Home Remedies, Recipe Books and 18th Century Medicine

Today I am going to talk to you guys about something I studied briefly during my masters, but did not really have the chance to look into. Yet, I think it is an interesting topic, and actually very much contemporary. If you are one of those people who worry about being healthy in an age of know-it-alls and what not, you may be aware of the great commotions that self-medicating and diagnosis has caused over the last few years. Well, this is only a very recent apprehension that has developed onto applying medicine yourself by your own procurement. It was certainly not the ordinary folk of the 18th century would have thought much about.

In the 1700s the four humours were still used as the main pathways for medicine. It was all about staying in synch with your body and find balance through diet, exercise and your environment – I guess nowadays we would call it a very holistic way of approaching medicine, right? And people would achieve this balance by obtaining health care by all sorts of ways. Practitioners were usually expensive so these would have been called only in certain occasions perhaps for more severe illnesses, or more frequently for those who could afford them. Mostly people would resource to self-diagnosis, as well as the purchase of commercial remedies, drugs and other type of herbs and natural remedies. Elaine Leong (University of Warwick) has developed her entire research around this subject. One of the aspects of her work that I found most intriguing is the use of gardening books as a compilation of advise and guidance of medical herbs. Books such as The New Art of Gardening with the Gardener’s Almanac would be popular best-sellers of the time. Moreover, people kept recipe notebooks alongside these type of publications where they would annotate lists of medicinal waters, syrups and other type of beverages for the cure of common ailments. These nasty tasting things would often been sweetened with sugar or honey – perhaps not so different from our current thoughts about certain medicines, I presume (Any of you had to take Dalsy or Apiretal when you were little? Did you not wished that their so-called strawberry and orange flavours where actually as advertised?).

These lists compiled over time also give us an insight into how intrinsically linked with the economy this homemade remedy business was. The pages would contain the ingredients required for each “potion” if you like, much like you would find in a cooking book these days. During the 18th century, the importance of international trade becomes transparent through the constant mention of spices and herbs obtained from southeastern Asia as well as the Caribbean. This was a serious task for whoever decided to follow the paths of self-medication and notebook keeping. Just consider the amount of time invested, as well as the money and resources required to get the job done right. So what sot of things did they make back then to keep all good and jolly inside? Well, believe it or not, a very frequent remedy for any kind of malady was a god purge. Purgatives were actively used in medicine, even for things that has nothing to do with the digestive system. And a lot of these laxatives you could just make at home. Here is a recipe for one such a thing that was published in A Book of Phisick, for a “pleasant purge”:

  • Manna – which was this magicky sounding name for the dried sap of the Southern European ash tree.
  • Lemon juice.

Aloe was actually use extensively during the 18th century for these remedies as well – and in fact if you substitute in the above recipe the tree for aloe that would apparently get rid of intestinal worms…One of the most common maladies that we also see cropping up often in these books are headaches – and here you are thinking of the convenience of just popping a couple of tablets of paracetamol/ibuprofen huh? Well, in the same book you find several different types of home treatments, from drinking strong tea or coffee (relatable?) or you know, just comb your hair upwards and rub in some nutmeg and vinegar…

If you are laughing at how silly this all may sound, think that this is a controversial issue nowadays and that the controversy has only started recently in the age of great pharmaceuticals, when you suddenly go to the doctor for the pills you were taking for xyz, and suddenly they change it so something else simply cause its cheaper (even though these pills may in the long run be 3 times worse for you, or have some ridiculous side effects). So perhaps, before you apply your critical eye to the situation of self medicating people or those who go or natural remedies, think that it is a very 21st century problem of 1st world countries, and perhaps you need to take a step back and think that when your granny use to tell you to take some chamomile tea before your exam to cool down, she may have had a point. And that like the good Paracelsus said back in the day  “Sola dosis facit venenum”.

