Gilded Age Medicine: Why Ordering Heroin from the Sears Catalog Was A Step Up

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.”

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Sugar Communion’s heroine, Dr. Elizabeth “Liddy” Shepherd, as inspired by an 1896 fashion plate at the Met. (She will borrow the dress.)

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!)

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Ohio Medical University was one of the predecessor institutions of the eventual Ohio State University Medical School, and the affiliated Protestant Hospital would eventually become Riverside Methodist Hospital. This original campus was at Goodale Park. Postcard courtesy of Historical Reflections, the Ohio State Medical Heritage Center Blog.

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.

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James Gillray’s “Breathing a Vein” and “Taking Physick” (calomel), published by H. Humphrey, 27 St. James’s Street, London, January 26, 1804. Images courtesy of the Claude Moore Health Sciences Library at the University of Virginia.

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.

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“Leeches, a type of worm with suckers at both ends of the body, were used in bloodletting. It was the job of the leech finders, usually women, to collect these creatures for medical use. The leeches attached themselves to the legs and feet of the women who plucked them off and stored them in the little barrels of water. Doctors grew rich at the expense of these low paid women. Leeches were such a popular treatment that by 1830 demand outstripped supply all over Europe. Today, leeches are used following plastic and reconstructive surgery as they help restore blood flow and circulation. The print appeared in Costume of Yorkshire, published by George Walker in 1814.” Image and caption from the Science Museum Group.

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.”

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Calomel display from the Musée Testut-Latarjet.

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).

Tobacco-Smoke-Anal-Furnace-Resuscitator
Resuscitation Set from the first half of the 19th century, courtesy of the Science Museum Group.

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.

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Snow’s map of cholera deaths in the Broad Street area, courtesy of the Department of Epidemiology, at the University of California Los Angeles School of Public Health.

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.

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Once the bacteriology-immunology ball got rolling, lots of diseases were ready to be prevented. This chart of the history of major vaccine development is from Bioinformatics for Vaccinology by Darren R. Flowers.

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.

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A compound microscope from the 1880s and a vintage bottle of Listerine, courtesy of Wikimedia Commons.

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!)

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Wien Wickenburggasse mit Riedhof, outside the Vienna General Hospital. Photo from vintage postcard.

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.”

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The General Hospital of Vienna, a favorite place for post-graduate study for American medical students in the late 1800s. Illustration from Wikimedia Commons.

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.

Marijuana in the Gilded Age
Who won the 2016 election? Marijuana, of course. But beware! Gilded Age America preferred cocaine tooth drops. Find out more.

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!

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Heroin advertisement from p. 377 the November 1899 issue of the New York Lancet, accessed at Wikipedia Commons.

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.

Modern Parallels

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.

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Microscopic images of nanostructural and biological bacteriophages, courtesy of Wikipedia Commons.

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.

Further Reading

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.

More Medical Advertisements from the gilded age
Allison-operating-table-fishnet-stockings
I just could not help including this. It is the Allison “operating” table, as advertised on page 352 in the New York Lancet. Maybe they’re going to try the tobacco smoke enema?
biseda-morphine-strychnine
Bisedia advertisement from a 1908 edition of the Lancet. The compound included bismuth, “Pepsina liquida” (“a palatable, standardized solution of gastric juice from the pig”), morphine hydrochloride, hydrocyanic acid, and tincture of nux vomica (strychnine). Yikes, please don’t take this.
Glyco-Heroin-Smith-Lancet
Want more heroin? This advertisement was in the 1908 volume of The Lancet. Notice the dosing for children.
Allenburys-Cocaine-Throat-Pastilles
Cocaine drops, anyone? This advertisement is from the 1908 Lancet.
Antikamnia-Heroin-Lancet
Yet more heroin advertisements from the 1908 Lancet.
Valentine-Meat-Juice-Lancet
I got nothing. Also from the 1908 Lancet.

