Painted faces: cosmetics in the 18th century

The vicissitudes of pre-modern life invariably took their toll on the health and appearance of 18th-century Europeans; their faces were often riddled with smallpox scars, their teeth decaying, their gums caved in from lost teeth, their gait uneven from childhood rickets. One way both men and women could hide these defects was to wear a thick face of makeup. A very specific beauty ideal was common to European countries at the time, which often involved using highly toxic cosmetics. Recounting a visit to the theatre in 1716, Lady Mary Wortley Montagu described what would remain the fashion for the rest of the century: ‘all the ladies have…snowy foreheads and bosoms, jet eye-brows and scarlet lips’. The only thing she missed out was brilliantly red cheeks. So, how did men and women achieve this desirable look?

A white complexion

For centuries, the fashionable skin colour in Europe was palest white as it suggested wealth and idleness, rather than having to labour in the fields and get sunburnt. This pale look became even more pronounced in the 17th and 18th centuries as fashionable men and women increasingly resorted to artifice to make their complexion yet whiter.

A pasty face could be achieved by using one of the many face creams and washes which promised to whiten and bleach the skin. One advertisement for a ‘Chemical Wash’ promised to get rid of ‘all deformities…[such] as Ringworms, Morphew, Sunburn, Scurf, Pimples, Pits or Redness of the Smallpox, keeping [the skin] of lasting and extreme Whiteness’.

English portrait, 1780s

Rather more dangerously, people used heavy white foundations to achieve the desirable pale complexion. These were slathered over the face and bosom, and in order to heighten the effect, some ladies painted blue veins on their bosoms. The more harmless ingredients in white makeup preparations included rice powder, vinegar, hartshorn, gum arabic, and bismuth subnitrate (the latter still being used in modern paints). However, many of the most popular facial cosmetics included lead, as it had desirable opaque qualities. One toxic recipe for white face paint went as follows:

Steep the lead in the pot of vinegar, and rest it in a bed of [horse] manure for at least three weeks. When the lead finally softens to the point where it can be pounded into a flaky white powder [chemical reaction between vinegar and lead causes lead to turn white], grind to a fine powder. Mix with water, and let dry in the sun. After the powder is dry, mix with the appropriate amount of perfume and tinting dye.

Of course, the major downside of using lead-based makeup was that it proved highly poisonous to the wearer over time. Incredibly, people used it even though the effects of lead poisoning were pretty well known. Several English socialites actually died from lead poisoning this way, such as Maria, Countess of Coventry, who died of blood-poisoning in 1760 at the tender age of 27.

Maria, Countess of Coventry
Maria, Countess of Coventry

Rouged cheeks

A white complexion was not, however, deemed complete without a very visible application of rouge. This could range from a large swathe of red from the eyes down to the mouth, to neat red circles in the middle of the cheeks. The most harmless rouge concoctions were made of vegetable matter. Rouges made in this way might contain sandalwood, brazilwood, safflowers, red wine, or carmine (derived from the cochineal insect).

Some of the most popular recipes for rouge were, however, like the lead-based white makeup, highly toxic. Many women used a vermilion-based rouge as it gave a particularly brilliant red colour; vermilion is made from the mineral cinnabar, also known as mercury sulphide! The author of the 1760 work The Art of Beauty warns against using cinnabar as a component of rouge, arguing that ‘it is very dangerous; for by using it frequently they may lose their teeth, acquire a stinking breath, and excite a copious salivation’. The author correctly identifies the effects of mercury poisoning, but goes on to recommend ‘a fine White Paint’ containing the equally poisonous lead!