 

…And if you are intrigued by some of these books and notebooks, here are some links to the Wellcome Library where you can have a peak at some of these manuscripts.

https://wellcomelibrary.org/item/b19293938#?c=0&m=0&s=0&cv=0&z=-0.0637%2C-0.0356%2C1.1275%2C0.713

https://wellcomelibrary.org/collections/browse/collections/digrecipe/#t

Micro War – The Spanish Flu Epidemic

As the country was enduring a catastrophic experience and (although they did not know it yet) in the last year of The Great War, Britain and the world were about to feel the strain of a particularly violent and virulent disease that would wipe out 50 to 100 million people. The Spanish Flu epidemic first began to flex it muscles in January 1918 in a world with limited life expectancies and war-torn countries that would proceed to blame each other for the dire circumstances some families would find themselves in.  The Spanish Flu first showed strains across Europe, the United States of America and parts of Asia, and due to the increased movement of individuals globally, before steadily spreading across the world. Although vaccinations had been around for over one hundred years, with the invention of the Smallpox vaccine in 1796, there was no effective treatment for this influenza strain.  Before the end of the epidemic in Britain citizens were forced to wear masks, entire institutions were bordered up and bodies piled inside the door of poorly constructed new morgues to cope with the demand. The strain did not discriminate, wealthy and poor, young and old all succumb quickly, sometimes spreading across an entire estate upstairs and downstairs to further add grief to families who’d lost someone in the war.

Influenza is a virus that dominates the lungs and whole respiratory system and is one of the most contagious diseases known to humans. Spread easily when someone coughs, sneezes and/or talks it is transmitted through the air into the breathing space of anyone nearby. The likelihood of it spreading to everyone in one household once one member has it is extremely high especially if an infected person touches items that is also handled by others. Many influenzas, or flu, appear yearly and vary on severity, think on the 2017 Aussie Flu outbreak, but none had been as virulent as the Spanish Flu. It is particularly dangerous in people with diabetes, young children, pregnant women and asthmatic people, but the flu also brings a myriad of issues including pneumonia and bronchitis. Many doctors in the war period would have been familiar with flu seasons that occupy late autumn to early spring every year however none would have been prepared for a strain that has little immunity globally.

The first wave of the Spanish flu arrived in spring 1918 but did not cause much concern as deaths did not exceed normal flu fatalities and most victims regained health within a week of their worst day. Doctors reported that the initial cases appeared in Spain hence why the sufferers based blame around the Spanish people who were hit the hardest during the most dangerous periods of the strain. There were reports of cases appearing elsewhere yet the censorship within the media prevented anything being reported that would lower morale of the people and those on the front lines. Spain was not under these regulations as heavily as the UK and Germany hence why Spanish cases were heard of first, especially since one of the first victims included the King of Spain Alfonso XIII. Spain had declared neutrality because of familial connections to both sides of the war therefore news leaked easily into the newspapers of the world. The world war had caused an extensive amount of deaths in people in the regions affected by bombing and trenches, yet the world was not ready to combat a micro-war, one that would creep into all corners without any particularly compelling reason as to where it came from or why.

The UK was hit in a series of waves throughout the year of 1918 with the end of World War One bringing the harshest low points. The disease spread from soldiers returning to train stations from abroad thus allowing the strain to be contracted from the inner cities and to slowly spread outwards in to the countryside. Prime Minister David Lloyd George contracted the disease alongside Walt Disney and Kaiser Willhelm II of Germany yet all survived. Onset of the more virulent periods were quick and violent with cartoonists displaying people healthy at breakfast and then dead by dinner. The flu initially caused the common flu symptoms of fatigue, fever and headaches before rapidly becoming serious in slowly suffocating the victims through increased shortage of oxygen. Hospitals were stretched to breaking point with medical students being drafted in early yet there was nothing to be done except give those dying comfort as there were no antibiotics to treat any part of the strain or resultative conditions.

In one year fifty million people died worldwide. Two hundred and twenty-eight thousand people died in the UK and the global mortality rate landed between ten and twenty percent. Historians have discovered that a larger amount of people died during this one year of epidemic flu than across the worst four years of the Bubonic Plague in the fourteenth century. Across the known world only one small region did not report any outbreaks down the Amazon river of Brazil.

