In New York City in 1900, the Knickerbocker Hospital operates with innovative surgeons, nurses and staff who have to overcome the limitations of the then-current medical understanding and practice, to prevent staggeringly high mortality rates.
When we’re ill in the 21st century, our first port of call is usually some kind of self-medication, normally obtained from the chemist, then our GP. The situation in the 18th century was actually quite similar, although then there was no state provision of healthcare and it was up to you what kind of treatment you chose, if indeed you could afford any.
Given the prevalence of illnesses of all kinds, the predominant concern was to avoid being ill in the first place. In medical historian Roy Porter’s apt phrase, ‘People took care before they tookphysic.’ The proverb ‘Prevention is better than cure’ dates back at least to the seventeenth century and there was a growing tradition of preventive medicine to avoid what might be called dis-ease, including attention to diet, exercise and a healthy environment, extending to fads for balneology or cold-water therapy and vegetarianism,
If self-medication failed or the illness was serious and you could afford the services of a professional, you would consult one of three kinds of medical practitioner, physicians, surgeons and apothecaries, in descending professional status.
- Physicians were university educated, usually attended on their patients (rather than the other way round) and provided a diagnosis, although they had no real cures. Top physicians were part of the elite and tended to concentrate in London, where much of fashionable society congregated.
- Surgeons had served an apprenticeship and had the role of treating external problems such as wounds and boils, setting bones and doing simple operations. It wasn’t until 1745 that the Barber-Surgeons Company of London split into two branches.
- Theoretically, the apothecaries dispensed the medicines which the physicians had prescribed. In practice, in small towns there was one practitioner who took on all three roles
There is a modern-day psychological concept called hedonic adaptation, which may help to explain why what we would regard as a limited degree of wellbeing did not seem to have a drastic effect on 18th-century people’s overall happiness. The theory goes that we adapt to both good and bad situations, changing our expectations accordingly, and that our level of happiness remains about the same. There is thus no clear correlation between health and wellbeing.