At Home - Bill Bryson [179]
Syphilis was for a long time a particularly unnerving disease because of the way it came and went in three stages, each successively worse than the last. The first stage usually showed itself as a genital chancre, ugly but painless. This was followed some time later by a second stage that involved anything from aches and pains to hair loss. Like first-stage syphilis, this would also resolve itself after a month or so whether it was treated or not. For two-thirds of syphilis sufferers, that was it. The disease was over. For the unfortunate one-third, however, the real dread was yet to come. The infection would lie dormant for as long as twenty years before erupting in third-stage syphilis. This is the stage nobody wants to go through. It eats away the body, destroying bones and tissue without pause or mercy. Noses frequently collapsed and vanished. (London for a time had a “No-Nose’d Club.”) The mouth may lose its roof. The death of nerve cells can turn the victim into a stumbling wreck. Symptoms vary, but every one of them is horrible. Despite the dangers, people put up with the risks to an amazing degree. James Boswell contracted venereal diseases nineteen times in thirty years.
Treatments for syphilis were severe. In the early days a lead solution was injected into the bladder via the urethra. Then mercury became the drug of choice and remained so right up to the twentieth century and the invention of the first antibiotics. Mercury produced all kinds of toxic symptoms—bones grew spongy, teeth fell out—but there was no alternative. “A night with Venus and a lifetime with Mercury” was the axiom of the day. Yet the mercury didn’t actually cure the disease; it merely moderated the worst of the symptoms while inflicting others.
Perhaps nothing separates us more completely from the past than how staggeringly ineffectual—and often petrifyingly disagreeable—medical treatments once were. Doctors were lost in the face of all but a narrow range of maladies. Often their treatment merely made matters worse. The luckiest people in many ways were those who suffered in private and recovered without medical intervention.
The worst outcome of all, for obvious reasons, was to have to undergo surgery. In the centuries before anesthetics, many ways of ameliorating pain were tried out. One method was to bleed the patient to the point of faintness. Another was to inject an infusion of tobacco into the rectum (which, at the very least, must have given the patient something else to think about). The most common treatment was to administer opiates, principally in the form of laudanum, but even the most liberal doses couldn’t mask real pain.
During amputations, limbs were normally removed in less than a minute, so the most traumatizing agony was over quickly, but vessels still had to be tied off and the wound stitched, so there remained much scope for lingering pain. Working quickly was the trick of it. When Samuel Pepys underwent a lithotomy—the removal of a kidney stone—in 1658, the surgeon took just fifty seconds to get in and find and extract a stone about the size of a tennis ball. (That is, a seventeenth-century tennis ball, which was rather smaller than a modern one, but still a sphere of considerable dimension.) Pepys was extremely lucky, as the historian Liza Picard points out in Restoration London, because his operation was the surgeon’s first of the day and therefore his instruments were reasonably clean. Despite the quickness of the operation, Pepys needed more than a month to recover.
More complicated procedures were almost unbelievably taxing. They are painful enough to read about now, but what they must have