How to Prevent and Cure the Black Death

We have talked previously in a few occasions in W.U Hstry about the Black Death. However we have not dedicated much time to talk about the medical side of things, particularly how people dealt with it. Therefore, today we will have a look at the ways in which medieval society tried to get rid of the plague before it got to them, as well as how they tried to fight it once they were already infected. The treatment of the Black Death consisted of many diverse types. Some of them made logical sense such as cleaning the streets of all human and animal waste and this waste being taken by a cart to a field outside of the village and burnt. Furthermore, all bodies were required to be buried in deep pits outside of the village and their clothes burnt. However, some of the other treatments were a bit more…well, see for yourselves:

-Nice smells: if you had not contracted the plague just yet, then you ought to be surrounding yourself by “nice smells”. Yes, it was wholeheartedly advised that people would carry flowers or herbs with them in their jackets pockets, or somewhere by their faces so the air they smell would be pleasant. This was suggested as they believed that the illness was transmitted through the airways. You know that rhyme, Ring a Ring O Roses? Supposedly the song could have dated to old times, and it seems likely it could have sparked during any of the many plague infestations known to have taken place in Europe. However, as an interesting counterpart to the recommendation of carrying nice smells, many people in Europe actually moved and lived in the sewers!  The same believe of the air transmitted disease caused the opposite effect, if it smells bad in the sewers already, for sure it couldn’t get any worse…!

-Crushed emeralds: this would have only worked if you were wealthy, of course. (And I mean would have worked in the sense of, only in that way you would have been able to access emeralds, of course). Apparently, emeralds were smashed into a super fine powder that then would be mixed with food or drinks, just like you do nowadays with your vitamin supplements. I would have quite literally felt like swallowing glass, and it would have been as likely to kill you as it could have prevented the disease.

That goes as far as preventing the illness. Now if you are already ill, you might as well try some of these remedies as suggested by expert Johny Wilkes…:

-Blood letting: everything was fixed in medieval times (and even sometimes well into the modern period) by drawing some blood. Practitioner will apply leeches to cause the bleeding, but sometimes they will use the more brutal way of cutting off skin and draining the blood from the open wound into a bowl.

-Live chicken: there was an English doctor, by the name of Thomas Vicary, who suggested that a live chicken, should be tied to a sick persons body so it would be touching the buboes. But there was one condition: the chicken needed to have its bottom shaved! In this was it was believed that the infection would pass from the human to the chicken.

-Cover your buboes with a variety of the following: many things were supposedly good for the oozing sores. For example, it was believed that treacle would hep the sores..but only if it was at least 10 years old?! Other things perhaps are less unheard off, and seen as common treatment for other wounds. Urine was advised because of its ammonia content. In addition, a good rub of tree resin, flower roots and faeces would also help the buboes.

As ridiculous as any of these measures may seem, what we need to understand is that the great lack of knowledge about of the plague drove people to try pretty much anything as a remedy. Those who were desperate would be willing to even drink highly poisonous stuff such as arsenic or mercury. Some thought that by constantly sitting in the warmth by a fire the illness would leave them be. Others thought that abstinence was the best cure – after all this was sent by the wrath of God for their sins, right? – so people would stop eating meat, or having sex. Absolutely anything could appeal to the tormented minds of those living under such precarious circumstances.

In many ways, the Black Death led to the collapse of medieval medicine, however because of this failure came the renewal and first steps towards modern medicine. Public health measures were established to cope with epidemics, many of which are still in use today to control infectious diseases. The rise of modern science and medicine helped the future generations to understand the issues implicated in dealing with diseases in places of high concentration of the population such as towns and cities, and put emphasis in the idea of personal hygiene and public well-being. Interestingly enough, we are still trying to understand truly what the epidemic of the 14th century was – as not all historians and scholars in the subject agree that it was bubonic plague or just such thing. And here is some food for thought: as citizens of the 21st century we still probably look at these treatments as outrageous. However, if an epidemic of such scale was to hit our society, don’t you think that in the face of such brutality and despair some may still try such things? Perhaps we should stop accusing our forebeards of being under developed and stupid…Just trying to survive at the best they could with the resources they had.

July, 1916: Medical Shortcomings at the Somme

The 1st of July, 1916 marked the beginning of The Somme Offensive, one of the bloodiest battles in history. On the first day alone, 57,000 casualties were sustained by British Forces, a figure significantly higher than the predicted 10,000. Peter Barton, speaking in a recent documentary for the BBC (The Somme 1916- From Both Sides of The Wire), notes that it was this figure upon which the medical corps based all of their planning; ‘from hospitals, to bandages, to graves.’

As the actual number of casualties proved to be over five times greater, there were serious implications for the fate of those wounded. The catastrophic underestimation of medical requirements meant that resources were soon overwhelmed, and countless men died whose lives might otherwise have been saved. Barton stresses this point, suggesting that the prediction of 10,000 casualties was emblematic of the habitual underestimation of the German enemy.