Madame de Pompadour at Her Toilette Boucher 1758
Boucher, ‘Madame de Pompadour at her Toilette’ (1758)

Aside from the very real dangers posed by cosmetics containing large quantities of lead and mercury, white face paint and vivid rouges were disadvantageous in other ways. For one thing, they were susceptible to run off in stressful conditions, leaving the wearer looking rather ghastly. In Fanny Burney’s 1778 novel Evelina, the narrator says of a distressed Frenchwoman who had suffered an accident, that ‘her face was really horrible, for the pomatum and powder from her head, and the dust from the road, were quite pasted on her skin by her tears, which with her rouge made so frightful a mixture, that she looked hardly human’. Indeed, not everyone thought that rouge made a man or woman more attractive. The French critic Charles-Nicolas Cochin, writing in about 1750, opined that:

It is well known that rouge is nothing more than the mark of rank or wealth, because it cannot be supposed that anyone has thought to become more beautiful with this terrible crimson patch. It is surprising that such distinction has been attached to a colour so common and inexpensive that even the lowliest grisettes [working-class women] can make this expenditure as abundantly as a person of the highest birth.

Roslin, ‘The Countess de Bavière-Grosberg’ (1780)


The ideal 18th-century eyebrow was thin, half-moon shaped with tapered ends, and conspicuously dark. Eyebrows could be darkened with lead, kohl, burnt cork, elderberry juice, or the soot from oil lamps. If someone had lost their eyebrows from excessive plucking, they could always stick on a pair of false eyebrows made of mouse-skin. Satirists made much of this particular phenomenon: Jonathan Swift describes a woman’s ‘eyebrows from a mouse’s hide / Stuck on with art on either side’, and the poet Matthew Prior described in 1718 how: ‘HELEN was just dipt into bed / Her eye-brows on the toilet lay / Away the kitten with them fled / As fees belonging to her prey.’

From 'The New London Toilet' (1778)
A recipe to darken eyebrows, from ‘The New London Toilet’ (1778)

Beauty patches

Beauty patches, made of silk velvet, taffeta or satin and attached with glue, were fairly common in the 18th century. They served several purposes. Due to their dark colour, beauty patches heightened the contrast with artificially whitened skin, and were also very useful in covering up particularly noticeable smallpox scars. In fact, beauty patches developed a whole language of their own. At the French court, for instance, a beauty patch at the corner of the eye signified passion; one on the forehead was supposed to look majestic; and a patch on a dimple was considered playful. According to Joseph Addison in an early issue of The Spectator, the position of beauty patches in England could even be a symbol of political allegiance. He described the following scene at the Haymarket Theatre:

I could not but take notice of two parties of very fine women, that had placed themselves in the opposite side boxes, and seemed drawn up in a kind of battle array one against another!  After a short survey of them, I found they were patched differently; the faces, on one had, being spotted on the right side of the forehead, and those upon the other on the left…Upon inquiry, I found that the body of Amazons on my right hand were Whigs and those on my left Tories…

Gainsborough, ‘Portrait of a Lady In Blue’ (1777-79)
Boucher, ‘A Lady Applying Beauty Patches’











The public attitude towards ‘painting’ one’s face was mixed. At the French court, no one would have been caught dead without a thick face of makeup, but England was more conservative, and the English generally thought it inappropriate for younger women to paint their faces. In Maria Edgeworth’s 1801 novel Belinda, we are supposed to feel pity and contempt for the aging socialite Lady Delacour when she tells the young eponymous heroine, ‘but you don’t paint – no matter – you will – you must – every body must, sooner or later’.

Many moralists condemned the practice of painting altogether. Society was more willing to forgive the foibles of the young, but was particularly vicious towards older ladies who resorted to paint and other beauty aids to hide their aging complexions. Lady Archer in particular came under much critical scrutiny for her continued application of heavy makeup as she grew older:

HER Ladyship’s figure has been for many years common to this metropolis, but the natural complexion of her face, is no more remembered, it having been so long disguised by cosmetic art, that flesh and blood seem not to form the least part of its composition. The art of painting, however, of brushing up an old decayed picture, is not the only art in which she excels…

'Six Stages of Mending a Face'
‘Six Stages of Mending a Face’. A 1792 Rowlandson caricature of Lady Archer

Never…did any person labour more indefatigably to fill up the wrinkled deformities of nature, with the impotent remedies of art; but all is labour in vain, the remedy worse than the disease, it chiefly consisting of mercurial and a variety of pernicious ingredients, often inflicting palsies and other most fatal maladies: nor…does it ever answer the purpose intended, exciting disgust, instead of stimulating desire: a revolting melancholy instance of which, we have now before us—a PAINTED SEPULCHRE…

If it be men whom [women] aspire to please, if it be for them that they daub and varnish their complexions, I have collected the opinions of mankind, and I promise on the part of the great majority…that the use of paint renders women hideous and disgusting, that it withers and disguises them, that men hate as much to behold the female countenance thus plaistered, as to see false teeth in the mouth, or balls of wax in the jaw; that they decidedly protest against every artifice employed to disfigure the sex.


