of humor,” as it was known, even dictated which internal organs were most likely to fail you, like a combined CT-scan-slash-Meyers-Briggs personality test.
Blood was the only humor that could be spilled on command, so bleeding became a popular treatment for any imbalance. If you were sick in the eighteenth century, you headed off to your neighborhood barber-surgeon, maybe get a few teeth pulled while you were there. In 1793, when Founding Father Dr. Benjamin Rush faced a yellow fever epidemic in Philadelphia—then the nation’s capital—he treated one hundred people a day by draining two liters of blood per person. That’s about forty percent of the blood in their bodies! Half of Rush’s patients died. When George Washington fell ill from a throat infection in 1799, he was bled the same amount by his doctor. He died. Washington’s physician, like Rush before him, and like the barber-surgeons before them, used a specific scalpel named after a medieval weapon. It was called a “little lance,” or a lancet. A publication named The Lancet was and still is a leading medical journal. That’s like naming an education blog The Paddle.
Less extreme than the lancet were leeches, or parasitic worms. At the beginning of the nineteenth century, Britain imported 42 million leeches a year, seven million for London alone. That was about three leeches per person, but it still wasn’t enough. One British doctor admitted to using the same leeches on fifty different patients in succession—not realizing that he was exposing that fiftieth patient to blood-borne diseases from the last forty-nine people he treated. No wonder Napoleon called medicine “the science of murderers.”
He should know. He had been given another favorite prescription of the age: calomel, or mercurous chloride, which was prescribed as a magical tonic for almost any ailment, from tuberculosis to ingrown toenails. It was another humoralist treatment: if you did not want to drain blood, you might choose purge your patient from both ends with powdered mercury. Among the many, many symptoms of mercury poisoning are tremors, loss of teeth, and amnesia. Oh, and death.
No, I’m not blowing smoke up your ass. Wait, did you ever wonder why we say such a thing? The biggest fear of the eighteenth and nineteenth centuries was, shockingly, not doctors themselves but their doctors burying them alive. George Washington’s last words were instructions not to conduct any funeral for three days, just in case his physicians were not capable of distinguishing between life and death. Apparently, he had not heard of the latest sure-fire test, a tobacco smoke enema. Blowing smoke through a tube into a person’s nether region was sure to animate any phlegmatic—even before Dr. Previnaire added a bellows, a hand-held blower like I use in my fireplace, to create his patented anal tobacco furnace. The Academy of Sciences in Brussels gave Dr. Previnaire a prize for his work (Bondeson 139).
This is not medicine, you say; it’s snake oil! Absolutely, another popular remedy.
There were some bright spots. British Naval surgeon Dr. James Lind discovered that oranges and lemons helped his sailors recover from scurvy, but he did not know why. He did not even know what Vitamin C was. Still locked into a humoralist mindset, he believed scurvy was caused by cold, wet sea air and a lack of exercise. And, yes, vaccination did exist at this time—in fact, a form of vaccination has been around for a thousand years—but originally no one could explain how it worked.
It was not until the population medicine studies of Pierre Louis in 1820s and 1830s France that people looked at the data and said maybe bleeding doesn’t work. Louis introduced a new way of examining the efficacy of treatment: looking at large numbers of similar patients and studying their reactions to different applications of medicine. It was the first baby step toward clinical trials, though it was not yet randomized and his sample sizes were not very large.
Bloodletting faded from life slower than the patients who were being bled. Despite a very public debate between doctors in the 1850s, the practice persisted in textbooks as late as 1942. One part of the appeal may have been its accessibility and affordability. There were bloodletters everywhere, and they were cheap “health care.”
Another reason it persisted: no one had yet proven another theory of disease. All the pieces were there. Contagion was not a new concept: even as far back as the Islamic scholar Ibn Sina, there was an idea that disease could be spread by touch. Animalcules, or microscopic organisms had been seen as early as the 1670s. Dr. John Snow (not that Jon Snow) had shown it was not miasma, noxious urban gasses, that caused cholera but something the sick had passed to the water through their feces. Snow did not make this discovery with a microscope, though, but with a map showing clusters of cases around certain well pumps.
