"The 'doctor' will see you now": Medical care in Turvey in the 1830s.

Being ill was a familiar but challenging experience in 1830s Turvey, especially if you were poor, as indeed were the majority of villagers. Crowded and insanitary housing, inadequate nutrition and arduous working conditions increased vulnerability to infection and accident and hampered recovery. Physiology and disease were poorly understood and medical treatments were limited or of dubious value in the early nineteenth century.

Access to the expertise of the available medical practitioners, such as it was, depended on what you could afford. The rich could purchase the services of university-educated elite physicians. The poor made do with the traditional remedies of ‘domestic medicine’ or, if they could afford it, the treatments of the surgeon-apothecaries who learned their craft largely by apprenticeship.

People in Turvey, however, had a further option – the attention of 23 year old Henry Longuet Higgins, the son of John and Theresa Higgins of Turvey Abbey.

Henry Longuet Higgins

Born in 1814, Henry studied at Corpus Christi College, Cambridge, graduating with a BA in 1836. He became ordained in the Church of England in 1839 but had a lifelong interest in science, later becoming President of the Liverpool Field Naturalist’s Club and an active amateur researcher in the fields of geology and natural history.

In 1837, however, he was living at Turvey Abbey and his letters, mainly to his older brother Charles, reveal that he engaged in considerable amateur ‘doctoring’, visiting the sick and prescribing various potions for the poor of the village. They would have been unable to afford Dr George Witt, the Bedford physician, who treated the Higgins family, and, it seems from the letters, villagers had mixed feelings about Nathanial Godfrey, the Turvey surgeon-apothecary.

Henry’s letters, which can be read at Bedfordshire Archives, give a fascinating insight not only into the ill-health of people in the village at that time, but also into the state of medical practice in a period before professional regulation was fully established and unqualified practitioners were commonplace.

Medical professions in the nineteenth century

Surgeon-apothecaries were the forerunners of the modern General Practitioner. They were far more numerous than physicians but in the early nineteenth century had a mixed reputation. Despite the respectable practice of many, quacks abounded and the sentiment expressed in an old joke “I felt unwell, I resolved to get better, I took medicine, I died” would still have struck a chord for many people (Corfield, 2009). People were often suspicious of medical treatments and preferred to trust in folk remedies.

Certificate licensing Nathaniel Godfrey to practise as an Apothecary. Image used by kind permission of The Worshipful Society of Apothecaries.

In a spirit of reform, the Apothecaries Act had been passed in 1815. This was the first major legislation to set standards for medical education and regulate unqualified practice. The Act granted the Society of Apothecaries the right to conduct examinations and  license apothecaries to dispense and practise medicine throughout England and Wales. Training requirements were specified including a five year apprenticeship, attendance at a range of courses and six months hospital experience. However unqualified practitioners remained widespread, and it wasn’t until 1858 that the Medical Act established a single medical register, specified entry qualifications and created the General Medical Council (GMC) with responsibility for ensuring standards of registration and conduct. Despite this, a report by the GMC as late as 1910 found significant evidence of people still claiming to be qualified when they weren’t, even signing death certificates!

The article ‘Getting a medical qualification in England in the nineteenth century‘ by  J.J. Rivlin explains, in more detail,  the different types of medical practitioners in the nineteenth century  and their origins and training.

Henry’s medical ‘training’

Charles’s Museum, Turvey Abbey, where Henry did his ‘compounding’. From Turvey Abbey Scrapbook. Copyright Rev. J. Longuet Higgins

By the 1830s, therefore, efforts to regulate medical practitioners and ensure they were qualified had not been in place for very long. Given this, it is perhaps not surprising that  Henry Higgins, despite having no formal medical training, felt able to offer medical treatment to some of Turvey’s villagers. However he appears to have been diligent in learning as much as he could by his own efforts. On the 2nd March 1837 he tells his brother:

I have been reading very hard at medicine in the evenings and have been up till past twelve often. I like the lectures of Dr Stokes very much there is no humbug what[ever] but they require more knowledge of medical terms than I posses and were it not for the Greek derivations I should not be able to understand many of them at all.

Dr Stokes was an Irish physician who wrote medical lectures in the London Medical and Surgical Journal, wrote texts on chest and heart conditions, promoted the use of the stethoscope (which had been invented in France in 1816) and went on to have an important impact on medical training. Henry also relied on the advice of his brother who was studying medicine at St Bartholomew’s Hospital in London between 1836 and 1838. In the same letter he comments that people are looking forward to Charles’s forthcoming visit:

and I shall be glad to get the responsibility off my shoulders though I hope I do not attempt to bear it by myself for if I did I should fail.