Caricature of Lady Archer driving to a shop on Pall Mall selling rouge and mouse-skin eyebrows
Caricature of Lady Archer driving to a shop on Pall Mall which sells rouge and mouse-skin eyebrows

Further reading

Anon., The New London Toilet (1778)
Pierre-Joseph Buc’hoz, The Toilet of Flora (1772)
Charles Pigott, The Female Jockey Club, or, a Sketch of the Manners of the Age (1794)
J. Williams, The Art of Beauty: or, a Companion for the Toilet (1760)

A history of Bedlam, the world’s most notorious asylum

The Bethlem Hospital, or Bedlam as it is more commonly known, is Europe’s oldest extant psychiatric hospital and has operated continuously for over 600 years. It was founded in London in 1247 during the reign of Henry III, as the priory of the New Order of St Mary of Bethlehem. Bethlem was not actually intended as a hospital, much less as a specialist institution for the insane, but rather as a house for the poor and a centre for the collection of alms to support the Crusader Church. However, the crown seized Bethlem in the 1370s and it became an increasingly secular institution staffed by crown appointees.

The first definitive record of the presence of the insane in Bethlem is from the details of a visitation of the Charity Commissioners in 1403. This recorded that among other patients there were six male inmates who were “mente capti”, a Latin term indicating insanity. The visitation also noted the presence of four pairs of manacles, eleven chains, six locks and two pairs of stocks, presumably used to restrain the most violent inmates. In c.1450 the Mayor of London described Bedlam as a “place [where may] be found many men that be fallen out of their wit. And full honestly they be kept in that place; and some be restored onto their wit and health again. And some be abiding therein for ever, for they be fallen so much out of themselves that it is incurable unto man”. Little is known of the treatment of the insane for much of the medieval period, though mechanical restraint, a meagre diet and solitary confinement are likely to have been common practices. The name “Bedlam” developed in the 14th century as a corruption of “Bethlem”, or “Bethlehem”.

Plan of the medieval Bethlem hospital
Plan of the medieval Bethlem hospital

By 1600, Bethlem was co-owned by the crown and the City of London, and run by a board of governors. The change in management doesn’t seem to have benefited the hospital’s inmates; conditions in 16th- and 17th-century Bedlam were appalling. Bethlem had been built over a sewer which served both the hospital and the surrounding area, and as it regularly blocked, waste of all kinds would seep into the building. The 1598 visitation by the Governors had observed that the hospital was “filthely kept”, and a later inspection found inmates actually starving. Under the leadership of the aptly-named Helkiah Crooke, who was dismissed in 1632 on grounds of absenteeism and embezzlement, charitable goods and foodstuffs were stolen by the steward and either personally consumed or sold on to patients. Those without the resources to trade with the steward often went hungry. It was at approximately this time that the word “Bedlam” seems to entered everyday speech to signify a state of madness and chaos.

The admittance of public visitors as a means of raising hospital income may have been allowed since the late 16th century; certainly there are 17th century accounts which describe the “Swarms of People” which descended on Bethlem during public holidays in order to amuse themselves by watching the mad inmates. The number of visitors seeking entertainment rose in the 18th century, becoming one of Bedlam’s most notorious characteristics. Visiting was defended by some commentators as a form of moral instruction, as it illustrated the dangers of immorality and vice which could, in popular belief, lead to madness. As one spectator commented, “[there is no] better lesson [to] be taught us in any part of the globe than in this school of misery…From so humbling a sight we may learn to moderate our pride, and to keep those passions within bounds, which if too much indulged, would drive reason from her seat, and level us with the wretches of this unhappy mansion”.