History Ever After, Part I: The Fabricated Chronotopes

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Diversity of geography, time period, and representation exists in historical romance novels, both traditionally and independently published. However, mainstream bestsellers are disproportionately: (1) set in Great Britain; (2) overpopulated with nobles; and (3) selective in their historical accuracy. These three criteria define the most popular chronotopes.

Before we break down these three observations, it’s definition time. The Literary Encyclopedia says that a chronotope is: “A term taken over by Mikhail Bakhtin from 1920s science to describe the manner in which literature represents time and space.” I am adding geography and ethnicity to this construct. Therefore, this study examines historic, geographic, racial, and ethnic diversity within English-language romance sold in the United States and written at least fifty years after the events described.

the British setting

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I began with bestseller data for the last six months, relying first upon Romance Writers of America to identify the bestselling books by member authors and then doing my own investigation to determine whether these romances were historicals. This past April at the New England Chapter of RWA’s annual conference, Cat Clyne, editor at Sourcebooks, called the historical market “soft.” And this is partly true: in conventional print bestseller lists, historical romances by RWA-member authors are at most 11% of bestselling romances. They have the largest market share on the Barnes & Nobles Top 20, but in total sales that may not be much. As we will see later, the role of historical romance has a larger impact than sales on the overall romance industry.

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But let’s look at these 2018 bestsellers: 4/5th of them are set in one of only two periods: (1) 19th century England and (2) Scotland, in any period. Regency romance is almost half of the industry. The Regency, when Prince George ruled in proxy for his incapacitated father, George III, lasted only from 1811-1820. However, the era’s “style” may extend a decade or two on either side. Queen Victoria ascended to the throne in 1837, a date that should be the firm beginning of the Victorian age. Publishers still play with this date, though, depending on how they want to market a book. For example, Devil in Winter by Lisa Kleypas—a book that earned the title of #1 romance of all time in the All About Romance readership poll—is marketed as Regency, even though it is set in 1843. (More on this poll below.)

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The obsession with the Regency is backed up by my own survey in February and March 2018 of 336 self-identified historical romance readers. Respondents could choose more than one favorite, and over 90% of them chose Regency, with Victorian romance following closely behind at over 70%. More revealing, actually, is the fact that when asked if there were more periods that they would like to see used in romance, 25% said no. They are perfectly sated by the dominant chronotopes that exist. (However, 8% would like to see anything non-Western, a statistically-significant number because this was a write-in response chosen independently by 27 readers.)

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Critical reception follows the 19th-century British trend. All About Romance periodically identifies the top 100 romances of all time through a readership poll, and though this survey process was problematic from a social science standpoint, they do provide us with a current read on a longer-term market. Of their ranked top ten, six out of ten are historical, which skews high as compared to current sales data. Five out of these six are set in the 19th century. (The other is a time-travel Scottish romance. Ahem, Outlander.)

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The British Peerage

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Another characteristic illustrated by the AAR poll is the obsession with the British peerage: five out of six historicals dealt with peers or lords and their heirs. Only KJ Charles has a relatively elite gentleman without a family title. Moreover, her book breaks class and sexuality assumptions that exist within the chronotope. This proves that alternatives do exist, and they do garner critical and reader attention—but note that this book is still not available in paperback and therefore will have a hard time making the conventional bestseller lists. And keep in mind that this is the only one of six that broke the mold.

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The 2018 RITA finalists showed a similar result: out of the seventeen finalists in historical categories, including historical novellas, 71% were set in the Regency and 24% were set in Scotland (with some overlap between those two). That is a total of 88% set in these two chronotopes. Note that 35% of these finalists have duke or duchess in the title—not in the book, but in the title.

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Neither the AAR poll or the RITAs are outliers: in the past six months, over one-third of the top 20 Regency and Victorian romances on Amazon’s bestseller lists have included either duke or duchess in their titles. If you extend that count to marquess and earl, the numbers jump to one half. In my industry producer survey, one author called this the 10,000 dukes problem.