But Snow did not really change long-term thinking. The handle was reinstalled on the Broad Street pump in London a couple of weeks later, after the cholera crisis had passed. Maybe, they thought, Snow did not really know what he was talking about. Mysterious waterborne poison, indeed.
Gilded Age Medicine
You cannot change the answers until you change the questions. And you cannot change the questions until you admit what you don’t know. What was in the air—or water—that we were not seeing? At the beginning of the Gilded Age, Louis Pasteur introduced an anthrax vaccine in 1881 and a rabies vaccine in 1885. Pasteur’s best frenemy, German physician Robert Koch, isolated the bacterium that causes tuberculosis in 1882. In 1884, he did the same for cholera. These were four of the worst disease bogeymen of the modern age. Modern bacteriology and immunology were born.
By the way, the man who introduced these two rivals, Koch and Pasteur, was Dr. Joseph Lister, the first surgeon to disinfect wounds and sterilize surgical equipment. You know his name as the root of the brand name Listerine. Yes, you are rinsing your mouth with surgical antiseptic. Please continue to do so.
It would take time before the best and brightest of the American college set would pursue a career in medicine. And, like my character Liddy, if you wanted the best post-graduate education, you really had to go to Europe. While earlier in the century that may have meant Edinburgh or Paris, by 1890 that meant Germany or Austria, and in particular the Allgemeines Krankenhaus (General Hospital) of Vienna. (And you ate dinner at the Riedhof too!)
Back in the US, it was not until 1910 that medical education truly changed. Two of the richest men to ever live, John D. Rockefeller and Andrew Carnegie, funded the Flexner Report, which was like an early US News & World Report ranking guide to medical schools—and like all of those publications, it was deeply flawed. The publication of the Flexner Report in 1910 is credited with creating the modern scientific medical school system in the US, but it also directly or indirectly caused the closure of many medical schools for women and African Americans. Those that had been coeducational reduced their admission of women, partly because they had a rise in male applicants. One study calls an unintended consequence of Flexner’s report “the near elimination of women in the physician workforce between 1910 and 1970.”
Nevertheless, the Gilded Age must have been very exciting to live through. Every day, it would seem, more diseases were being identified and explained. Notice that I did not say cured. Calomel was still popular in the early 1880s, as were chocolate-covered arsenic tablets. Aspirin existed, but no one knew how it worked until 1971! Cannabis was legal until the xenophobic backlash against refugees fleeing unrest south of the border after the 1910 Mexican Revolution, and then this effective pain reliever was demonized.
There still was no real anesthesia for surgery except ether and cocaine. Cocaine was quite handy, actually, and it was sold in lozenge form for toothaches. Bayer Pharmaceuticals introduced a new form of cough relief that they said was just as good as morphine, but not as habit-forming. They trademarked this miracle compound: Heroin. You could buy two vials for $1.50 from Sears, complete with carrying case and dosage instructions for children!
Paul Ehrlich was playing around with dye stains when he stumbled upon the inspiration for a chemotherapy treatment for syphilis that would eventually be known as Salvarsan. He and his assistant, Sahachirō Hata, introduced their “magic bullet” to the world in 1909. It was an actual medicine with laboratory-tested results, and really the importance of this fact cannot be overstated. There was no other treatment for syphilis at this time. (And masturbation was discouraged in the strongest moral terms. See more on syphilis in historical romance—or, really, the lack of it.) The administration of Salvarsan was technically complicated and cumbersome, though, and the disease had to be caught in time. Ehrlich had wanted to discover a “magic bullet” for what ailed us, but nothing was that simple. Eventually, post-Gilded Age, sulfa drugs were introduced (1930s) and penicillin and other antibiotics shortly thereafter, but old habits of calomel and bloodletting died harder than they should have.
