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Book review: Shattered Nerves

Brooklyn_Museum_-_The_Invalid_-_Louis_Lang
The Invalid by Louis Lang from the Brooklyn Museum

“Shattered Nerves”: Doctors, Patients, and Depression in Victorian England, by Janet Oppenheim (1991; Oxford: Oxford University Press) is the best book I read in researching the historical background for Moriarty Takes His Medicine. Oppenheim writes clearly, often elegantly, without pretension or unnecessary jargon.

I wanted to learn about neurasthenia and its treatment, having decided that my victims would be nervous women. I ended up not using the word, which is very uncommon, but my private hospital made its fortune pampering women who suffered from that very vague malady. 

OED tells us the word is largely obsolete, although there are citations as late as 1998. It was devised in the mid-nineteenth century as part of the emerging disciplines of neurology and psychology. 

Here’s the basic definition: “A disorder characterized by feelings of fatigue and lassitude, with vague physical symptoms such as headache, muscle pain, and subjective sensory disturbances, originally attributed to weakness or exhaustion of the nerves and later considered a form of neurotic disorder.”

But wait! There are more symptoms: “ticklishness, lack of decision in trifling matters, sensitiveness to cold or hot water, shooting pains, special idiosyncracies in regard to food, general or local itching, general and local chills and flashes of heat, partial or complete impotence, vertigo or dizziness, fear of lightning, fear of responsibility, fear of open or closed spaces, fear of society, fear of fears…”

Disease à la mode

Doctors might have been pressured by patients to dispense the neurasthenia diagnosis. People heard about novel illnesses and wanted to have them. (We still do that.)

“Like the eighteenth-century cult of sensibility, the late nineteenth-century incidence of neurasthenia was probably augmented by the potent influence of suggestion and imitation, for neurasthenia was widely perceived as a malady that bestowed on its victims special claims to consideration.”

Charles Darwin and Herbert Spencer suffered from nervous exhaustion from time to time. Sir Richard Quain, consultant physician in London, had a clientele “at once fashionable, artistic, and literary.”

“Flora Thompson observed that the inhabitants of her rural hamlet ‘Lark Rise’ enjoyed excellent health in the late Victorian years, largely thanks to ‘lack of imagination.’”

Still, nervous exhaustion was common among all classes, both sexes, any age. And men and women of that day were not cowed by medical authorities. On the contrary, they were quite prepared to discard one doctor for another if the first one failed to satisfy on any grounds.

Biology vs. culture

Oppenheim’s book continually returns to the theme of how much culture affects our interpretations of biological realities. “Public perceptions of disease are never merely reactions to discoveries of microbes, toxins, or genes; they are molded, too, by systems of values, ethical codes, religious beliefs, and all manner of preconceived opinion.”

This is the part that fascinates me. We would never lump all those symptoms together, but we have many, many more diagnostic tools and a greater ability to discriminate among possible causes. Some of those symptoms sound like menopause to me, another term invented around this time.

We also distinguish more degrees of depression, separating situation-based cases from chronic ones. In the mid-nineteenth century, both doctors and patients used terms loosely, like nervous exhaustion or nervous collapse. These descriptions “sometimes indicat[ed] a condition of dullness, inertia, pessimism, and deep unhappiness that nonetheless permitted the victim to function and, at other times, describ[ed] complete paralysis of the will.”

Doctors worried that if left untreated, prolonged nervous exhaustion might develop into a complete loss of reason. But they didn’t like the idea of a purely mental disorder. They wanted the medical legitimacy of a bodily cause. “Yet to insist that mental illness revealed some malfunction of the nervous system brought alienists into competition with virtually every kind of medical practitioner.”

“The attempt to carve out a remunerative and prestigious medical niche for themselves involved nineteenth-century alienists in what might be called elaborate role-playing. Through the Victorian and Edwardian periods, they posed as scientists, single-mindedly pursuing their physiological inquiries, or as moral guides, firmly but sympathetically redirecting their patients’ thoughts away from morbid into healthy channels, or, yet again, as social disciplinarians, resolutely advancing against deviancy on all fronts.”

The nerve of some people!