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Several other authors reported that they had been asked to change the settings of their novels to Regency, and often specifically to dukes. One wrote: “Hero had to be a duke (again) to improve marketability. This is ridiculous. There were at most a couple dozen dukes running around Regency London at once, and they were not all tall, dark, grouchy, and in want of female companionship. Try telling my trad house editor that.”

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This author was on the money: there were 24 non-princely dukes in 1815, out of a British population of 19.2 million. These dukes averaged over 50 years of age, and if you have ever seen The Supersizers Go “Regency,” which is recapped at Just Hungry, the period diet would not quite leave one with chiseled abs. You may remember the era of baron romances, so where did all this peerage inflation come from?

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Mary Lynne Nielsen suggested this may be a symptom of rising wealth inequality in the US. The appeal is not just the power that comes with money, but the perceived security that this money brings. It is a similar phenomenon to billionaire books in contemporary romance, though it is easier to run into an American billionaire today (1:598,889) than a Regency duke in Britain (1:800,000).

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Despite the fact that Pride and Prejudice earned the 5th place spot on AAR‘s survey, Jane Austen is not really to blame for this duke obsession. First, while some claim their love for the historical romance genre stems from Austen’s work, she wrote contemporary novels. Some would argue, moreover, that these are comedies of manners with romantic elements rather than romance genre books. But, most importantly for our peerage discussion, Austen only mentioned a duke once, in the most passing of ways, according to the Jane Austen Wikia. Fitzwilliam Darcy was the nephew of an earl, the closest Austen ever comes to a peer hero.

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Georgette Heyer, on the other hand, was much more interested in peers, especially in her Regency novels. 43% of Heyer books have duke, marquess, or earl (or their issue) as heroes; and if you consider all peerage ranks (down to baron), 68% of Heyer’s heroes are peers or their issue. According to Laura Vivanco, the bestselling authors who shaped the modern standard of Regency—including Stephanie Laurens, Mary Balogh, and Mary Jo Putney—cite Heyer as their inspiration. Everyone claims to love Austen still, but do we love a Heyer-istic or chronotope remake of what we expect Austen to be, possibly based on our film and television adaptations of her work?

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Historical Selectivity

Let’s look more deeply at our Regency heroes and where they got their wealth. One author in my survey commented:

For bigger picture things, I hate that there’s so little acknowledgement in historical British-set stories where wealth comes from. They might have a throwaway line about ‘sugar’ or ‘land in Jamaica’ or ‘sent to India to make his fortune,’ but there’s absolutely no acknowledgement that this wealth is built on the backs of slaves or violent oppression. I don’t want every historical I read to be a history lesson on the evils of slavery but this refusal to even nod to the realities of historical fact completely erases entire continents and populations from their place in history.

For all the reasons mentioned above, it is unfair to pick on Mr. Darcy—except for the fact that Jane Austen gave us a figure: £10,000 a year. This may have been an exaggeration, but it is a number to start with. How much does this mean in modern terms? Well, it depends on how you measure the purchasing power of the money, but it could be a princely sum. Where did he get this money? Tenant farmers? Coal mines? Sugar trade in the Indies? Why don’t we ask?

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The chronotope is selectively inaccurate when realism endangers the happily-ever-after. Can you have a happily-ever-after with a slaveowner? (No. And I know there was a 2015 RITA finalist with a Nazi concentration camp commandant, but let’s not go there.)

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The popular chronotope of 19th century Britain avoids such issues by erasing these uncomfortable aspects of history from the story. And yet the authors I surveyed claimed that accuracy was extremely important to them, and in impressively specific ways. For example, when was the doorknob invented? Ella Quinn will tell you that it was not until June 8, 1878, that Osbourn Dorsey filed the patent for a turning doorknob. There were no doorknobs in the Regency. Some readers who are sticklers will pan a book for a doorknob, waltzing before the scandalous dance was introduced, decorating a German-style Christmas tree in Regency England, or using peerage titles incorrectly.