Figures representing Melancholia and Mania, at the entrance to Bedlam
Figures representing Melancholia and Mania, at the entrance to Bedlam

All well and good, but for the vast majority, Bedlam was simply a titillating source of cheap amusement which provided what historian Roy Porter describes as the “frisson of the freak show”. An 18th century observer recorded how on one occasion, “a hundred people at least [were] . . . suffered unattended to run rioting up and down the wards, making sport and diversion of the miserable inhabitants, [some of whom were] provoked by the insults of this holiday mob into furies of rage”. Unrestricted public access continued until 1770, after which time visitors required a ticket signed by a governor of the hospital. As distasteful as it was to have crowds flocking to make fun of the mentally ill, some historians have speculated that the lack of public oversight after 1770 allowed for more flagrant abuses.

Being such an infamous institution, Bedlam did not lack for attention in the public, literary and artistic spheres. Jonathan Swift memorably quipped, where better to recruit the nation’s politicians than Bedlam, since the inmates could not be any more insane than the ones in power! Bedlam provided a wonderfully melodramatic backdrop to literary texts, as in Eliza Haywood’s 1725 play The distress’d orphan or, Love in a mad-house. Haywood describes how “the rattling of Chains, the Shrieks of those severely treated by their barbarous Keepers, mingled with Curses, Oaths, and the most blasphemous Imprecations, did from one quarter of the House shock…tormented Ears while from another, Howlings like that of Dogs, Shoutings, Roarings, Prayers, Preaching, Curses, Singing, Crying, promiscuously join’d to make a Chaos of the most horrible Confusion”. Perhaps the most famous depiction of Bedlam is the final painting in Hogarth’s cycle The Rake’s Progress (1723-25). Driven mad by debauchery (probably an effect of syphilis), the cycle’s protagonist Tom Rakewell presents a sorry sight, sprawled on the floor of a dank cell in Bedlam. He is surrounded by other lunatics, one of whom thinks he is a king, another a bishop; wealthy visitors laugh at the wretched scene.

Bedlam, as depicted in the final scene in Hogarth's cycle A Rake's Progress (1723-25)
Bedlam, as depicted in the final scene in Hogarth’s cycle A Rake’s Progress (1723-25)

Bedlam’s medical regime – such as it was – was at best useless, at worst actively injurious to the mental health of the inmates. Mental illness was completely misunderstood at the time. Epileptics and people with learning difficulties and dementia were classed in the same group as people suffering from paranoia, schizophrenia and depression. Following Greek and Roman philosophy, it was believed that ailments were generally caused by an imbalance of the four humours; too much black bile, for instance, was thought to lead to depression. Consequently, a depletive medical system held sway in Europe until the 19th century.

The most common treatment in this system was blood-letting, but patients at Bedlam were also subject to forcibly induced vomiting, scarification and purgation. Such was the violence of the standard medical course that patients were regularly discharged or refused admission if they were deemed unfit to survive the physical onslaught. Alexander Cruden, a writer who was briefly incarcerated in Bedlam, said bitterly of the physicians there: “but is there so great Merit and Dexterity in being a mad Doctor? The common Prescriptions of a Bethlemitical Doctor are a Purge and a Vomit, and a Vomit and a Purge over again, and sometimes a Bleeding, which is no great mystery”.

Applying leeches, ready for blood-letting (C18). A common treatment in pre-modern European medicine
Applying leeches, ready for blood-letting (C18). A common treatment in pre-modern European medicine

The years 1814 and 1815 proved a turning point in Bedlam’s history. Edward Wakefield, a Quaker philanthropist and leading advocate of lunacy reform, visited several times during 1814 with the aim of inspecting conditions. Fearing bad publicity, Bedlam personnel tried to keep Wakefield out, but he eventually gained entry in the company of an MP and a governor of the hospital. He found that inmates were not classified in any logical manner, as both highly disturbed and quiescent patients were mixed together indiscriminately. Patients were chained to the wall, sometimes with thick iron rings around their necks; it was said that “chains are universally submitted for the strait-waistcoat”. In 1818 a former Bedlam inmate, Urbane Metcalf, described the case of a man named Popplestone, “whose leg rotted off as he was chained up for such a lengthy period that the metal cut into his flesh”. There was also the infamous case of the American marine, James Norris, whose intestines burst after being confined in chains for over a decade.

