Monday, May 30, 2016

What to do in case of death

A few days ago somebody asked on Twitter: ‘Imagine there is no medicine or intervention. How would you have died and at what age?’ The answers were many and varied. I was interested that so many people – including the asker – seemed so sure. Me, I could have died right away as I developed aspiration pneumonia at the age of six hours. I had a couple more infections that cleared with antibiotics as a child, all potentially fatal events. But modern medicine also means we don’t get a lot of diseases that have been kept at bay not just thanks to better diets and living conditions, but also vaccinations and prophylaxis. We’re not just better at curing ourselves, but also at not getting sick.

Therefore the hypothetical question, whilst intriguing, can’t really be answered with any great certainty except in limit cases of extreme complications at birth. Four generations ago, in countries like ours, childhood used to be a leading cause of death, as demonstrated by the ghastly institution of the poor having to take out funeral insurance for their young. (Therefore becoming poorer. Therefore increasing the risk.) I remember my own grandmother reminiscing about deaths in the village and explaining some of them away, with a fatalistic shrug, as having belonged to children: ‘They were just little,’ she would say.

Mass preventable death, in the form of unequal access to medicine, is an appalling mark of our age. Back then, there was just so much less anyone could prevent. Reference books on family health, a genre that was very popular in literate homes, allow us indirect access to the prevailing psychology of a time when life was far cheaper than it is today.

Published by the London imprint Ward Lock & Co, The Home Doctor dates back to 1926 and was sold as far as New Zealand. Its prescriptions were general and universal, if not its advertisements. On the subject of which, I wish I could send away for a copy of AW Scott’s free health book The Joy of Life, guaranteed to help sufferers overcomes diseases as disparate as hay fever, sciatica and diabetes without ‘drugs or exercises’.

What are ‘Perry’s Powders’, and will they keep my children fit and well? Another advertisement, addressed ‘to the ruptured’, urges hernia sufferers to purchase ‘the Morso appliance’, which appears to be nothing more than a sturdy, British-made abdominal truss: the first in a long list of words in the book that aren’t really used anymore.

The reading greatly enlarged, or maybe I should say backdated, my vocabulary. I didn’t know a constitution could be said to be scrofulous. Nor that a ‘lousy scalp’ is literally a scalp affected by head lice, which is where the word lousy comes from. (Sorry if this is painfully obvious to you.) I didn’t know the word aperient nor the word poultice, the latter used here to mean what I knew as a cataplasm. Or that a fomentation was the act of applying said poultice, and that it is also were the verb foment comes from. Or that tonsillitis used to be called quinsy. And so forth.

Some of the advice is on the quaint side, too. When in doubt, the authors either advise to administer endless fomentations or to paint the patient liberally with iodine. (The unpleasant yellow tincture hadn’t been quite phased out by the time I was a child.) For cases of concussion, they claim the best practice is to retreat to a quiet, darkened room. An alarming number of conditions seem to require placing the person in a well ventilated room and making sure they abstain from talking, for some reason. Eating gruel and taking baths are also listed as popular remedies.

Crushed ice mixed with lard is said to help with burns. If a substance causing choking is at the upper part of the throat, we’re told to try to seize it with the finger and thumb. Otherwise, ‘take a penholder, a quill or a piece of whalebone and endeavour to push it down the gullet.’ (I wonder if this sort of reverse Heimlich is still practiced.) In the passage I found perhaps most perplexing, removing adenoids is advised in order to prevent mental retardation. In the one I found most interesting, about neurasthenia – a constellation of symptoms widely recognised by people of my parents’ generation, and which may have come back in the form of what we call chronic fatigue syndrome today – we are told that
the patient’s friends are usually a great hindrance to the successful treatment of the disease. They either display a foolish sympathy or believe the disease to be imaginary.
Which frankly strikes me as quite insightful.