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And yet no hero has syphilis. Of course not because it is a reality that does not fit the romance genre requirements. There can be no HEA with syphilis. Until penicillin was widely introduced in the 1940s, the recovery rate was 1%. After a latency period (3-15 years), the disease caused seizures, internal bleeding, physical deformations, loss of motor functions, organ failure, dementia, aneurysm, and death. We know that taming the Regency rake is a common trope—and where does one become a rake other than with a mistress, or at a gaming club, or brothel, where it had to be easy to contract syphilis through sexual contact. Honestly, though, it was easy to contract syphilis anywhere: between 8 and 15% of the general population was infected with this disease in the 19th & early 20th centuries. And because of the latency stage, you often did not know you had it. Doctors would often not tell their patients that they had syphilis, nor would they tell a man’s wife about his diagnosis, even though he was 92% likely to give it to her within the first year. [Read more about medicine in the nineteenth century here.]

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And being wealthy or a duke did not protect you from this scourge. In fact, you were more likely to die from the disease than your textile workers, coal miners, or tenant farmers. Being young didn’t help either: based on records of Chester, England, 8% of our heroes should be contracting syphilis before age 35. But they don’t, and this is why the Regency chronotope works.

Advantages of the Regency Chronotope

Let’s stop talking about syphilis. Let’s be historically selective for the purposes of a happily-ever-after, character-driven story: this is “escapism.” One blogger called this chronotope a “Never-Neverland mash-up that’s been dubbed ‘The Recency’ or ‘Almackistan.’” I have also heard it called a “wallpaper historical,” a ”costume drama,” or a “Disney Regency.” It is a cleaner, safer, prettier, better-smelling, and happier world than the real Regency ever was.

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Best of all, there are low barriers to entry, for both readers and authors. A reader can jump into a new duke Regency as easily as an episode of a favorite television program. It takes only a little marginal effort to start a new book, or a new author, or a new series. Because the history and rules are already known before the reading begins, the author can dive right into character development. The key research for the author is reading more of the same. One author, Maggie Mackeever, advised prospective authors to ”Immerse [themselves] in Georgette Heyer” and to “Read until [they] have the era fixed clearly in [their] head[s].” In other words, Regency dukes are commodities. We can buy and sell them easily on the free market—in novel form, of course.

Where is the harm in this? A good book is a good book, right? With an audience who understands how this world has been fabricated, any reader can enjoy a Regency duke story. No single book, author, publisher, or reader is wrong. Read it all! But there are problems, in the aggregate. To find out what the are, read part two of History Ever After.

(To go back to the History Ever After content page and find the handout flyer, click here.)

History Ever After, Part II: The Problem of Chronotopes

In part one of History Ever After, I illustrated how bestselling historical romance is dominated by selectively accurate British peerage chronotopes, especially the Regency. So what, you ask? A good book is a good book. Any reader can enjoy an exciting duke romance. I agree! I read everything.

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However, the aggregate impact of these chronotopes can be harmful to our understanding of history, to the romance market as a whole, and particularly to authors of diverse books.

Mirrors and Windows

A popular concept in the discussion of multicultural books is the question of whether fiction is meant to reflect one’s own identity and experiences, or provide insight into the identity and experiences of another. British peerage historical romance bestsellers are mirror texts for the dominant culture and windows text for readers of color. We need more of the reverse too.

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This is not a new concept. In 1965 Nancy Larrick wrote up a study in which only 6.7% of children’s books had one or more African American character. This was a problem for African American children who could not see themselves in books as heroes, wizards, or just boys and girls. But Larrick saw another problem, too. She wrote that “the impact of all-white books upon . . . white children is probably even worse. . . . There seems to be little chance of developing the humility so urgently needed for world cooperation, instead of world conflict, as long as children are brought up on gentle doses of racism through their books.”

