How would you treat sprains and bruises in the Regency?

Winter Amusements - A Scene in France (1803)
Published by Laurie & Whittle © The Trustees of the British Museum
Used under Creative Commons Licence (CC BY-NC-SA 4.0)  

How would a Regency lady treat a sprained ankle?

There is a skating scene in A Reason for Romance where my heroine’s sister Eliza falls and badly sprains her ankle. I researched what would have been done and how long such an injury would keep her out of action. I wanted to know whether it would be reasonable for her accident to make her miss the season.

Of course, one of the best types of research is a re-enactment. This was not a piece of research I intended to do! No, I wasn’t skating. I merely missed my footing as I stepped outside my front door for my daily exercise during lockdown. Four weeks later, I can walk again, but my leg is still sore, and my ankle a bit swollen and aches if I do too much. I certainly won’t be up for a ball anytime soon and have every sympathy with Eliza who was forced to miss the whole season as a result of her accident.

The danger of sprains and strains

In his 1790 book Domestic Medicine, William Buchan wrote:

Strains are often attended with worse consequences than broken bones. The reason is obvious; they are generally neglected. When a bone is broken, the patient is obliged to keep the member easy, because he cannot make use of it; but when a joint is only strained, the person, finding he can still make a shift to move it, is sorry to lose his time for so trifling an ailment. In this way he deceives himself, and converts into an incurable malady what might have been removed by only keeping the part easy for a few days.1

Remedies for sprains

1. Immerse in cold water

Country people generally immerse a strained limb in cold water. This is very proper, provided it be done immediately, and not kept in too long.2

2. Bandage the sprained limb

Wrapping a garter, or some other bandage, pretty tight about the strained part, is likewise of use. It helps to restore the proper tone of the vessels and prevents the action of the parts from increasing the disease. It should not however be applied too tight.3

3. Bleeding

The treatment of almost every ailment in Georgian times seemed to involve bloodletting or bleeding!

I have frequently known bleeding near the affected part have a very good effect.4

4. Rest

What we would recommend above all is ease. It is more to be depended on than any medicine, and seldom fails to remove the complaint.5

5. Poultices

A great many external applications are recommended for sprains, some of which do good, and others hurt. The following are such as may be used with the greatest safety, viz. poultices made of stale beer or vinegar and oatmeal, camphorated spirits of wine, Mindererus’s spirit, volatile liniment, volatile aromatic spirit diluted with a double quantity of water, and the common fomentation, with the addition of brandy or spirit of wine.6

If you are interested, I discovered that Mindererus’s spirit is an aqueous solution of acetate of ammonium named after a Augsburg physician called Minderer (but I confess that doesn’t actually make me any the wiser as I’m not at all medically minded!)

Treatment of bruises

Dr Buchan believed bruises were as much a problem as sprains:

Bruises are generally productive of worse consequences than wounds. The danger from them does not appear immediately, by which means it often happens that they are neglected.7

Remedies for bruises

1. Bathing in warm vinegar

In slight bruises it will be sufficient to bathe the part with warm vinegar, to which a little brandy or rum may occasionally be added, and to keep cloths wet with this mixture constantly applied to it. This is more proper than rubbing it with brandy, spirits of wine, or other ardent spirits, which are commonly used in such cases.8

2. Cow-dung poultice

In some parts of the country the peasants apply to a recent bruise a cataplasm of fresh cow-dung. I have often seen this cataplasm applied to violent contusions occasioned by blows, falls, bruises, and such like, and never knew it fail to have a good effect.9

A cataplasm is a poultice or plaster. This sounds like a particularly smelly and unpleasant remedy!