Stewart Emmens however, writing in ‘Wounded: Conflict, Casualties and Care’, is rather more forgiving. ‘This was war on a vastly different scale,’ he writes, ‘a new kind of war that produced levels of wounding unparalleled in severity and casualty numbers.’ It was also a war fought in unimaginable conditions, within an environment that could be hugely detrimental to efforts to save the wounded. As such, a great many medical challenges arose from the carnage of the Somme, challenges which Emmens believes would later be countered by scientific, technical or strategic innovations.

One such example, offered by Emmens, is the pioneering use of blood transfusions in 1917. As although the procedure had been around prior to 1914, it was only later in the war, after the experiences of the Somme, that the technique was refined. The blood transfusion set represented a major advance in medical treatment which arrived late in the war, but within a very short period of time ‘proved the life-saving potential of what is now a standard procedure in emergency medicine.’ Ultimately, it has helped to save countless lives, both during the war and in the years since.

blood transfusion set, 1917 - science museum
Blood Transfusion Set (1917)

Yet, Emmens also writes that ‘it is not a simple case of “the triumph of medicine.”’ He asserts that the medical experience of 1914-1918, and the implications for the years that followed, forms ‘a vast and complex narrative.’ Therefore, while real medical innovation did arise- as new techniques and strategies were pioneered, rediscovered, or adapted and evolved through experience- many mistakes were also made. This was particularly apparent in the short-term as, ‘time and time again,’ medical services were simply overwhelmed by both the nature and the sheer scale of casualties.

Many who witnessed the effects of these shortages first-hand were the nurses, doctors and medics who served during the conflict. Sister Edith Appleton, a nurse who worked at General Hospital No. 1 during the Somme, kept a diary which reveals a harrowing change in tone during the first week of the battle. It makes for difficult reading.

Sunday, July 2, 1916

The last eight days the guns have been firing the whole time. Fine big ones they must be for us to hear them so distinctly. The Germans have been giving themselves up and coming across in dazed groups – which is fine.

How absolutely glorious if we knock them right out and level them flat, so our infantry and cavalry can have a walkover such as would make good reading in history.

Tuesday, July 4

Wounded! Hundreds upon hundreds on stretchers, being carried, walking – all covered from head to foot in well-caked mud. We had horribly bad wounds in numbers – some crawling with maggots, some stinking and tense with gangrene.

One poor lad had both eyes shot through and there they were, all smashed and mixed up with the eyelashes. He was quite calm, and very tired. He said, ‘Shall I need an operation? I can’t see anything.’ Poor boy, he never will.

Thursday, July 6

I give up trying to describe it – it beats me. In ordinary times we get a telegraph from Abbeville saying a train with so many on board has left and is coming to us.

Then they stopped giving numbers – just said “full train”. Not even a telegram comes – but the full trains do.

Yesterday, in addition to our 1,300 beds we took over the lounge of a large restaurant, the orderlies’ barracks, the ambulance garage, the Casino front and part of the officers’ mess, and all used except for the garage- which is ready for today. We were not able to send any on to England, as the boats were full, so if full trains continue to pour in today we shall have to start on private people’s houses.

(Quoted from: A Nurse at the Front: The First World War Diaries of Sister Edith Appleton)

Penny Starns, writing in Sisters of The Somme: True Stories from a First World War Field Hospital also offers an incredible insight into the difficulties of nursing in such extreme conditions, by examining official war diaries from the first week of the Somme, when medical supplies and resources were stretched to their absolute limits.

‘Casualty clearance stations were soon overwhelmed.’ She writes, ‘A basic triage system assessed the injured upon arrival, and many men were simply put to one side to die; others, unable to access medical assistance, died where they fell. Those who were fortunate enough to reach first-aid posts and advanced dressing stations were quickly treated with rudimentary dressings. As many of the injured as possible were placed on hospital trains and shipped back to England. Casualty numbers were so high that only the most seriously wounded could be kept in France.

‘By 3pm on 1 July news of the appallingly high casualty figures gradually filtered through to Sloggett [Director General of the Medical Services], and he called the rail transport office at Amiens to urgently order more hospital trains. By this time base hospitals were overrun with wounded. Every conceivable mode of transport had been commandeered to shift wounded men away from the battlefield toward some semblance of care, and medical personnel worked around the clock to help the injured.’