Ripped-Bodice-Diversity-Report-2016Fifty years on from Nancy Larrick’s study, we’re not doing any better in Romance, according to the Ripped Bodice’s State of Racial Diversity in Romance Publishing Report.

[Edited to add in March 2021: Professional statisticians Nick and Ari have published a full report on data and ethics concerns in TRB’s reporting. As there are no better statistics available yet, and because this post is representative of the presentation that I gave in 2018, I will not remove my text below. Based on the experience of BIPOC authors, as related to me personally and on social media, I believe the conclusions drawn below are still relevant generally, but they should not be relied upon for statistical accuracy. This warning applies only to the TRB report, not the Lee & Low study that is subsequently mentioned.]

Half of the publishers surveyed in 2016 had only 5% or fewer of their books written by people of color. While diverse books do exist, it is not enough—and too often they are published independently, without traditional backing or wide print distribution. This is a self-fulfilling prophecy: if you publish only what is selling best now, then future bestsellers will be confined to this same limited chronotope—a vicious cycle. True to form, the numbers are worse in 2017 than in 2016: 10 out of 20 publishers surveyed had fewer books published by authors of color than the year before.
Ripped-Bodice-Diversity-Report-2017

Part of the problem is the lack of diversity WITHIN publishing. This 2015 Diversity Baseline Study by Lee & Low Books, a multicultural publisher that is minority-owned, illustrates the problem. These numbers do not include two of the Big Five publishers: Simon & Schuster (which includes Pocket Books) and HarperCollins (which includes romance behemoths Avon and Harlequin). Given the Ripped Bodice numbers, though, I cannot imagine their inclusion would make the industry more diverse, at least on the author side.

industry-diversity-publishing-lee-low

Last year, Penguin UK announced the new company-wide goal for “both our new hires and the authors we acquire to reflect UK society by 2025.” If American publishers tried this, they would need to target the following numbers, based on 2016 estimates by the United States Census Bureau: 61% white, 17% Latino, 13% Black, 6% Asian, 2.6% mixed race, 1.3% American Indian, and more. The numbers Lee & Low show us are far from such a representative target.

Everyone needs both mirror texts and window texts. We need them in different balances at different times in our lives, but we need both. We need diverse historical romance to be pushed with the same kind of institutional support that an Avon Regency duke book gets. Why isn’t that happening?

Misunderstanding History

Part of the reason is we misunderstand history. There is damage done when people believe that the chronotope is history. For example, if one only read the British peerage chronotopes, one might not know that people of color existed in Europe from Rome to the Middle Ages and beyond. Examples from art of the period not only proves this, but also that people of color existed at every level of society, too. Medieval Europeans discriminated more by class than race, a word they did not have.

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Images from the period, from left: Amazons, Le secret de l’histoire naturelle, France ca. 1480-1485, BnF, Français 22971, fol. 2r; Juriaen van Streeck, Still Life With Peaches and a Lemon Netherlands (c. 1650s), Oil on Canvas, 90.5 × 80 cm; Rosalba Carriera (Italy), Africa, (1673 – 1757); The Limbourg Brothers, Très Riches Heures du Duc de Berry f. 193r: Exaltation of the Cross France (c. 1412) Illuminated Manuscript. All courtesy of the @medievalpoc account at Twitter.

And do not be fooled: people are getting their history from the genre. Bobbi Dumas wrote an article for NPR entitled “Don’t Know Much About History? Read A Romance.” She quoted Sabrina Jeffries as saying, “Everything I know about the personal cost of Waterloo, I learned from Regency-set historical romances.” Dumas also claimed that “Georgette Heyer wrote such a fine treatment of [Waterloo] in An Infamous Army that it ended up on a reading list for students at Sandhurst, the British military academy.” African American author Beverly Jenkins calls her books “edutainment: entertainment and education,” which may be the most accurate way of putting it. “There’s no test on Friday,” she says, “so [the readers just] drink up the history. They just inhale it.”