Opioid addiction rates are not the only modern parallels to Gilded Age medicine. We still distribute poisons that would make the merchants of mercury blush. For example, botulism bacteria produce a paralyzing substance so toxic that one teaspoon could kill as many as a million people. You know it as Botox, a medically recognized treatment for Cerebral Palsy and chronic migraines. Or you might have it injected into your face to smooth your wrinkles. No judgment.
Progress is not always a straight line. Leeches and maggots are making a comeback—raised in sterile conditions, fortunately, and shipped to an intensive care unit near you. The leech releases an enzyme that keeps blood vessels open, which is essential in reattachment surgery particularly in fingers and toes. Maggots are good for recurring ulcers of the skin caused by drug-resistant infections like MRSA. Maggots only eat dead tissue—as long as you get the right type—and also release an enzyme that promotes healing. And even bloodletting, or phlebotomy therapy, may be used today for specific diseases of overproduction of red and white blood cells and excess iron.
The medicine of World War I is also making a comeback. Bacteriophages are viruses that destroy bacteria. Honestly, they look like creepy spiders from a horror movie. They are hard to keep alive in transport—which is why they were tossed aside when antibiotics were discovered—but in an era of resistant superbugs, they may be the answer.
My father is now retired from stitching up humans and stuffed animals. There are many talented, highly-trained, and impressive women and men who have taken his place. This Thanksgiving I am grateful for them all, from emergency room nurses to the scientists behind messenger RNA vaccine development. But if this somewhat sordid tour of medical history has taught us anything, it is this: whether you are doctor or patient, teacher or student, we need to keep in mind the wise words of 12th-century rabbi, scientist, and physician Maimonides: “Teach thy tongue to say ‘I do not know,’ and thou shalt progress.”
Even Maimonides should have trained his tongue better. After all, he believed in bloodletting.
Want to know more about the history of medicine? I used a collection of podcasts introduced in my previous post, and I cannot recommend them highly enough! For more on sex education manuals of the time, check out my random sampling.
Award-winning author Joanna Shupe writes the men of Edwardian era New York like no other. While some are born to the Knickerbocker Club set, others are self-made titans of industry. But whether they are from Five Points or Fifth Avenue, they are all swoon-worthy. In Mogul, one will battle a real historical injustice: the racist immigration laws of the late nineteenth century.
She never expected to find her former husband in an opium den.
Thus begins Mogul, Shupe’s last book in the Knickerbocker series.Calvin Cabot, the son of humble American missionaries in China, has grown up to become one of the most influential men in America. Even with his lucrative newspapers and powerful friends, though, can he find a way around one of the worst laws of the Gilded Age—the Chinese Exclusion Act—to reunite a friend’s family?
In this post, Joanna Shupe answers our questions about the Chinese Exclusion Act and how she came up with the idea to work such substantive history into the conflict of her novel.
What was the Chinese Exclusion Act, and how will it affect your characters?
The Chinese Exclusion Act of 1882, signed into law by President Arthur, severely limited the ability of Chinese men and women to enter the United States. It’s the most restrictive immigration policy the U.S. has ever had to date and wasn’t repealed until the early 1940s.
So why were Chinese immigrants singled out? In the 19th century, America was undergoing a massive transformation. The Gold Rush and the railroad expansion led to the need for cheap labor, and many Chinese immigrants (mostly men) were able to find jobs here. Gradually, anti-Chinese sentiment increased, polarized by a few politicians who used the Chinese immigrants as excuses for why wages remained so low. Their solution was to call for the banning of any Chinese laborer, thereby freeing up those jobs for American workers.
Starting in 1882, no Chinese laborer could enter the United States—and it was nearly impossible to prove you weren’t a laborer. Only diplomatic officials and officers on business, along with their servants, were considered non-laborers, so the influx of Chinese immigrants came to a near standstill. They also tightened the rules for reentry once you left, which meant families were separated with little hope of ever reuniting.