Dorothy Field was one of the many medical personnel to work ‘around the clock’ during the first week of the Somme. She was a member of the Voluntary Aid Detachments of the British Red Cross, working at General Hospital No. 10. In small pocket diaries, Dorothy recorded brief details of her wartime experience. For example the first convoy of 170 men who arrived at the hospital at 4am on the 2nd of July, described by Dorothy as the ‘going over the top result. Practically all surgicals.’ (Source). Over the next forty-eight hours, four convoys of wounded arrived, while two convoys of stabilised patients left for other hospitals in France or Britain. Such was the intensity of work at the hospital that it was not until the 13th of July that Dorothy had a rest from her duties.

Dorothy’s diary also manages to capture the horrors of war in one simple, epitomising sentence:  ‘Too awful for words.’

yorkshire regiment during battle of the somme
A Yorkshire regiment at the Somme

The Angel of Auschwitz: Gisella Perl

Gisella Perl was one of the several million Jews to be sent to a concentration camp during the Second World War. She was one of the lucky few to survive unlike the majority of her family. Despite the death and horrors of the camps, Perl managed to save many of the lives of her female camp mates. Yet Perl’s name is largely unknown. Why? The likelihood is how she saved many of these women’s lives, by providing them with abortions.

Gisella Perl was born in Romania in 1907, graduating first in her high school as the only woman and the only Jew. Her father was initially reluctant to allow her to enrol in medical school fearing she would lose her faith, but when he relented Perl learnt the skills that saved hers and countless of others’ lives. After graduating she became a gynaecologist in Sighetu Marmației.

However her work was interrupted when the Nazis invaded this part of Romania, illegally, via Hungary. Originally placed in a ghetto, Perl and her family, barring her daughter who was sheltered by a non-Jewish family, were sent to Auschwitz in March 1944. Due to her medical training she was selected to work for the camp hospital under the notorious Joseph Mengele.

While called a hospital, it lacked the proper equipment and resources that a hospital required and could be almost as dangerous as the gas chambers. Even basic resources like anaesthesia and drugs were not available. This along with poor nourishment, and hygiene due to a lack of toilets, all made the job of staff much harder. Perl began to rely on her voice as a treatment, hoping she could at least give her patients some kind of relief:

”I treated patients with my voice, telling them beautiful stories, telling them that one day we would have birthdays again, that one day we would sing again. I didn’t know when it was Rosh ha-Shanah, but I had a sense of it when the weather turned cool. So I made a party with the bread, margarine and dirty pieces of sausage we received for meals. I said tonight will be the New Year, tomorrow a better year will come.”

However Perl, like many in the camps, did not realise the true extent of Mengele’s experiments until too late. Mengele had told Perl to send pregnant women to him, telling her they would be sent away for better nutrition. Many women upon hearing this themselves would approach Mengele telling him they were pregnant. Perl then found out that these women were used as guinea pigs in Mengele’s twisted experiments:

“…two lives would be thrown into the crematorium. I decided that never again would there be a pregnant woman in Auschwitz.”

Perl, due to her beliefs had not performed abortions prior to the war and under her own admission struggled greatly with this decision. However she believed it was better to save the life of the mother by performing an abortion before a woman could be sent away where they would die along with their foetus. Perl hoped these women would one day be able to give birth in safer conditions. Such abortions were made harder as Perl was forced to perform these with her bare hands, in the filthy barracks at night without any pain relief. It has been estimated that around 3000 abortions were performed by Perl, giving the women she performed them on a chance continue working, which in turn saved them at least temporarily from death.

Perl ended the war in Bergen-Belsen, moved with the surviving Auschwitz prisoners as part of the desperate attempts of the Nazis to mask what they had done from the oncoming Allied troops. As the camp was liberated she was delivering a baby, the first to be born not under threat of death. Perl had saved countless lives not just through abortions but her care to her fellow inmates, spending many of her nights treating them for the lacerations they suffered from whips brandished by guards. The testimony from her fellow inmates saved her from being accused of collaboration. However the death of her family in the camps; her husband, son and her parents drove Perl to attempt suicide whereupon she was placed in a convent to recuperate. Perl then moved to the US and eventually managed to open a new practice before moving to Israel. Upon entering the delivery room every time she prayed:

“God, you owe me a life – a living baby.”