Chinese-American-editor-historical-romance
The Chinese School in Mott Street, New York, 1879, from the New York Public Library Digital Collections.

But which history do readers inhale in bestselling chronotopes? One anonymous author in my survey reported:

I once was told to remove a secondary character who was Chinese-American from a book set in 19th century NYC because the editor believed having a character of Chinese descent in that time period and setting was anachronistic. It was in fact not—I could and did provide ample historical evidence of this—and I refused to change it because I believed not only did it damage the historical integrity of the work, but it also contributed to the white-washing of NYC history.

This editor should have known better. She or he may have even lived in New York. When people in control of publishing have such a warped impression of history by the books they have been the gatekeepers over, then we are in a terrible feedback loop of ignorance.

Perceived Accuracy as a Double Standard

historical-accuracy-weapon-diversity-chronotope

Perceived accuracy is a dangerous weapon, and it can hurt an author’s critical reception by people who should know better. Let me show you how this works.

In the AAR Top 100 romance novels process, there were no books by African American authors on the original stage one voting lists. AAR rushed to change the stage one list after Twitter blew up, but they still left off the Romantic Times 2018 Book of the Year Award winner, An Extraordinary Union by Alyssa Cole. I believe it is a particularly relevant example. First, AAR had the ambition to make such a list, so clearly they consider themselves an authority in the genre. Second, even before it became RT’s (last) Book of the Year, it was already a very, very highly praised book. An Extraordinary Union is the story of a free Black woman who goes undercover as a slave in the American Confederacy to spy for the Union and falls for a white pro-Union spy she uncovers along the way. What an interesting story, you say. And outside the British peerage chronotope! So why did AAR omit it? Because they had given it a C.

An-Extraordinary-Union-AAR-review-chronotope

One of the reviewers questioned whether this book provided a “realistic depiction of the slave experience”? If it were realistic to the slave experience, there would be no happily-ever-after. There was no HEA for slaves. When history endangers the HEA, the HEA comes first because this is romance. It is usually a minor accommodation, as it was in this case. (For example, one reviewer claimed that the heroine Elle had “an awful lot of freedom” for her spying, but this same reviewer later stated that she would still have liked to see “more emphasis placed on the spy portions of the story.”) I should point out that Cole’s book was a very well researched piece of fiction loosely based on a real person, Mary Bowser. Its treatment of everyone—from Black slaves to white Confederates—is highly nuanced and layered. It also includes a bibliography. [Edited to add: As pointed out in the Book Thingo podcast on romance lists, the real and harrowing risks Elle faced in her role as a slave were explicitly laid out in the book.]

Duke-Unexpected-Bride-AAR-review-chronotope

One month later, the same primary AAR reviewer blasted the historical flaws of a Regency duke book: “Ladies didn’t run amok unchaperoned in London, and dukes didn’t volunteer for the job without any prior introduction or connection to the lady in question.” She also wrote that “it’s awfully convenient how often [Max] breaks his own rules and finds himself alone with Sophie; and Sophie, country bumpkin, transforms into a sexually confident seductress.” The reviewer was “nevertheless charmed” and gave it a B. One reason this happened was because the Regency book was judged against a chronotope, not real history.chronotope-double-standard-historical-romanceThis is a double standard. Since there is not a pre-established model for diverse Civil War romance, An Extraordinary Union was compared to the inappropriate standard of historical fiction. No romance novel will stand for everything about slavery or the civil war. It can and should be a window into that history, but the world-building has to be done very explicitly to allow for a romance to develop between two characters and to make room for their HEA. Alyssa Cole’s Loyal League series is immersed in extensive research, down to a pro-Union insurrection within the Confederacy—an understudied part of the Civil War—but critics need to allow Cole at least a portion of the same authorial agency that they give to Regency duke stories. Overall, this series is more accurate than much in the Regency chronotope.