Uriah Heep and David (Harold Copping)
Uriah Heep and David (Harold Copping)

Actually, there was no stigma attached to nervous disorders until Freud came along at the end of the century and told everyone it was really all about sex. Before that, men and women wrote openly about their nervous breakdowns and no qualms about seeking treatment.

Nervous disease might be attributed to heredity. Beatrice Potter Webb traced her ‘Weltschmerz’, suicidal constitution, depression, to her mother’s relatives.

But the nervous disposition could also be acquired during one’s lifetime. “It could ensue ‘as a sequence of some severe illness, of some grave anxiety, or of some physical or moral shock.’” It could derive from overwork, physical or mental. It could arise from indulgence in imprudent habits, ranging from the dissolute to the religious fanatic.

Any kind of excess could cause it. The Victorians were very concerned about excess and strain. In my previous post on mental illness, I mentioned that most of the male inmates at Halloway Sanatorium in Surrey were clerks. Think of poor Bob Cratchit and oily Uriah Heep.

Another obvious cause of nervous disorders was Londonism: the general indisposition caused by the fatigues and stress (and pollution) of the city. That giant, sprawling metropolis was very polluted and noisy through most of the nineteenth century.

Working hard enough to stress yourself severely enough to require special treatment was very fashionable in the eighties. Now in the new millennial teens, we’re all about balance.

Use the force

“All malfunctioning of the nervous system was believed to be attributable, in one way or another, to what Victorian doctors dubbed the vis nervosa [nerve force].” Doctors and patients both believed that human bodies contained a vital force which could be drained by excessive work, play, etc. Moderation was (and is) the key to health!

Victorians were also enchanted with modernity (like Elizabethans and, hm, possibly us.) They eagerly yodaturned to the achievements of their times for fresh metaphors to describe maladies of the mind and spirit.

Nerve force is an ancient idea. Galen invoked nervous spirits as transmitters of impulses from brain to muscle and of sensory information to the brain. The notion evolved over time, becoming a sort of fluid, reflecting the views of process and mechanics of the day. The Victorians’ favorite element of flow was electricity.

They compared the brain to a voltaic battery generating nerve force. Everyone possessed only limited amounts. “Heedless overexertion, whether mental or physical, could drain an individual’s supply, leaving an exhausted nervous system incapable of all endeavor. Failure of nervous power meant utter incapacitation.”

One of the principal functions of sleep was the restoration of nerve force. Time to recharge the batteries, an expression we still use!

Neurotic persons were compared to an engine with a light fly-wheel and a small furnace, whose work is fitful and unsteady. Nerves could easily be thrown out of gear or lose their spring of recoil. We still talk about being wound up or tightly wound or over-wrought (an iron-working metaphor.)

Flywheel_of_the_Boulton-Watt_steam_engine
Flywheel of the Boulton-Watt steam engine

Another thriving area of invention in c19 was the world of finance. Man has a reserve of force, like the balance of a prudent firm at its bankers. If this is too far drawn upon, a sudden demand becomes a very serious matter. (A run on the bank.) Man cannot estimate his physiological capital as exactly as he can his financial reserve, but loans of force may be repaid by economy — by quietude and sleep.

George Beard, the American alienist who invented the term ‘neurasthenia,’ blamed modern civilization for the malady. Rapid transportation and communication, great advances in scientific learning, and the widespread education of women, all contributed to the depletion of vital nerve force at an extraordinary rate. 

One doctor of the day scoffed, ““Among the nerve-doctor’s best customers was the ‘City man’… [who] poisons nerves and blood with champagne, stodges his stomach with rich food three times a day, feeds his mind with vulgar shows and ‘dreams of avarice,’ finds his recreation in Zola and the Society journals, and then tells us, forsooth, that the nineteenth century is too much for his nerves.’”

That’s Emile Zola, the important and popular French writer. Caveat lector!

 

 

Officer Krupke’s dilemma

Treatments for nervous diseases hovered between physical and moral, medicine (diet, exercise) and exhortations. Gone are the eighteenth century ideas about restraint. In comes the new idea of moral management and humane treatment, consisting of decent food, proper beds, patience, kindness, and shuttlecockcheerfulness.

And outdoor exercise. The inmates of my imaginary hospital play badminton, a game invented in mid-c19, especially popular with the ladies.