Perl would go on to deliver around 3000 babies before her death in 1988. Over a hundred mourners attended her funeral with the Jerusalem Post bequeathing the title of “the angel of Auschwitz” on her.

The choice that Perl made has been subject to some debate, some have been inflexible on the position on the morality of abortion. These people believed no matter the circumstances there was no justification such as David Deutschman who said:

“there is no rational or moral justification for . . . wholesale slaughter of infants . . . whether it was done by the brutal Nazis, or by a sentimental and well-meaning female medical personality.”

However many, even those who may generally not approve of abortion, have defended Perl such as Hans Meyerhoff who said:

“[She] risked death and eternal damnation . . . and came to be hailed on behalf of ‘simple humanity’ at the price of thousands of lives which might have been, but never were and never will be. [She] was right in being what she was by committing this enormous wrong.”

Such supporters of Perl believed that she was faced with a choice of preserving the life of the mothers or losing both, Perl did her best to save as many lives as possible, which under the circumstances was only possible through the termination of the foetus. However more important than any moralist’s opinion on Perl’s actions, was the opinion of Perl’s patients who considered her to have saved their lives. One anonymous patient proclaimed:

“Without Dr. Perl’s medical knowledge and willingness to risk her life by helping us, it is would be impossible to know what would have happened to me and to many other female prisoners”.

In the opinion of this writer, whilst I am pro-choice and in support of abortion under circumstances in cases much less horrific than this, I find it hard to see how those who did not suffer under such circumstances, those who faced a choice between abortion or the death of themselves and their foetus, to judge the actions of a doctor who was just doing her best to save as many lives as possible.

The Plague of Athens

This month is a time for us all to jump out of our comfort zones and write about a time in history we know little or nothing about. As someone who is very happy to stay in modern-day times and stick to political and social matters, going back as far as Fifth Century BC Athens is very out of my comfort zone. Although I enjoy medieval and classical history, the last time I learnt about the Greeks, I was ten and part of the class included watching Disney’s Hercules (not, I think, the pinnacle of historical material when looking at Ancient Greece). It seemed to me that discussing the plague of fifth century Athens would be the perfect opportunity to jump as far back as I can, especially since during a quiz, I guessed that the year it occurred was 100BC  (I didn’t hear the ‘Fifth Century’ bit, I swear). Hopefully, by the end of this post both you and I will know far more about the plague of Athens more than we do now.

What was the Plague?

Concerning what the plague actually was – and what illness it manifested as – is still disputed to this day. Some claim it could perhaps have been a flu strain epidemic, the bubonic plague, Ebola or measles. The dispute comes from the fact that the symptoms described during the plague don’t match the symptoms of the previously mentioned diseases. Disease, of course, changes over time, and a case of the measles, flu or Ebola could be very different 2,500 years ago than today. It could be possible in fact, that the disease that caused this plague no longer exists in a recognisable form.

Thucydides, an Athenian historian and also a surviving victim of the plague, wrote the disease had an “abrupt onset, persons in good health were seized first with strong fevers, redness and burning of the eyes, and the inside of the mouth, both the throat and tongue, immediately was bloody-looking and expelled an unusually foul breath. Following these came sneezing, hoarseness . . . a powerful cough . . . and every kind of bilious vomiting . . . and in most cases an empty heaving ensued that produced a strong spasm that ended quickly or lasted quite a while.”

Bust of Thucydides
Bust of Thucydides

He described skin as being “reddish, livid, and budding out in small blisters and ulcers.” Victims often were subjected to incredible thirst and fever, becoming so hot they didn’t even want to be covered by a thin blanket. Sleep was near impossible. He noted that after just over a week the victims would either begin to get better or, in the case of most, die. Survivors became immune, but it seemed to be contagious as it was noted that those who visited the sick and cared for them often became ill themselves.

Dr. David Durack and Dr. Robert Littman of the University of Maryland claim that the best possible explanation for the plague is typhus fever. Evidence also suggests that typhus fever was spread by lice and through air during the plague.

Dr. Durack claimed: “Epidemic typhus fever is the best explanation. It hits hardest in times of war and privation, it has about 20 percent mortality, it kills the victim after about seven days, and it sometimes causes a striking complication: gangrene of the tips of the fingers and toes. The Plague of Athens had all these features.”

How and When did it Occur?