Through-the-Storm-AAR-review-chronotope

But be careful: historical world-building also opens an author to the criticism of including too much history in the romance. This was true for Through the Storm by Beverly Jenkins on AAR. Jenkins HAS to do this historical work because it is not a chronotope that the reader understands before page one. But, again, both Jenkins and Cole include bibliographies in the back of their books. How many Regency duke stories do? And yet it seems there is no way to win: these authors are criticized for too much history or too little history.

inertia or incentive

Are the mirror texts of the dominant culture creating bias? AAR is not included in the diversity of reviewers study by Lee and Low Books, but I looked through their site. By self-identification, there seemed to be 2 reviewers of South Asian descent? I saw no African American representation, though there were a few reviewers under pseudonyms with no identifying details so I cannot be sure. I do know that AAR’s historical categories only include European and American settings. They have ”Indian Historical Romance,” but it is about Indigenous Americans (“American Indians”), not Indians from India. I did not set out to pick on one review site—but, again, if you aspire to poll readers and rank romance novels, your reviews and ratings do matter.

[Edited to add: based on inquiries from an AAR reviewer, I acknowledge that other review sites may not be more representative. I did not break down the ethnicity and race make-up of other romance review sites, like Dear Author or Smart Bitches, Trashy Books, the two the reviewer asked me about. The Lee & Low Books study (above) shows that lack of representation in published review journals (also asked about by the AAR reviewer) is a significant problem. I focused on AAR‘s reviews in this study because of the visibility of the Top 100 list during the period of my research, along with the bias issues in the survey process.]

Still, no single book, publisher, reviewer, or reader is the problem. The aggregate is the problem. In the aggregate, if authors writing diverse historical romance, particularly authors of color, are not getting traditional publishing support (which the Ripped Bodice statistics show), and they are not getting critical acclaim because of an unequal standard, then they will have a harder time finding their market. They could have a harder time being mainstream bestsellers. And then traditional publishers might say “those books don’t sell,” which is a way to obscure the fact that publishing has helped establish a market that is unfriendly to these books.

pew-study-readership-affinity-groups

They will be sorry. Pew Research found that the most likely person to pick up a book—in any genre and any publishing format—is a Black woman who has been to college. Reading is an inclusive activity. Moreover, the younger the reader, the more likely she or he is to be non-white in the United States. Yet RWA’s own study of romance readers and their membership is significantly less diverse than the nation as a whole. Diversifying the books in the genre should be a matter of survival for the industry—as well as a matter of variety and accuracy.

readership-compared-ethnicity-population

Is there some optimism from my survey of 336 historical romance readers that they are interested in fresh, new settings outside the British peerage chronotope? If we assume the readers who answered these questions were at least as white as the United States as a whole (61%), then many white readers also want diverse books.

new-time-periods-historical-romance

Romance is a commercial industry, and readers can choose to read as they wish. But do they understand that their Regency dukes are a fabricated chronotope? More importantly, do industry professionals realize it? If they focus only on current bestselling trends, they will crowd out other books, alienate future readers, and weaken the industry itself by making it less elastic.

Change is happening fast. Vested interests are facing a challenge in one of the most money-dominated industries in America: politics. On 28 June 2018, the 28-year old Bronx hometown hero Ocasio-Cortez handed a primary defeat to the 4th ranking Democrat, Chair of the House Democratic Caucus, and ten-term incumbent in the US House of Representatives, Joe Crowley—a white man. This is how fast markets can change. Ocasio-Cortez had no corporate donations and 1/16th the funding. And the New York Times missed it.

alexandria-ocasio-cortez-change-america

Similarly, will New York publishing houses miss a similarly sudden shift in historical romance readership? If they do, we need to help each other find books that are a little different: set somewhere else, with more political plot lines, or with broader character representation. Help me crowd-source these lists on Goodreads so we can find the historical romances we need for the 21st century:

historical-romance-chronotope-original-list

(To go back to the History Ever After content page and find the handout flyer, click here.)