He clearly recognised when he needed to refer on to a more experienced practitioner, but,  whether because of the villagers’ inability to afford the apothecary’s medicines or fears about what might happen to them, Henry struggled to get some of his patients to consult Nathaniel Godfrey. On the 26th January 1837 he wrote to Charles:

The poor people complain most grievously of Godfrey and those that are in the club will not apply to him if they can help it.

(The ‘club’ was the Friendly Society that had been founded by the Rev Legh Richmond. It provided financial support for members during periods of sickness.)

Henry’s ‘medical practice’

Henry’s letters to Charles are full of descriptions of his ‘patients’, their symptoms,  and the treatments he is trying. In a letter on the 23rd February 1837 he describes his routine, which includes making up medications (“compounding”), and some current “interesting cases”:

I generally go out to see my patients about half-past ten and get back about two (more or less) then I go out on the pony until five, then come home and dine, go into your museum light a cigar !!! and begin compounding, at seven “the house begins to fill” and continues full till near half-past eight, at which time I generally get done.

He is meticulous in his recording of symptoms:

Sarah Sharman. Looks dolorous, cough troublesome especially at night, profuse night perspirations followed by debility during the day, pulse irregular, no pain on pressure upon the epigastric regions.

Henry prescribed Opii Pulvis Ipecac, Colycynth, Acid Sulphate, a tonic expectorant cough mixture and “gentle aperient medicine” (laxative) for Sarah. The preparation of Opii Pulvis Ipecac, also known as Dover’s Powder (Banatval, 2016), was a mixture of powdered opium and ipecacuanha (an expectorant) and was commonly used for febrile illnesses, even up until the 1960’s. We are now rightly aware of the dangers of opioids and, with the benefit of hindsight, their widespread historic use is alarming.

Nineteenth Century Opium bottle. Science Museum London CC BY

Colycynth was used as a laxative and is still in use as a traditional medicine in parts of  the world although it was banned as unsafe by the US Food and Drugs administration in 1991. Clearly, however, these combined treatments did Sarah no harm as she was described a week later as being “not like the same woman”. In fact she went on to live until she was eighty!

Fortunately he is “very careful in my use of mercurials”. Mercury was used in the treatment of syphilis and skin diseases in the nineteenth century but is now known to be highly toxic. Henry goes on to say “and in about the only case where I have used it (Lydia Johnson) a sore mouth followed the fourth pill….so that I shall not meddle much more with it”. Luckily for Lydia, he concludes “she is however decidedly better”.

Not all Henry’s treatments were medicinal. As well as making up some “powders” for Rebecca Tysoe, Henry “sent her down six ounces of your [Charles’s] port wine” because “she complained of excessive weakness”. In a later letter he describes Rebecca as being “very ill, but I hope not worse, she complained of cold so I sent her down a large heavy blanket which seems to make her more comfortable”. This latter comment reveals the degree of poverty typical at the time.

Common, and not so common, illnesses

Coughs, fever, pains and weakness are frequently described and waves of illness sweeping through the village are also evident, often leading to prolonged debility and continuing symptoms, especially amongst children and the elderly. Influenza was a recurrent feature of Henry’s writing.  On the 26th January 1837 he asks his brother to let him know “what you think is the best treatment for influenza” and writes:

I visited a great many poor people on Monday, scarcely a house where there is not someone ill. Thirteen came on the new benefit society on that day….and five on the men’s club.

A month later on the 23rd February 1837 Henry wrote:

The influenza has left a strain that will show itself for some time yet. I think about 800 in Turvey have had it, no wonder that it has left so many bad coughs and cases of general debility.

Given that the population of Turvey in the 1841 census was 960, Henry is clearly suggesting that the vast majority of the population had succumbed.

At first sight, perhaps Henry’s diagnosis of Elizabeth Ayres, “sick from eating a swede turnip” is more unusual. However, given the fact that sanitation was poor and food storage probably vulnerable to contamination, many cases of sickness may have been due to these reasons. Children of course were more likely to become ill in this way, and at the time Elizabeth would have been about eleven. There is more information on the website about the Ayres family, see the Sylvia Purdie Collection.