The advice for living is centred around diet, exercise and healthy homes, which is not terribly dissimilar to the present day, although in this case too the language has changed quite a bit. Listen to the advice on food consumption:
A healthy, full-grown man, doing a moderate amount of work, requires daily about 4 and a half ounces of nitrogenous, 3 ounces of fatty and 15 ounces of sugary and starchy food, besides 1 ounce of saline matter.
Did you have enough saline matter today? As for exercise, try programming into your Fitbit a daily amount of activity ‘equal to that put forth in walking 8 and a half miles on level ground.’

But this pocket medical encyclopaedia for the home tells another story. 1926 was after the invention of vaccinations but before the discovery of penicillin. The world’s most affluent and technologically advanced societies were still at the mercy of a great number of diseases, while some centuries-old mass killers – such as typhoid, diphtheria and smallpox – were finally on the retreat. Cancer was all but completely untreatable, as reflected in a sparse, timid entry that declares it to be ‘out of the scope of this work’ and hopefully suggests that ‘electrical treatment has, in many cases, very satisfactory results’. In my country at this time uneducated people called it il brutto male, ‘the bad disease’ – at once a euphemism and a sentence.

The social significance of the book lies in the fact that this was an age when home medicine was still widely practiced, and included not just treating any number of minor ailments without so much as a trip to the apothecary but also caring for incapacitated family members via the institution of the sick nurse – who may either be a professional or a family member herself. Home is where you were born but also where you died. Thus, strict rules are given in the book for the daily care and disinfection of the sick room, and even stricter timetables for the segregation of contagious siblings, parents or children: in upper-floor rooms as far away as possible for the family, after having removed ‘curtains, carpets, woollen goods and all unnecessary furniture’; rooms that would reek permanently of carbolic acid, sulphur or borax – the smells that haunted the gravely ill.

It breaks my heart a little bit that, in its alphabetical lists of diseases and their remedies, the book includes a small entry on death. It starts with a succinct account of its symptoms – which at this time were ‘complete and continued cessation and respiration; complete and continued cessation of the heartbeat and loss of the eye reflexes’ – followed by instructions for how to treat it, as it were:
Within an hour or so of death the eyes should be closed, a four tailed bandage should be applied to the jaw to keep the mouth closed, and the limbs should be straightened out.

I am reminded that when lives were shorter, death was more normal; that even if it still affects all of the people, it was more of an everyday occurrence back then than it is for us, at least in the countries where this little book was sold. Things could change again, of course. I’m sure it never occurred to the pioneers of the medical use of penicillin that some day their miracle cure could stop working, and time be wound back. This and other developments might drive us back to the widespread use of sick rooms in our homes, and to a new normalcy closer to death and disease. You never know when the old books could become useful again.

In my family we had our own glass syringe, just as The Home Doctor prescribes as part of the medicine chest that every home needs. I remember that when the local nurse came calling to give me a shot of penicillin when I was a child – one of those times I could have died, if we’re still playing the game – she asked if we had one, and we gave her that, and it was the last time I saw it being used. I saved it, anyhow. Of such objects family histories are also made.

Wellington friends: this Friday I'm taking part in a reading at Pegasus Books (Left Bank, off Cuba Street) along with Greg O'Brien, Lee Posna and the great Ashleigh Young. It starts at 7pm, come along. More details here if you're a Facebook person.


Viridessence said...

Quinsey is an extreme form of throat infection, not quite the same as tonsillitis. It involves the closing of the throat due to extreme ulceration, hence potentially fatal. My son has had it twice, resulting in hospitalisation, the lancing of ulcers and intravenous antibiotics.

Giovanni Tiso said...

Yikes. Being pre-antibiotics, the book suggests, in case of suppuration, fomenting often with a solution of 1 part lactic acid to 7 of water, and giving a mixture containing 2 drachms of tincture of iron and 4 drachms of glycerine to 6 ounces of water, as well as gargling with carbolic acid.

Megan Clayton said...

I recall a first-person essay on Slate about the author's early years as an unvaccinated child in the 1980s. She had quinsy in her early 20s and mentioned its role in the death of Elizabeth I.