Medicine in the 90s

The 1890s, that is. For $20 plus shipping, Powell’s sent me The Practice of Medicine: A Text-Book for Practitioners and Students with Special Reference to Diagnosis and Treatment by James Tyson, MD (1897). If any of my readers are writing a romance circa 1890-1910 and need medical advice, just let me know.

I found this book online while preparing a talk for the pediatricians. Here’s the passage that caught my attention, regarding the treatment of tonsillitis:

In the first place, cold should be applied to the neck by cloths wrung out in cold water or by ice, which is conveniently applied by little muslin bags made to fit under the angle of the jaw and held in place by a bandage. Then iron and chlorate of potassium are, without doubt, the remedies par excellence, and to these may be added the bichloride of mercury, if measures recommended for the throat in diphtheria are not necessary.

Below the cut: more cutting edge medicine from the 19th Century.

How to treat airway obstruction from enlarged tonsils:

If the tonsils manifestly encroach on the faucial lumen they should be shaved off by the guillotine or a bistoury or galvano-cautery loop.

“Guillotine” I’m familiar with. I’ve used one myself, back in training, and I suspect some ENTs still prefer the instrument:

“Galvano-cautery loop” sounds like a clever version of the tonsil snare (another instrument we use from time to time):

There’s a small wire loop on the left which the surgeon works around the tonsil. Squeezing the action (on the right) cinches down the loop, amputating the tonsil. “Galvano-cautery loop” suggests that an electrical current ran through the wire, to cauterize the wound as the tonsil was removed.

But what’s a bistoury?

bis·tou·ry
n.
A long, narrow-bladed knife used for opening abscesses or for slitting sinuses and fistulas.

Ah. A scalpel. So in the old days, tonsillectomy options included cautery/snare, guillotine, and cold knife. Not too different from nowadays (although I use a clever gizmo that certainly wasn’t around in the 1890s).

One of the neatest things about old medical texts is the abundance of wholly unfamiliar diseases. Admittedly, most of these are quite familiar once I figure out the modern name for the illness, but for a moment it’s fun imagining diseases that are long since extinct (smallpox, anyone?) Lithaemia, for example, goes also by the name “American gout,” and the advice is what you’d expect from an era before there were drugs to lower uric acid levels: “The over-eating and over-drinking must be reduced and active out-door exercise must be practiced in order to oxidize the remnant of unburned tissue.” But what of “ephemeral fever,” or “febricula”?

A febrile movement, lasting twenty-four hours and disappearing, may for convenience be called Ephemeral Fever; if of three or four days’ duration, febricula.

Kind of thing a few dozen viruses might cause. Treatment?

Rest in bed, a simple aperient, a fever mixture consisting of solution of citrate of potash, sweet spirit of nitre, solution of acetate of ammonia or aconite tincture, will suffice to break up the fever and ensure recovery.

Aperient? A laxative. Guess that’s what we did before we had Tylenol (or aspirin!)

For funsies, I looked up tinnitus, a disorder for which we still have no reliable treatment. No surprise, they didn’t have much for it back in the 1890s, either.

Treatment. — This is generally most unsatisfactory. The ear should be explored and its surgical diseases treated.

The bromides are sometimes beneficial, and a few drops of tincture of belladonna are sometimes added. Nitro-glycerine has been highly commended. Beginning with doses of 1/100 grain (.00066 gm.) they should be rapidly increased until the physiologic effect is produced . . .

Counter-irritation is undoubtedly useful at times. It should be applied behind the ear, and actual vesication is the most efficient form. Temporary effect is sometimes often striking, while permanent effect may be produced by repeated blistering.

One thing missing from this book, for those of you who might ask me research questions: gynecology, or for that matter, any diseases of the genitalia. Syphilis is addressed (treated with mercury inunctions iodide of potassium, dontcha know) but forget about impotence or infertility. Damn. Would have been good for a laugh.

D.