Wakefield and others revealed how keepers at Bedlam could be brutal and even sadistic towards their mentally ill charges. Wakefield recounted an incident in which “a man arose naked from his bed, and had deliberately and quietly walked a few paces from his cell door along the gallery; he was instantly seized by the keepers. thrown into his bed, and leg-locked, without enquiry or observation”. Metcalf reported an alleged case of murder: “Fowler [a patient], was one morning put in the bath by Blackburn [a keeper], who ordered a patient then bathing, to hold him down; he did so, and the consequence was the death of Fowler, and though this was known to the officers it was hushed up”. Metcalf also described a how a keeper named Davis, a “cruel, unjust and drunken man…for many years as keeper secretly practised the greatest cruelties to those under his care”.

368px-James_Norris,_Bethlem_Patient,_1815.jpg. norris was American marine imprisoned in Bedlam since 1800
James Norris, the American marine whose intestines burst as a result of over 10 years of being chained up

Notwithstanding the prevailing idea that women were weak and fragile vessels who needed tender protection, female patients at Bedlam were not treated particularly gently. Wakefield describes his visit to the womens’ section as follows: “each [inmate was] chained by one arm or leg to the wall…The nakedness of each patient was covered by a blanket-gown only… One female thus chained, was an object remarkably striking; she mentioned her maiden and married names, and stated that she had been a teacher of languages…The Committee can hardly imagine a human being in a more degraded and brutalizing situation than that in which I found this female, who held a coherent conversation with us, and was of course fully sensible of the mental and bodily condition of those wretched beings [also incarcerated there]”. Sexual assault by male keepers was a problem faced by many women at Bedlam. John Haslam, author of the 1815 Report from the Committee on Madhouses, alleged that “some years ago, a female patient had been impregnated twice, during the time she was in the Hospital; at one time she miscarried; and the person who was proved to have had connexion with her, being a keeper, was accordingly discharged”.

Following Wakefield’s revelations, Thomas Monro, Bedlam’s principal physician, resigned after being accused of “wanting in humanity” towards his patients. Wakefield’s testimony, combined with reports about patient maltreatment at other asylums helped prompt a campaign for national lunacy reform, resulting in the establishment of a House of Commons Select Committee on Madhouses in 1815. This examined the conditions under which the insane were confined in county asylums, private madhouses, charitable asylums and in the lunatic wards of Poor Law workhouses.

Gradually, attitudes to madness changed across the medical profession and more widely in society. The emphasis increasingly shifted from the external control of the insane through physical restraint and coercion, to their moral management whereby a system of punishment and reward would encourage self-discipline. Bedlam itself became a more humane place under the influence of William Hood, who became chief medical superintendent in 1853. A further House of Commons Select Committee on the Operations of the Lunacy Laws, which met in 1877, heard the testimony of Sir James Coxe, who echoed society’s changing attitudes towards madhouses: “I think it is a very hard case for a man to be locked up in an asylum and kept there; you may call it anything you like, but it is a prison.” It was, however, not until 1890 that the status of lunatics was changed, by parliamentary legislation, from prisoners to patients.


A glossary of archaic ailments

The past was a dangerous time to be alive. If you were lucky enough to survive infancy and adolescence, you were very likely to die of any number of frightful diseases well before you reached what we regard as old age. Readers of old novels or historical death records are confronted with many unfamiliar names for these illnesses. I’m sure I am not the only person to read pre-1900 novels and think, what is brain fever? What’s the bloody flux? What on earth is pink disease? For the benefit of those readers, history students and any one else who is interested, I’ve compiled a brief glossary of medical terms which were once commonly used but are now rare or obsolete.