How effective were the Chinese Exclusion Acts at excluding the Chinese? For the last half of the 1870s, immigration from China had averaged less than nine thousand a year. In 1881, nearly twelve thousand Chinese were admitted into the United States; a year later the number swelled to forty thousand. And then the gates swung shut. In 1884, only ten Chinese were officially allowed to enter this country. The next year, twenty-six.
— “An Alleged Wife: One Immigrant in the Chinese Exclusion Era” by Robert Barde, Prologue Magazine, National Archives, Spring 2004, Vol. 36, No. 1.
Mogul is set in 1889, and circumstances have separated the hero’s best friend from his wife, who is still back in China. His best friend is African American, so they decide to tell politicians and the government that she is really the hero’s wife. This presents a problem when the hero falls in love with—and impetuously marries—the heroine of the story.
This sounds like a pretty sobering piece of history. What inspired you to use the Exclusion Act as a central plot line in Mogul?
I started with this idea that my hero would be discovered in an opium den in New York City, so that was where my research began. I didn’t remember the CEA from my history classes, so I was floored when I discovered it. It’s tragic and racist, and yet seems still so relevant today.
As romance novelists, we love to find conflict for our characters. I thought the CEA might be an interesting way to drive the story forward. I wanted to both highlight the xenophobia of the CEA and use the forced familial separation to craft the plot.
What kind of research did you need to do on the act itself and on the Chinese-American community in general? Do you have any sources that you recommend for students and researchers?
I read quite a bit online about the CEA and the effects of the legislation. The 19th century Chinese-American community was fascinating to research. A good friend of mine is Chinese-American, and I peppered her (as well as her family) with lots of questions about the language and culture. They were all very patient and helpful.
I used mostly archives of The New York Times for tidbits about Chinatown, opium, and the Tongs, which is how I saw a mention of the game fan tan and began researching that. As with most historical research, you can fall into a rabbit hole pretty easily because it’s all so fascinating.
In a genre that some claim is about “escapism,” did you encounter any resistance to using this real history as a conflict in your book—either from editors, publisher, or readers?
I didn’t receive any resistance about this storyline, per se, but I’ve had readers tell me that they won’t read any historical set in America. The reason given is they can’t “romanticize” it the way they can with British history.
While I understand what they’re saying—after all, we’ve lived and breathed American history in school since Kindergarten—I don’t agree. We can’t assume we know everything in our history so well that we can’t learn something new or enjoy a compelling story. There’s so much history that isn’t taught—or isn’t taught well—and looking into the past gives us the clearest view of where we are today.
The Gilded Age is one of our finest eras…but also one of our nation’s low points. In each of the Knickerbocker Club books, I’ve tried to highlight some of the issues and problems as well as the opulence and wealth.
Do you remember when New Year’s Eve 1999 was dominated by Y2K fears? (I know, it seems so naive and innocent, in retrospect.) Was there a similar Y1.9K crisis? What were Edwardian era fears? Thanks to the Library of Congress’s Chronicling America catalog of historical American newspapers from 1690 to the present, I was able to take a peak into the past. Through a search of front pages on New Year’s Eve 1899 and New Year’s Day 1900, I found both more and less than I expected.
In terms of hard news, the concerns were much as any other day, and any other year: war, terrorism, natural disasters, fires, religion, disease, health care, and politics. I did not keep track, but the most prevalent story seemed to be the Boer War in South Africa. And, no, the Americans were not a party to this conflict, but that did not mean Americans did not have opinions. (Do Americans ever not have opinions?) The war was a part of Britain’s attempt to annex two gold- and diamond-producing Boer Republics, where descendants of Dutch colonists lived. They wanted to stitch them into a British-federated South Africa—and they would eventually be successful. But, at the end of 1899, the Boers were winning. The Boers had besieged three cities and won several significant battles against the underprepared and undermanned British. In the United States, sentiment was generally unfavorable to British—especially in areas of large Germanic or Dutch settlement in the American Midwest, where newspapers depicted the British as mired in a “densely stupid policy.” According to the New York Sun, the American Irish also gave widespread support for Boers, based upon their hatred for British. “The enemy of my enemy is my friend.” And so it goes.
