In this great early English novel Henry Fielding describes several episodes that illustrate the way medicine was practiced in the days when doctors bled and purged their patients unconstrained by the shackles of evidence based medicine.
The story begins with a country squire surprised to find in his bed “an infant wrapped in some coarse linen, in a sweet and profound sleep.” He decides to adopt the infant and bring him up—assisted by his spinster sister. But soon the good lady is seized “with the gout in her head and stomach, which carries her off in a few hours”—leading the local physician to pronounce he wished he had been there, for although “the gout is a distemper which is very difficult to treat, he has been remarkably successful at it.”
Several years earlier, however, the spinster lady had found happiness by marrying a captain of the army, well built and with excellent teeth if he would only show them more often by smiling. But then cruel fortune intervened, for one cool evening the captain, while taking a stroll in the garden and meditating on the money he would soon inherit, dropped very dead.
So they carried the body inside. “Bleeding, chaffing, dropping, etc.: are applied, it is not clear by whom, but nothing works. Doctors arrive, not one but two, exactly at the same time. They feel the pulse, one on the right arm, one on the left, but there is nothing to feel, nothing to justify a reasonable fee. Aggrieved they argue whether death was from an apoplexy or an epilepsy. But now fortune smiles and the wife falls into a faint. Again the doctors feel the pulse, one on the right, one on the left. The lady opens her eyes. And they jointly persuade her that she is not at all well, and save the day by prescribing untold amounts of medicine for the ensuing month.
Earlier on, before the spinster sister had married her captain, she had met his brother, a doctor, and would have known earlier on the delights of love had the said doctor not already have been (in Jane Austen parlance) in possession of a wife. This poor fellow had been forced by his father in his youth “to study physic, or rather to say he studied it; for in reality books of this kind were almost the only ones with which he was unacquainted; and unfortunately for him, the doctor was a master of almost every other science but that by which he was to get his bread; the consequence of which was, that the doctor at the age of 40 he had no bread to eat.”
He further made the mistake of inviting his brother, the army captain, who, to cut the story short, marries the spinster, then has a falling out with him and makes his life miserable, so the poor unhappy doctor is left with no choice but to leave for London, “where he died soon after of a broken heart, – a distemper which kills many more than is generally imagined, and would have a fair title to place in the bill of mortality, did it not differ in one instance from all other diseases, viz., that no physician can cure it.”
Now the foundling has grown up. He falls in love, goes hunting with his beloved, and breaks his arm while catching her as she is thrown off her horse. A surgeon arrives, with lancets ready to bleed them both, which they both wisely refuse. He now sets about to work on the broken arm and while Jones is in considerable pain delivers “a very long and very learned lecture on anatomy, in which simple and double fractures were considered, . . . with proper annotation showing how many could have been better and how many worse than the present case,” of which “nobody understood a single syllable.”
Soon after that the good squire develops a cold, “attended with a little fever” which he neglected, despite the prevailing sensible view of “the gentlemen of the Aesculapian art that the moment the disease has entered at one door, the physician should be introduced at the other.” A doctor indeed is called, shakes his head and intimates that he was “in very imminent danger” and “wished he had been sent for sooner”—but against all expectations, the patient recovers.
A few years later at in an inn on the way to London, Jones has a fight with an officer who throws a bottle at him, hitting him in the right temple. Motionless and bleeding profusely he lies on the ground, apparently dead. There is consternation in the room, and everybody in the audience begins to prescribe:
“Bleeding was the unanimous voice of the whole room; but unluckily there was no operator at hand and; everyone then cried, ‘Call the barber’; but none stirred a step. Several cordials were likewise prescribed in the same ineffective manner; till the landlord ordered a tankard of strong beer, with a toast, which he said was the best the cordial in England.”
Only the landlady displays common sense. She cuts off some of her hair and applies it to the wound to staunch the bleeding; and ignoring her husband’s prescription makes Jones, who had just recovered consciousness anyway, drink a whole bottle of brandy. Now a surgeon arrives; shakes his head; blames everything that was done; and orders his patient to bed.
But is his skull is broken? That is not the right question to ask, the surgeon explains, for fractures are often less dangerous than contusions and lacerations, which is “not at all obvious to people who know nothing of these matters.” Indeed, “symptoms are not always regular or constant,” he explains, having seen “very unfavorable symptoms in the morning change to favorable ones at noon, and return to unfavorable again at night.” Indeed he remembers, apparently relevant to this case, seeing a man who had a broken piece of tibia sticking out of his wound “and febrile symptoms intervening at the same time (the pulse was exuberant and indicated much phlebotomy), I apprehended an immediate mortification,” requiring the immediate removal of twenty ounces of blood.
“To my surprise,” he explained, “the blood looked rosy and florid, not glutinous and coagulated as in pleuritic complaints, so that with repeated fomentations thick pus began to discharge from the wound, allowing the patient to recover.” And indeed, so did Jones, with chicken broth, whey, water gruel, and jellies, leaving doctor satisfied, but, as in many of these cases, emphasizing he wished he had been called earlier. So the lesson is clear—call your doctor early—especially if your symptoms last for more than four hours.1
- As with phosphodiesterase type 5 inhibitors.
GEORGE DUNEA, MD, Editor-in-Chief