Ague: Any intermittent fever characterised by periods of chills, fevers and sweats
Apoplexy: Now refers to bleeding within internal organs, but historically meant a death which began with sudden loss of consciousness; covered what we now call heart attacks, strokes and aneurysms
Bilious fever: A fever accompanied by nausea, vomiting and diarrhea
Bloody flux: Dysentery
Brain fever: Difficult to make a diagnosis in hindsight, but possibly meningitis or encephalitis. Very popular as a plot device with 19th century novelists, who portrayed it as a reaction to a severe emotional shock.
Camp fever: Typhus; so-called because it was common in military camps with notoriously poor hygiene
Consumption: Pulmonary tuberculosis. Another popular illness in Victorian novels.
Corruption: General term for infection
Distemper: A disease, especially an infectious one
Dropsy: Edema – abnormal swelling of the body, often caused by kidney or heart disease
Dropsy of the brain: Encephalitis
Falling sickness: Epilepsy

St Severin of Noricum healing a woman with falling sickness, c.1300
St Severin of Noricum healing a woman with falling sickness, c.1300

Gaol (jail) fever: Typhus
Great pox: Syphilis. Became something of a political football; the English, Poles, Italians and Germans called syphilis the ‘French disease’, the French called it the ‘Italian disease’, the Dutch called it the ‘Spanish disease’, the Russians called it the ‘Polish disease’, and the Turks called it the ‘Christian disease’.
Green fever/green sickness: Anaemia
King’s evil: See Scrofula
Lung fever: Pneumonia
Malignant sore throat: Diptheria
Mania: Insanity
Megrim: Severe headache, often limited to one side of the head
Melancholia: Severe depression
Mortification: Gangrene
Pink disease: Disease of teething infants due to mercury poisoning from teething powders
Plague: Any infectious disease with a high mortality rate, though will often refer to bubonic plague
Pox: Syphilis, though also referred to any unknown disease which caused sores to appear on the body

Harlot's Progress 1732
A prostitute (far right) dying of syphilis. From Hogarth’s ‘A Harlot’s Progress’ (1732)

Putrid fever: Diptheria
Screws: Rheumatism
Scrivener’s palsy: Writer’s cramp
Scrofula: Primary tuberculosis of the lymphatic glands. Also known as the King’s Evil, due to the old belief that the monarch was able to cure scrofula victims. Sufferers would hang around the royal residence waiting for the king or queen to bless them.
Ship fever: Typhus
Spontaneous human combustion: The burning of  a living human body without an apparent external source of ignition. Features in Charles Dickens’ Bleak House where the alcoholic Mr Krook dies of it.
Spotted fever: Meningitis or typhus
St Anthony’s Fire: One of several conditions characterised by intense inflammation of the skin, such as from erysipelas or ergotism. Rife in the Middle Ages due to the eating of ergot-contaminated rye bread.

Mathis Grünewald's grisly depiction of a man suffering from St Anthony's Fire (1512-16)
Mathis Grünewald’s grisly depiction of a man suffering from St Anthony’s Fire (1512-16)

St Vitus’ Dance: Phenomenon in which groups of people danced in a frenzy until they collapsed from exhaustion. Thought to have been a mass pschyogenic illness.
Strangury: Condition marked by slow, painful urination, caused by muscular spasms of the urethra and bladder
Surfet/surfeit: Vomiting from over-eating
Swamp sickness: Malaria
Sweating sickness: Infectious and often fatal disease affecting England in the 15th century
Teeth: Death of an infant when teething; symptoms included fretfulnes, convulsions, diarrhoea, and painful and swollen gums. Children appear to have been more susceptible to infection during this time, although malnutrition from being fed watered milk has also been suggested as a cause.
Tympany: A swelling or tumour
Winter fever: Pneumonia
Worm fit: Convulsions associated with teething, worms, elevated temperature or diarrhoea

What did people die of in the past?