Some updates on History Ever After

For a moment there, I wondered if I was getting to Sydney for IASPR at all. One of the legs of my journey was canceled, and it took two international calls to clear up the mess. (I think I’ve done it…we’ll see if I actually board a plane). When I hung up the phone, I thought to myself: “Gee, I would rather put the finishing touches on my History Ever After talk than grade those thirty-six exam essays waiting for me.”

(I would have probably also opted to fold laundry, clean out the fridge, and even scour the shower if any of those would get me out of grading. I feel bad about this reluctance because I teach really great students, and I love to see them succeed. But staring at such a large pile is disheartening.)

In any case, I procrastinated a few hours and updated the data on my slides. The last time I posted about my research, I only had about three months worth of market data to crunch. Now I have six. The results have not changed so much, even as Twitter has been alight with criticism of the lack of diversity in romance in general and historical romance specifically. But I should not get ahead of myself.

The dynamic duo of Regency and Victorian romance still dominates the industry. Of the historical romances that make the New York Times, Publishers Weekly, USA Today, Amazon, and Barnes & Nobles bestseller lists, 63% are set in 19th century Britain. And among online retailers, dukes are like kings:

peerage-book-titles-historical-romanceWith the royal wedding this past month, I understand the appeal of the royalty-slash-nobility happily ever after—though this wedding was far more inclusive and kick-ass than any Heyer book, I dare say. (While I am thinking of the wedding, let me give a shout out to my good friend Andres for bringing me a commemorative tin of shortbread. I may have been a little excited—ahem—when I received it. However, that “best by” date sticker has me confounded. I mean, really? The tin is what I want. That doesn’t expire. Who the heck cares about the shortbread?)

meghan-harry-wedding-tin

Anyway, I get it. I really do. But that still does not explain why dukes/duchesses appear in the titles of a third of the Amazon Regency and Amazon Victorian Top 20! (See the above slide.) About the same number of historical romance novel finalists in the 2018 RITAs have duke or duchess in the title. Not in the book; in the title!

RITA-2018-duke-regency-chronotope

The New York Times Review of Books just put out a Summer Romance Reads list. The Review‘s new romance columnist (yes, they learned to ask someone who actually reads romance to write about romance) indicates a fresh trend: poking a stick at the genre’s “reliance on aristocracy.” I would have cheered this news loudly if it were not for the fact that 3 of 4 historical romance novels mentioned have peerage or peerage-adjacent heroes (2 duke offspring—one illegitimate—and a marquess).New-York-Times-romance-recommendations-summer-2018I have no doubt these books are great, and I look forward to reading them. I love all four histrom authors featured, and I have even interviewed Joanna Shupe on this very blog! And a few of these books challenge the chronotope in different ways—for example, Cat Sebastian has written a bisexual marquess and a nonbinary love interest. Cool!

But I want commoner heroes and heroines who make things, heal diseases, and run businesses—and they did in history. Women did, too. The Times book reviewer writes: “In Regency England, the space [strong women] can eke is usually tiny, the size of a marriage and no more. Sure, there are outliers, but authors can only stretch historical constraints so far.” First of all, give me those outliers. Outliers make the best fiction! Second, this is true only as the Victorian era restricted women’s rights from what they had enjoyed before. So why do we love the 19th century so much?

Despite all these facts above, there are still strong women who made history, no matter the odds against them. And we might expand our understanding of women’s work to include the many household management and childrearing tasks that women had extensive control over. And you did see women in professional fields, such as education and health care. There are interesting stories out there.

And I do want to read all four of the historicals on the Times‘s review. The problem is not them, or any individual book. Any book is great if it is a good story well told. The problem is the effect of the aggregate. The overreliance on two chronotopes—19th century Britain (especially peerage heroes) and medieval England/Scotland—may distort readers’ view of history and make the market less friendly to diverse books and authors. This is a theme I will expand upon late this month in my recap of my talk, History Ever After. Stay tuned.