Doctors walked a wandering line between science, therapy, and making a living. “The attempt to carve out a remunerative and prestigious medical niche for themselves involved nineteenth-century alienists in what might be called elaborate role-playing. Through the Victorian and Edwardian periods, they posed as scientists, single-mindedly pursuing their physiological inquiries, or as moral guides, firmly but sympathetically redirecting their patients’ thoughts away from morbid into healthy channels, or, yet again, as social disciplinarians, resolutely advancing against deviancy on all fronts.”

Oddly, considering the lack of social stigma, many phsycians believed nervous disorders resulted from failure of the moral will. 

“At the center of this moral physiology was the concept of the will, on which virtually all Victorian and Edwardian attitudes toward adult mental health and illness were constructed.”

The will managed all other activities of the mind: imagination, emotion, desire, ideas, reason, etc. Failure of the will meant these elements could run out of control and become imbalanced. The individual would no longer be able to reason or exercise judgement.

The absence of will wrought havoc with the personality of the sufferer. It could cause oppressive lethargy, painful indecisiveness, no control of impulse or capacity for intentional effort — half of the symptoms listed at the top. When the will is impaired, the patient is said to have broken down.

Morality was a strongly social concept. As late as 1881, George Savage made explicit the social concerns implicit in the diagnosis [of madness]: ‘The eccentric person who neglects his relationship to his fellow men and to the society and social position into which he is born must be looked upon as morally insane.’”

Pity the scholarly introvert, of whom there were many in Victorian England! We’ll assume such persons were blissfully unaware of their mental peril.

We’ll discuss treatments in separate posts, because I studied them all carefully with an eye toward their usefulness as murder methods. Electrotherapy, hydrotherapy, hypnotism, and of course, tonics augmented the age-old standbys of common sense: a healthy diet, plenty of exercise, and a good night’s sleep.

References

Oppenheim, Janet. 1991. “Shattered Nerves”: Doctors, Patients, and Depression in Victorian England. Oxford: Oxford University Press.

Oh, just, subtle, and mighty opium!

The title is a quote from Thomas De Quincey’s infamous 1821 Confessions of an English Opium Eater. I got opiuminterested in opium whilst searching for methods to murder nervous women for Moriarty Takes His Medicine. The stuff was as common as aspirin is for us in the Victorian period. Not just legal, it was the active ingredient in laudanum, a remedy for practically everything for several hundred years.

Ancient origins

This history comes from the DEA (Drug Enforcement Agency) Museum. I didn’t even know there was such a thing! But yes, there’s a DEA Museum and Visitors Center in Arlington, VA. That’s good. Government agencies should have information centers and websites full of useful facts. It’s one of their functions.

The history of opium begins in Mesopotamia way back in 3,500 B.C. The Sumerians passed it to the Assyrians, who passed it on to the Egyptians. Good things travel fast! Humans have always loved to get high, one way or another. Opium was traded along the Silk Road, which stretched from China to Rome.

It was coveted for more than merely recreational purposes. Ancient Greek and Roman physicians used it as a pain reliever, probably the most powerful one they could supply. Opium and its derivatives have reigned supreme in that role upwards of five thousand years. Amazing!

Opium was known in Elizabethan times, but not common. It must have been imported at great cost along with other Eastern luxuries like cinnamon and pepper. Although given its disreputable character, it wouldn’t have been so well known as those highly desirable spices.

Here’s a quote from 1615, via the OED: “G. Sandys Relation of Journey 66   The Turkes are also incredible takers of Opium.” Turks were the ultimate in exotic and unacceptable behavior back then.

 A spoonful of poppies

laudanumI looked for quotes about laudanum and found this insightful thought from Frederick Saunders: “Pride, like laudanum and other poisonous medicines, is beneficial in small, though injurious in large quantities.” If I’ve got the right guy, Sir Fred was the Treasurer of Ceylon from 1890 – 1897.

Laudanum originally meant any preparation of which opium formed the major ingredient. It evolved into a somewhat standard tincture of opium, meaning a mixture of mainly alcohol with approximately 10% opium by volume.

This medicine was known in early modern times, as attested by my old pal the OED: “c1602   J. Manningham Diary (1976) 82   There is a certaine kinde of compound called Laudanum..the virtue of it is verry soveraigne to mitigate anie payne.”