The Plague of Athens did indeed occur during war – The Peloponnesian War. Athens were fighting against the Peloponnesian League of Sparta in order to achieve their vision of an Athenian Empire. Instead of acting in the more traditional ways Athens had acted in war in the past, Athens elected to rely on a strategy whereby Athenians would withdraw behind the walls of the city and rely on fleets for supplies, rather than going out into battle.

pericles
Pericles gives the funeral oration at the end of the first year of war – Artwork by Von Fulz

This was a decision was made by Pericles, a man who dominated Athens politically for over thirty years. His idea was to avoid superior Peloponnesian forces on the battlefield, to frustrate them and to tire them out, and to make Athens an impregnable island fortress. The result, however, would lead to a destructive plague, caused by containing Athens’s entire population alongside refugees within its walls, allowing disease to spread faster and more devastatingly.

In 430 BC, in the second year of the Peloponnesian War, Athens succumbed to its first bout of the plague, probably entering through Piraeus, the only port open in Athens to provide food, supplies and water, due to the city being almost completely closed off. The plague hit twice more, in 429 BC and in the winter of 427/6 BC.

What were its Effects?

Over the years the plague hit Athens, almost 100,000 people died – one-third of the total population. In 427, the Athenians had lost 4400 hoplites (heavily armed soldiers) and 300 cavalry men, nearly 25% of their frontline troops. Despite this Athens carried on its war effort for another twenty years. Athens was at a disadvantaged place in the war, due to how hard the plague had hit it, and with the Peloponnesians having largely escaped its effects.

plague of athens
Depiction of Plague of Athens – taken from Tiki-Toki.com

Its effect on the political stance of Athens was greatly changed by the plague – Pericles died of it only two and a half years after its initial onset, and he had played a great role within Athens for a long time beforehand. The War and its outcome may have been very different for Athens if Pericles had never died, and therefore the plague had a lasting effect on Athens’s war efforts and Athens itself.

How is it Remembered?

The Plague of Athens was not the most devastating plague in the Ancient World, but has been chronicled in-depth by Thucydides. This has allowed the plague to have been researched in-depth concerning the symptoms it caused, its effects on Athenian society, and how Athenians dealt with the spread. Contrary to other writings of the time, Thucydides did not mention the Gods when writing about disease and was able to give an in-depth discussion of its symptoms and its spread without this influence, perhaps as he had been a survivor and suffered through it himself.

Mass graves have since been found in excavations, reportedly having no character and hastily put together, with no, or only cheap, offerings. These hastily thrown together graves are a result of the panic the plague caused, with Thucydides himself writing that bodies were often abandoned in the streets and in temples, and they were collected and buried hastily due to the panic surrounding the city.

Site of mass graves from 4th and 5th century BC, taken by Nikos Axarlis
Site of mass graves from 4th and 5th century BC, taken by Nikos Axarlis

The importance of remembering the Plague of Athens has been described by Dr. Durack who explains, ‘Even if we can never be absolutely sure what caused the plague, the story is still relevant today because we continue to experience the outbreak of new emerging infectious diseases.’ Dr. Littman also agrees with this statement, saying that because plagues are a recurring event in human history, they remain a constant fear and therefore relevant.

The plague was hugely important, not only for scholars today to research infectious diseases and epidemics of today, but in its impact on Athens. Arguably, it helped cause the downfall of the Golden Age of Athens, killed a large number of its population, and heavily weakened the city at the beginning of its war against Sparta.

Further Reading

The Plague in Athens During the Peloponnesian War

Plague Victims Found: Mass Burial in Athens

The Plague of Athens – 430-427/425 BC

The Evolution of Midwifery

With a process as natural as childbirth, handy women and midwives were a common feature from the beginning of history. Even without medical training or basic knowledge of anatomy women were present at friends and families birth to help or hinder regardless of nation wide mortality. However from Medieval era there was little distinction between midwifery and witchcraft in dealing with conception, pregnancy and birth until the early twentieth century. Monumental medical discoveries and reforms formed during the nineteenth century began the upward track to lessening mother and child mortality. The term midwife essentially means ‘with-woman’, a person who would attend a woman in labour. For centuries midwifery was a woman’s world with male doctors only attending when there is an issue.