3. Bleeding

When a bruise is very violent, the patient ought immediately to be bled.10

4. Light food and weak drink

His food should be light and cool, and his drink weak, and of an opening nature; as whey sweetened with honey, decoctions of tamarinds, barley, cream-tartar-whey, and such like.11

I didn’t know what a tamarind was, let alone a decoction of tamarinds! According to the BBC website, it is a tart fruit from the tamarind tree which tastes like a sour date. The fruit is shaped like a long bean which contains a sour pulp of seeds which can be made into a paste. It is a key ingredient in Worcestershire sauce.12

I found a recipe for a decoction of tamarinds in Thomas Fuller’s Pharmacopoeia Extemporanea (1719):

A Decoction of tamarinds

Take tamarinds 2 ounces; raisins stoned 4 ounces; boil in fair water 3 pints to 1 quart which strain.

It restrains the Flame of the Blood, allayeth unquenchable Thirst, humects, loosens, and is proper for constant Drink, in those Fevers that bring with them Costiveness, Drought, and parching Heat.13

5. Vinegary poultice

The bruised part must be bathed with vinegar and water, as directed above; and a poultice made by boiling crumb of bread, elder-flowers, and camomile-flowers, in equal quantities of vinegar and water, applied to it. This poultice is peculiarly proper when a wound is joined to the bruise. It may be renewed two or three times a-day.14

Mr Parker’s sprained ankle15

A Calm by James Gillray - published by H Humphrey 16 May 1810
© The Trustees of the British Museum
Used under Creative Commons Licence (CC BY-NC-SA 4.0)  

Mr Parker sprains his ankle at the beginning of Jane Austen’s unfinished novel Sanditon:

In a most friendly manner Mr. Heywood here interposed, entreating them not to think of proceeding till the ankle had been examined and some refreshment taken, and very cordially pressing them to make use of his house for both purposes.
‘We are always well stocked,’ said he, ‘with all the common remedies for sprains and bruises.’16

Unfortunately, Jane Austen didn’t tell us what these remedies were.

Later, Mr Parker’s sister Diana hears about his accident and writes to him:

If indeed a simple sprain, as you denominate it, nothing would have been so judicious as friction, friction by the hand alone, supposing it could be applied instantly. Two years ago I happened to be calling on Mrs. Sheldon when her coachman sprained his foot as he was cleaning the carriage and could hardly limp into the house, but by the immediate use of friction alone steadily persevered in (and I rubbed his ankle with my own hand for six hours without intermission) he was well in three days.17

I’m glad Diana didn’t get her hands on my ankle – it sounds very painful!

My treatment

I suppose immersing in cold water is a similar idea to ice treatment – I got my frozen peas on my swollen ankle promptly. I used witch hazel gel and later arnica for the swelling and bruises – no bloodletting or cow dung poultices, I hasten to add. I used an elasticated bandage for support but above all, plenty of rest, as recommended by Buchan.

Rachel Knowles writes clean/Christian Regency era romance and historical non-fiction. She has been sharing her research on this blog since 2011. Rachel lives in the beautiful Georgian seaside town of Weymouth, Dorset, on the south coast of England, with her husband, Andrew.

Find out more about Rachel's books and sign up for her newsletter here.

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Notes

1. Buchan, William, Domestic Medicine: or, a treatise on the prevention and cure of diseases (1790, 11th edition)

2. Ibid.

3. Ibid.

4. Ibid.

5. Ibid.

6. Ibid.

7. Ibid.

8. Ibid.

9. Ibid.

10. Ibid.

11. Ibid.

12. BBC website

13. Fuller, Thomas, Pharmacopoeia Extemporanea or a body of medicines (1719)

14. Buchan op cit.

15. Thanks to Gordon Le Pard for reminding me of Mr Parker’s sprained ankle. I added this Sanditon section on 16 May 2020.
16. Austen, Jane, Sanditon (1817).
17. Ibid.

Sources used include:
BBC website

Buchan, William, Domestic Medicine: or, a treatise on the prevention and cure of diseases (1790, 11th edition)

Fuller, Thomas, Pharmacopoeia Extemporanea or a body of medicines (1719)

Regency medicine - the invention of the stethoscope

Left: Laennec's original stethoscope © Science Museum, London
Right: A modern Littmann stethoscope © Medisave UK Ltd

This year, 2016, is the 200th anniversary of the invention of the stethoscope. As with so many innovations, the stethoscope was not immediately welcomed by many Regency physicians. But then, so much of the medical knowledge we now take for granted was a mystery to doctors in the early nineteenth century.