I should note that poppy juice, the substance from which pure opium is extracted, was not an uncommon medicament in Elizabethan times. Francis Bacon liked a few drops in his wine now and then, possibly to cool his brain down so he could sleep.

I’m not sure you can read the label in this photograph. You can probably see the word “Poison” at the top, but perhaps not the entries under “Directions.” Here they are, for your shocked amusement.

Three months old…….. 2 drops

One year old…………… 4 drops

Four years old…………..6 drops

Ten years old……………14 drops

Twenty years old……….25 drops

Adults…………………….30 drops

I like that distinction between 20-year olds and adults! But you can clearly see that laudanum was given tolaudanum ad absolutely everyone. According to the Victorian Web, laudanum was “recommended for a broad range of ailments including cough, diarrhea, rheumatism, ‘women’s troubles’, cardiac disease and even delirium tremens.” That article lists notable persons who used the stuff, including Charles Dickens and Mrs. Gaskell.

I must note that in normal use, the effects were mild. More like a couple of Tylenol than a needleful of heroin. If used as directed, there was very little risk of addiction. But that’s a mighty big IF in a time when regulations were few and far between. Apothecaries mixed their own proprietary blends and nobody went around testing them for purity or toxicity. Caveat emptor was the rule of the day!

Drops and drachms and daily doses

opiumSince my villains were murdering nervous women without detection, I had to be precise about dosages. Here’s a description of Sydenham’s Laudanum: “opium, 2 ounces; saffron, 1 ounce; bruised cinnamon and bruised cloves, each 1 drachm; sherry wine, 1 pint. Mix and macerate for 15 days and filter. Twenty drops are equal to one grain of opium.”

A drachm is a weight approximately equivalent to the ancient Greek coin = 60 grains or 1/8 of an ounce.

4-5 grains may be regarded as the minimum fatal dose for an adult. That would be 100 drops. Apparently there are different conversion methods, but one teaspoon equals between 76 and 98 drops. I’d just give my victim a full teaspoon to be sure. 

Although, the more of the stuff you took, the more you could tolerate. De Quincey brought himself to the daily use of 9 ounces of laudanum, which is equivalent to about three hundred and sixty grains of solid opium. Mind boggling, and I mean that in every sense of the term.

If you wanted to murder someone by tampering with their laudanum, obviously you would just add more opium to their formula. You could be really clever and make the second bottle the one with the fatal dose. The neat trick is that their families and servants would assume the victim had simply forgotten and taken too much.

And the limited forensics of the day couldn’t reliably detect an opium overdose anyway. A forensics textbook from 1884 says, of the opiates, “Their morbid effects are not very distinctly marked.”

Opium derivatives

morphineBy the nineteenth century, doctors were beginning to worry seriously about addiction. They also wanted more predictable, faster-acting pain medicines. Science had advanced to the point where new, sleeker derivatives of opium could be produced.

This from the DEA: “In 1803, morphine, the principal ingredient in opium, was extracted from opium resin. Morphine is ten times more powerful than processed opium, quantity for quantity. Hailed as a miracle drug, it was widely prescribed by physicians in the mid-1800s. Morphine is one of the most effective drugs known for the relief of severe pain and remains the standard against which new pain relievers are measured.”

Codeine was discovered and named in 1832 by Robiquet of Paris. Heroin was produced at Bayer Laboratories in Germany in 1897 by chemist Felix Hoffman. The name ‘heroin’ was based on the German word ‘heroisch,’ heroic or strong. They were looking for a drug as effective as morphine and codeine, but less addictive. Oops.

For a decade or so, doctors thought heroin bayer heroinmight be useful in helping people break their addictions to morphine. Well, yes, and no.

All of these drugs were freely available for many years. They must have been relatively expensive, though. I don’t read about opioid dependency epidemics in Victorian London although pretty much everyone took laudanum. Gin seems to have remained the drug of choice for the working class.

References

Reese, John J. 1884. Textbook of Medical Jurisprudence and Toxicology. Philadelphia: P. Blakiston & Son, Co. (Yours through the efforts of Google Books and the libraries whose collections were scanned.)

 

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