The ancient Greeks and Romans ensured there was not a distinction between male or female scholarship in childbirth. Yet still women had the majority of control in training to be midwives. There are plenty of male writing on the topic including Hippocrates’ et al. Hippocratic Gynaecea, essentially the ‘Diseases of Women’. Hippocrates along with the popular beliefs of the Romans thought that men were the rational half of the species. Women were susceptible to diseases, such as pregnancy, that caused them to be irrational. The Romans created an early professionalization of medicine meaning that births would be attended by a midwife, in the upper classes naturally. In antiquity the role of a midwife or physician earned the person civic rights and privileges within society in terms of money and status and often methods and practises were handed down through the family. Since medicine often coincided with religion, medical schools were held in temples and this had been wide-spread since the Ancient Egyptians. Hospitals in the modern sense did not exist so birth took place in the home of the expectant mother. Artemis was the goddess associated with labour so thanksgiving and offerings to her became the norm, before and after labour. Experimentation was common also since it was believed the womb could move and had to be shifted back during herbs. The womb was thought to be the source of several illnesses in women and there is extensive study around it. The midwife in antiquity followed an expectant mother throughout the pregnancy and was on hand for massages, tinctures and advice. Ancient midwives thought there were three stages in pregnancy: conception, pica (cravings) and labour. Caesarean sections were also practised and some are known to have been successful. This was thought to have been first achieved by the Roman Jewish society yet skill in this era declined during the rise of Christian Rome away from Pagan Rome. The mother would give birth on a birthing stool, a tradition that continued beyond antiquity into the Middle Ages.

Not much changed in how pregnancy was perceived between the Romans and the medieval people. Many doctors and nurses relied upon ancient documentation for childbirth and generally practised medicine. Unlike in antiquity were midwives were respected they achieved a lowering in status beyond the fall of the Roman Empire. Most were from the illiterate masses and did not attend a pregnant woman until she goes into confinement, if she were of the upper classes. The lower classes either had family attend the birth with only the grandmother and married female relatives in attendance, or a midwife that does not cost much to procure her services. The tools of the trade changed from herbal and natural remedies to instruments such as scissors and early scalpels. Medieval midwives carried on the tradition of anointing the pregnant women’s genitals before birth in case of a still-born ensuring the child’s passage to heaven; this comes from Greek pagan practises. There was no organization of midwives, they were trusted purely on the basis of their reputation. They could earn a fair amount if they attend multiple births of one family successfully or serve the royal family. On the other hand, payment was often only received on the condition of a live child, an issue due to the high mortality rates of medieval and early modern women and children. It was more common for a woman to die in childbed despite measures taken to ensure safety. In the upper classes a birthing chamber would be hung with biblical tapestries, the windows kept shut and fires kept alight even in heated summer months. A woman would always give birth at home. A woman would be told not to be active until she was churched as a pregnant woman was considered unclean. She could not leave the birthing chamber until a few months after the birth yet usually the child would have been removed to the nursery long before she left the chamber. It was during the medieval and early modern era that midwifery was held in close contact with witchcraft. As a midwife you would be expected to have knowledge on conception and tools used to get a women with child were often thought to be devils work, specifically if the child was born disfigured. Poor regulations and no consistent training of midwives continued through to the early twentieth century.

From 1900 onwards there was a move towards the medicalization of pregnancy. Many thought that there ought to be proper training and scholarship into childbirth considering the great medical leaps from the mid-eighteenth century. However this was not achieved until 1902 when the first Midwives Act was passed in government meaning that all women had to be attended by a properly trained midwife at birth. The act introduced the Central Board of Midwives, meaning midwives had to be sufficiently trained and certified to practise midwifery. This meant assessment throughout pregnancy; continuous training and regulations were placed for midwifery protocol. Much of the neonatal and antenatal discoveries were done at Edinburgh University. It was here that the first antenatal bed/ward was created nearly 10 years later after antenatal clinics were being opened across the country. Yet there was still the popularity of women giving birth in their homes until the 1960’s when a hospital birth was becoming increasingly common. Hospitals specifically designed for antenatal and neonatal clinics became popular before being submersed into general hospitals.

Midwifery changed quicker in the space of a hundred years then it did for several centuries. Many people wonder whether hospital births are better than home births. The debate and discussion on how best to have child is still ongoing, something that midwives are all keen to stay apart of.

If anyone is interested in midwifery I would recommend Jennifer Worth’s books or look at the Central Board for Midwives website for a full bibliography on the history of midwifery.