One of my favorite things about being an author, aside
from sharing my stories with readers, is all the wonderful information I find
while doing research. Writing The Illegitimate Duke allowed me to
dive back into Regency medicine, an area that first caught my interest seven
years ago when I started work on There’s Something About Lady Mary.
What intrigues me just as much now as it did back then, is discovering how
advanced some physicians and surgeons were in the past. They weren’t all the
blood-letting quacks so often depicted in the movies. For instance, I bet it
would surprise you to know that the first successful heart surgery on record,
was performed by the Spanish surgeon, Francisco Romero, in 1801! Granted, he
‘only’ worked on the lining of the heart in order to drain excess fluid, but he
did this twice without either patient dying. And don’t forget that this was
done at a time before anesthesia, which is really quite amazing. Unfortunately,
finding information on Francisco Romero wasn’t easy. It required a bit of
digging and eventually I just stumbled upon him by chance. If you do a search
for ‘history of heart surgery’ or ‘first heart surgery’ etc. other more recent
surgeons are credited, which in my opinion is rather unjust.
“Delayed acceptance of discovery happens in
all areas of science, of course, but it always happens in the field of medicine
with great poignancy, since there the human costs of dropping the technological
ball are usually great.”
– Alcor. Life Extension Foundation
Similarly, Charles Kite and William Buchan were medical
pioneers who ought to be household names. Instead, other people are more
famously known for discoveries and claims these men made long before anyone
else. I bet it would surprise you to know that the first cardiac defibrillation
was given to a three year old girl on July 16th 1774, long before Jean-Louis Prevost and Frederic Batelli demonstrated the use of defibrillation
in 1899. When Catharine Sophie Greenhill fell out of a first floor window, an
apothecary pronounced her dead. Thankfully, a neighbor named Squires, an
amateur scientist, arrived on the scene twenty minutes later with an
electrostatic generator and proceeded to pass electricity through her body.
History records that after giving her several shocks to the chest, her pulse
reappeared and she began breathing again. Eventually, after a short time in
coma, she recovered fully.
This incident is remarkable and this is where Charles Kite comes
in, because he took note. As a member of the Humane Society (still in existence
today and originally named The Society for the Recovery of Persons Apparently Drowned), he not only
advocated the resuscitation of people in cardiac arrest by using bellows as
well as oral and nasal intubation, but also developed his own electrostatic
revivifying machine. This used Leyden jar capacitors in a similar way to the DC
counter shock of the modern cardiac defibrillator, which makes you stop and
think, doesn’t it? I mean, we’re still talking late 18th Century here
since Kite received a silver medal for his work in 1788.
In The Illegitimate Duke, the hero, Florian Lowell, is a very
progressive man of medicine who has traveled the world and likes to keep up to
date with new discoveries. Through him and his conversations with the heroine, Juliette
Matthews, it is my hope that Charles Kite will be brought to people’s attention
and remembered for his extraordinary contribution to both science and medicine.
The same can be said about
William Buchan. I have used his book, Domestic
Medicine, as the foundation for Florian’s knowledge about hygiene. He even
lends the book to Juliette and advises her to read it. This is because it
really aggravates me when the wrong person is acknowledged for an achievement.
While the Hungarian physician, Ignaz
Philipp SemIgnaz (1818-1865), did find the connection between the handling of
corpses and puerperal fever in childbirth, he is not the first person to
discover the significance of hand washing, even though his finds in this area
did result in greater attention to cleanliness in operating rooms.
Because
here’s the problem with that theory: William Buchan wrote about the importance
of hand washing in Domestic Medicine, first published in 1772, where he says:
Were every person, for example, after
handling a dead body, visiting the sick, etc, to wash before he went into
company, or sat down to meat, he would run less hazard either of catching the
infection himself, or communicating it to others.
Buchanan
also mentions the importance of cleanliness aboard a ship where escaping an
epidemic would be difficult. In this context, he advises that if infectious
diseases were to break out, cleanliness is the most likely way to prevent it
from spreading. This includes the washing of all clothing and bedding used by
the sick as well as fumigation with brimstone or the like.
In
The Illegitimate Duke, Florian
applies these methods during a typhus outbreak. He uses tar water instead of
brimstone, however, and cleans the quarantine ship with a solution of lime, as
implemented by the Edinburgh Infirmary and advised by practitioners of the
Royal Army and Navy during the early 19th Century. Furthermore,
inspiration for the treatment of typhus was found in the Edinburgh Infirmary’s insistence
that patients be stripped of their clothing, given haircuts to remove lice (which
would have been helpful since typhus was spread by lice, though this wasn’t
known until Charles Nicolle made the connection in 1903) given a bath and in
some cases rubbed with mercurial ointment.
Florian
also uses morphine, a narcotic that wasn’t commercially available in 1821 when
the story takes place, even though it had been produced in Germany by pharmacist Friedrich Sertürner in 1804. I like to think that Florian corresponded
with Sertürner who happily supplied him with
morphine after Florian carried out his own tests. This attention to detail and
willingness to stay apprised of medical advancements is what makes Florian such
a wonderful physician and hero.
When asked how he came by
his profession, he responds:
“Saving lives is a never- ending struggle
against the evils of the world. The things I have seen have changed me in ways
I am not always fond of. When I began my apprenticeship, I was sixteen years
old and used to a life of leisure and luxury. Seeing a boy my own age lose a
limb that first day was shocking. I confess I fled the operating room to cast
up my accounts.”
“And the boy?”
“He died three days later from infection.”
Florian’s voice was strained with emotion. “I made it my purpose then and there
to discover the best methods of medical treatment and surgery. Forced to
complete my apprenticeship in order to be admitted into Oxford, I
dedicated my free time to reading medical texts and interviewing not only other
physicians, but anyone I could find who had traveled abroad and born witness
to successful surgeries.”
Since Florian had the
funds to attend university and I don’t go into detail, this doesn’t really
convey how easy it was to gain a medical education and start your own practice prior
to 1815. Apprenticeships for physicians, apothecaries and surgeons were
extremely popular. No examination was required at the end, which lead to a huge
imbalance in student competence, depending on who the teacher had been.
Like Florian, many
aspiring physicians did attend university since this added an element of
prestige to their profession. But obtaining a degree did not require the sort
of hands on experience one might expect. It focused mostly on writings
of physicians from classical times such as Hippocrates and Galen and on the
student’s ability to defend two theses before the Professor of Medicine in
Latin. Shockingly, however, it was quite acceptable for the student to pay
someone to do this for him.
Some of this leniency changed after 1815, at least for
the apothecaries who were now obligated to adhere to the Apothecaries Act. Enforced
by the Society of Apothecaries and requiring qualifying examinations, its main
features were:
• The Society of Apothecaries became the main
examining body for entry into general medical practice
• A five year apprenticeship was compulsory
• The holder of the Licence of the Society of
Apothecaries (LSA) must be willing to dispense physicians' prescriptions
• The LSA was compulsory for all who dispensed
It seems that because of
the lack of regulations during most of the nineteenth century, ridding the
medical community of quacks and ensuring high levels of skill, was an uphill
battle. Even so, there were some remarkable physicians and surgeons who were truly
dedicated to their work and to their patients, such as Charles Kite and
Franciso Romero. These are the men on whom Florian is based – on the men who
saw medicine as a vocation instead of simply a way in which to make a living.