The Georgian killer disease: consumption

Consumption, or tuberculosis as we now know it, killed more people in Georgian England than any other disease. Spread by contact with an infected person, tuberculosis thrived in the crowded streets and homes of rapidly growing cities. 

By 1800 it may have taken the lives of up to one in four Londoners each year. There was no cure and doctors were at a loss how to prevent infection. One of the biggest unknowns was how people contracted the disease.

Across the Channel, in Paris, a 35 year old French doctor was making the study of tuberculosis his life work. In 1816, René Laennec had just been appointed chief physician at Hôpital Necker, where he regularly encountered patients exhibiting symptoms of consumption.

René Laennec (1781-1826)
from Laennec, sa vie et son oevre by H Saintignon (1904)

Physicians had long understood that listening to the body could help them understand a patient’s condition - a technique known as auscultation. Putting an ear to the chest was common practice. An alternative method involved percussion, which meant tapping or striking the body and using the sound to assess what was going on within. Laennec had been schooled to use percussion.

The fat young lady inspires an idea

Soon after taking up his post at Hôpital Necker, Laennec encountered a tricky situation.

In 1816...I was consulted by a young woman labouring under general symptoms of diseased heart, and in whose case percussion and the application of the hand were of little avail on account of the great degree of fatness.1

The only other option was to put his ear to her chest, which he felt was “rendered inadmissable by the age and sex of the patient.”1 

 

At that moment he remembered a simple acoustic principle and, grabbing a piece of paper and rolling it into a tube, he placed one end on the patient’s chest and put his ear to the other. Laennec had created the first stethoscope.

Amazed by the quality of the sound, Laennec dedicated himself to perfecting the instrument. What became of the young lady is not recorded, but within months, Laennec had decided on the ideal form for his new device. It was a hollow wooden tube about 30cm long, funnel-shaped on the inside. He also gave it the name it’s been known by ever since.

Laennec’s original stethoscope (the wooden version, not the paper tube!) is on display in the Science Museum, London.

Laennec's original stethoscope © Science Museum, London

The stethoscope comes to Georgian England

Laennec announced his creation of the stethoscope in front of an audience of medical and scientific specialists at the Academy of Sciences in Paris in 1818. Perhaps unsurprisingly, not everyone thought it was a good idea - hadn’t putting the ear to the chest worked well for hundreds of years?

In 1819, Laennec published a book about his work on chest diseases, including the designs for the stethoscope. In 1821 he returned to Paris and his work at Hôpital Necker. From then until his death in 1826, he regularly entertained medical visitors wanting to see him and learn about his invention.

Plate showing Laennec's design for the stethoscope as shown
in the first edition of his work, A treatise on the diseases of the 
chest and on mediate auscultation (1819)

In 1826, the authors of The Medico-chirurgical Review and Journal of Medical Science claimed to be “the first in this country to introduce the subject of auscultation, (January, 1820) through the medium of an extensive review of Laennec’s work.”2

They noted that in 1826 only a small number of practitioners studied auscultation and percussion, and very few of those were aged over 45. On these “we cannot expect to make much impression. Their habits are confirmed - their routine established - their opinions almost irrevocably fixed.”2 

 

This reluctance to change they refer to as “the stigma of indolence (to give it the mildest term)” which gives rise to “the taunts of the prejudiced and the ignorant.”2

One of those under 45 was Sir John Forbes, who was aged 34 when he published his first edition of Laennec’s work translated into English in 1821, following it with further editions into the 1830s.

In the preface to the second edition, published in 1827, he is presumably addressing sceptics when he makes a plea to physicians to learn how to use the stethoscope properly.