A more serious disorder was dysentery, caused we now know by bacterial or amoebic infection. Poor sanitation and contaminated water supplies were associated with transmission. Dysentery and other diarrhoeal diseases accounted for significant numbers of adult deaths in the nineteenth century and about 10% of child deaths under the age of five (Greaves, 2018). Treatments mainly involved emetics and opium (McMahon and DuPont, 2007). Perhaps wisely, Henry tells Charles:

Phoebe Bell and the man Weed are cases of dysentery which I don’t meddle with and have therefore sent them to Godfrey.

You can read more about the Bell family’s later life in Turvey in the 1850’s.

Cholera had arrived in England in 1831 through the port at Sunderland and there was a further epidemic in 1848-9. However in 1837 Henry commented that influenza was a “greater evil” than cholera in neighbouring parishes.

In a couple of letters Henry refers to “ague”. Ague was a form of malaria spread by mosquitos. It was prevalent in low lying marshy areas in the nineteenth century, particularly in eastern England in the Fens, Essex and Kent, and it is possible that Turvey’s situation alongside the river may have provided the conditions for transmission. Henry treated it with Quinine, still used today for the treatment of malaria, with good effect:

Ezra Reynolds has had an attack of the ague very bad. I gave him a strong emetic and a black dose and afterwards the Quinine mixture, and he has had no return.

The perks and pitfalls of doctors’ rounds

Then, as now, money could buy access to preferential medical treatment. Henry, no doubt with a wry smile, wrote to his brother:

I have sent a child of Elizabeth Wright’s (used to be a servant at the cottage but now lives where Dinah W used to) to the Infirmary for a very bad eruption of boils all over him, he is much under age but Dr Witt saw him and happening to cast his eye on a fine old long stalled wine glass beautifully spiralled, he promised to take him in. The child is gone and the glass is the doctor’s.

Dr Witt regularly attended the affluent Higgins family when they were unwell, no doubt enjoying a glass of Charles’s port wine when he did! However, he hadn’t had such a good visit to Turvey Abbey the week before he examined  the Wright child:

Dr. Witt when he was coming over here today met a drove of pigs, one of which ran between his horses’s legs , and threw it down and broke the gig all to pieces and chucked the Doctor & John into a ditch together, neither of them were hurt, and Thomas drove the Doctor back to Bedford.

Postscript

Henry’s later life as a clergyman took him away from Turvey but perhaps his interest in ill-health continued as he became chaplain to the Rainhill Asylum in Liverpool.

Dr Witt emigrated to Australia, had a successful career as a banker and then returned to England where he built up a collection of objects associated with ancient cults, notably the cult of Priapus, the god of fertility. He donated these objects to the British Museum but they were deemed unsuitable for the public to see and so were stored in the Secretum, that part of the museum opened in 1865 for artefacts that were “abominable monuments to human licentiousness”! Gentlemen of “mature years and sound morals” could apply for a special permit to study objects in the Secretum.

Nathaniel Godfrey had an altogether more ordinary life, continuing his practice and living in Turvey. In the 1861 census he is recorded as living on the High Street next to the Independent Chapel.

References

Primary Sources

Bedfordshire Archives, Letters from Henry Higgins to Charles Longuet Higgins,

HG12/6/2, HG12/6/3, HG12/6/4, HG12/6/5, HG12/6/6, HG12/6/7.

Secondary Sources

Banatval J., Thomas Dover: doctor, privateer, and rescuer of Robinson Crusoe, British Medical Journal, 2016,

Bynum, W.F. and Porter, R., Companion encyclopaedia of the history of medicine (London and New York, Routledge, 1993).

Corfield, P.J., From poison peddlers to civic worthies: The reputation of the apothecaries in Georgian England, Social History of Medicine, 22, 1 (2009), pp.1-21.

Fitzroy, A., Report as to the practice of medicine and surgery by unqualified persons in the United Kingdom, London, HMSO, 1910,

Greaves P. Regional differences in the mid-Victorian diet and their impact on health,  Journal of the Royal Society of Medicine 9, 3 (2018), 

Kuhn, K. G., Campbell-Lendrum, D. H., Armstrong, B., and Davies, C. R., Malaria in Britain: Past, present, and future, Proceedings of the National Academy of Sciences, 100, 17 (2003), pp. 9997-10001,

McMahan, Z. H. and DuPont, H.L., Review article: The history of acute infectious diarrhoea management – from poorly focused empiricism to fluid therapy and modern pharmacotherapy,

Alimentary Pharmacology and Therapeutics, 25, 7 (2007),

Nichols, A., Fenland ague in the 19th century, Medical History, 44 (2007), pp. 513-530,

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