The Boer War was a guerrilla insurgency similar to the Philippine-American War—which was happening at the exact same time—and generally the papers who were critical of British efforts to “pacify” the Boers were maybe a little more honest about the difficulty of “pacifying” the Filipinos, too.
One way they could do this was to cover an attempt by Filipino partisans to launch an assault on the funeral of General Henry Ware Lawton, the only American general to be killed in action during the conflict. The Americans caught wind of the plan and found a stash of four bombs meant to be dropped from the rooftops, along with five hundred rounds of ammunition and a few firearms. Other papers, interestingly enough, did not mention the “diabolical plot” at all. Instead they gave detailed coverage of the people at the funeral and the new cabinet planned by Governor Leonard Wood.
Some papers were admiringly local in their coverage. Both Hawaii papers (The Hawaiian Star and The Evening Bulletin) were devoted to either island news or, at their most global, events around the Pacific. One such story was the Black Plague outbreak in China. The Tombstone Epitaph reported on local weather and wedding announcements on the front page. Both Richmond (VA) papers were darned near full of advertisements—for the city itself. The Richmond Dispatch reported on “A Year of Great Prosperity” and that the “Future [Would Be] a Brilliant One.”The Times (of Richmond) proudly proclaimed that “Everywhere in Virginia People Busy and Happy.” How nice. The Brownsville (TX) Daily Herald was an odd little paper. Their front page was devoted to vignettes and humorous stories collected from other papers. One revealing piece applauded how the people of Leadville, Texas, ran two law-abiding Chinese men (“celestials”) out of town.
And, of course, some papers did not cover hard news at all. The New York Evening World’s front page was dedicated to the results of the McCoy-Maher boxing bout. Pugilism mattered to the readers of the Daily Inter Mountain of Butte, Montana, as well.
The Ocala (FL) Evening Star and the Morning Appeal of Carson City, Nevada were all advertisements. One product featured in the Carson City paper was one of the biggest patent medicines of the turn of the century: “Dr. Pierce’s Favorite Prescription for the relief of the many weaknesses and complaints particular to females.” This gave a “fountain of health for weak and nervous women.” The nostrum was a botanical mix of many relaxants designed mostly to help with menstrual pain—though no one would say such a thing, of course. It was just a “weakness” or “complaint.” And if it was just botanicals and not morphine, cocaine, or even mercury, then that was pretty good for Gilded Age medicine.
Y1.9K did have some technological fears, especially centered around the newest invention of the day: the horseless carriage, or the automobile. There were no alarmist articles about how motorized transport would lead to lazier Americans, more fractured and transient communities, suburbs, and eventually mechanized weapons. Nope, the sentiment was more subtle, as captured in a political cartoon of Father Time saying: “They want me to try that. Guess I’ll stick to wings.”
I am not sure what I expected when I began this search, but I think I wanted the papers to seem a little silly. A little quaint. (And Dr. Pierce’s medicine was both of those.) In the end, the biggest surprise may have been the optimism of some of the papers. At first I snickered, but now I realize that this positivity is the very reason I write romance. After being the cynical, hard-headed history teacher all day long, I love the idea that love can triumph over all. Maybe not “everywhere,” but at least somewhere people can be “busy and happy”—even if in my mind. May your New Year be full of happily-ever-afters.
I am thrilled to announce that I will be posting biweekly on Evangeline Holland’s magnificent website, the Edwardian Promenade. Established in 2007, this site is the #1 resource for readers, writers, and students alike for everything Edwardian. As years have passed, the site’s focus has widened beyond 1900-1914 Britain to include global society between 1880-1930. While you are there, take a look through this fantastic, rich site, and check out what Evangeline has been up to, both scholastically and artistically (including her own novels).
I will be cross-posting here, too, so you will not lose any content from this site. To see my introductory post, click here. Since I cut my hand unloading the dishwasher last night, now have eight stitches in my left hand, and am typing this post one-handed—only me!—I will keep it short. Happy reading, everybody!