When, therefore, we hear, as we sometimes do, that certain persons have tried the stethoscope, and abandoned it upon finding it useless or deceptive; and when we learn, on enquiry, that the trial has extended merely to the hurried examination of a few cases, within the period of a few days or weeks; we can only regret that such students should have been so misdirected, or should have so misunderstood the fundamental principles of the method.1

He also writes that following another work he had published about the stethoscope in 1824, he had received a letter from the Director General of the medical department of the British army. In this letter he was told that general directions had been given to the medical officers of the army to make trial of the new methods, and to report the result. The Navy was also experimenting with the stethoscope.

The stethoscope as a symbol of forward thinking

In a preface to a translation of another work on the stethoscope, published in 1825, W N Ryland wrote that some objected to the device because it “has too much the appearance of quackery”3 and offered no real benefits. 

He went on to say:

As to what has been advanced in favour of bringing the ear in immediate contact with a female’s breast, in preference to the use of an instrument which enables to hear with ten times the accuracy, at a respectful distance, and seldom requires the part to be naked, it would be ridiculous to waste an argument upon it: let both plans be tried upon half a dozen patients, and the one which merits preference will soon be decided upon.3

Just as some resist innovation and change, others are keen to experiment with new ideas. Records of a clinical examination in Edinburgh, in November 1821, make reference to the use of a stethoscope.

In her novel Middlemarch, published in 1871 but set in the 1830s, George Eliot put a stethoscope into the hands of a doctor and explained that using a stethoscope “had not become a matter of course in practice at that time.”4

Throughout the late Georgian period, the stethoscope remained a single wooden tube. Variations in design included some that were bell-shaped, and smaller models intended for use with children. Doctors began experimenting with flexible tubes in the late 1830s, but the binaural stethoscope (with two earpieces) didn’t arrive until around 1850.

A modern Littmann stethoscope © Medisave UK Ltd

 Laennec’s achievement

René Laennec, inventor of the stethoscope, is remembered as one of France’s greatest doctors. He knew that his discovery was a significant step forward for medicine, allowing a better understanding of the body while the patient still lived.

Sadly, his work in close proximity to tuberculosis sufferers meant that he too became a victim of the disease and he died in 1826, ten years after inventing the stethoscope. For the next sixty years, doctors would continue to be mystified as to how tuberculosis spread. It wasn’t until a hundred years after Laennec’s death that effective vaccinations were made available.

 

Rachel Knowles writes clean/Christian historical romance set in the time of Jane Austen. She has been sharing her research on this blog since 2011. Rachel lives in the beautiful Georgian seaside town of Weymouth, Dorset, on the south coast of England, with her husband, Andrew, who wrote this post.

Find out more about Rachel's books and sign up for her newsletter here.

If you have enjoyed this blog and want to encourage me and help me to keep making my research freely available, please buy me a virtual cup of coffee by clicking the button below.

Notes
(1) From A treatise on the diseases of the chest and on mediate auscultation by René Laennec, translated by Sir John Forbes (1838)
(2) From The Medico-chirurgical Review and Journal of Medical Science, Volume 8 (1819)
(3) From A treatise on the different methods of investigating the diseases of the chest particularly percussion and the use of the stethoscope, translated from the French of M Collin with preface by W N Ryland MD (1825)
(4) From Middlemarch by George Eliot (1871)

Sources:

Collin, M, A treatise on the different methods of investigating the diseases of the chest particularly percussion and the use of the stethoscope, translated from the French with preface by WN Ryland MD (1825)
Laennec, René Théophile Hyacinthe, translated by Sir John Forbes, A treatise on the diseases of the chest and on mediate auscultation (1838)
Nicholson, Malcolm, Medicine and the five senses, The introduction of percussion and stethoscopy into early nineteenth-century Edinburgh (1821)
Saintignon, Henri, Laennec, sa vie et son oeuvre (1904)
The Medico-chirurgical Review and Journal of Medical Science, Volume 8 (1819)