Slate magazine has created an ‘Interactive Game of Death’ in which you can find out what you might have died of had you been living at various points from 1647 to the present. It churns through historical English and American death records in order to come up with a list of the ailments and accidents which killed people in any one year. It’s a fun way to spend ten minutes, but more than that, it allows us an interesting glimpse into the shifting patterns of death and disease over the last three and a half centuries.
Results for the year 1647, from Slate magazine's 'Interactive Game of Death'
Results for the year 1647, from Slate magazine’s ‘Interactive Game of Death’

I’ve spent some time having a look at the results and have pieced together some interesting patterns. Sometimes these are difficult to explain, not least because of the bewildering variety of medical terms which confront the historian. There are some terms which are impossible to translate into modern medical terminology, and others, such as ‘fever’, are frustratingly vague. There are, however, some indications that socioeconomic developments could influence the spread of new diseases or contribute to the disappearance of old ones, as was the case with the rise of the industrialised city in 19th century Europe and North America. I have divided the patterns of mortality into four sections; seemingly ‘harmless’ killers, unusual or vague ailments, the rise of the industrialised city, and death in the 20th century.

‘Harmless’ killers

Almost all of the diseases and ailments on the older historical death records can be treated today if caught in time. Despite this, some of their names still arouse a sense of dread. So terrible was their hold on the popular imagination at the time, that epidemics such as the Black Death and the Spanish Flu at once produce mental images of mass graves and deserted towns (the Black Death) and desperate parents all over the world unable to do anything for their previously healthy teenage children (Spanish Flu). We have not forgotten that these were deadly diseases.

It is not so with everything on the historical death records. Particularly in the older, pre-1800 records, there are many ailments which we would never associate with death. At first it seems odd to see toothache and worms listed as causes of death. Today, toothache is a painful nuisance, but no-one in the developed world should die from it if they have access to a doctor. We sometimes fail to appreciate that in an age before antibiotics and satisfactory hygiene (from a modern medical perspective), everyday complaints could turn fatal. Toothache was a routine ailment for almost everyone in pre-modern Europe. The best that could be done to combat it was getting some dodgy barber-surgeon to pull the offending tooth out with a pair of pliers. The worst consequence was death by septicaemia if the infection seeped into the blood.

Tooth extraction in the early 19th century
Tooth extraction in the early 19th century
Advertisement for cocaine tooth drops. New York, 1885
Advertisement for cocaine tooth drops. New York, 1885











Other illnesses and ailments listed in historical death records which are no longer linked with death in the popular imagination include indigestion, kidney stones, dysentery, worms, and teething. Teething is listed as a cause of death because the mercury used in many teething corals slowly poisoned the baby. Dysentery (then called the flux or the bloody flux, now better known as a form of gastroenteritis) was a a particular problem in places such as military camps. The overcrowding and particularly poor hygiene meant that contagion spread easily .

Unusual and vague ailments

‘Plague’, a catch-all term for bubonic or pneumonic plague, was one of the most feared killers in the medieval world. It was still endemic at the time of the earliest death record here (the London Bill of Mortality for 1647), yet in England, deaths from plague were almost unheard of after the Great Plague of London in 1665. It’s not entirely clear why it virtually disappeared from the records, but it did, putting an end to many centuries of terror of the ‘plague’ – only for new diseases to appear and terrify future generations with devastating epidemics.

Plague victims being carted away for burial. London, 1665
Plague victims being carted away for burial. London, 1665

Often in the pre-1800 records the causes of death are not unusual per se, but they are recorded in peculiar ways. For example, sometimes euphenisms were used to cover up deaths from sensual over-indulgence. Thus in 1801, someone in Porstmouth, New Haven, died of ‘debauchery’; probably what is meant is venereal disease. In 1647, a Londoner died of ‘surfet’ that is, vomiting from over-eating. Other causes of death are not just given unusual names, but would be deemed impossible now, as with the Londoner who is recorded as having died of grief in 1647. It’s easy enough to imagine how such a death record might have come into being. The authorities come round to the house to find out the cause of death; no one knows what it was, but the victim’s neighbour asserts that Tom or Mary has been prostrate with grief since their son died a year ago. The authorities promptly write ‘grief’ as the cause of death before moving on to the next person on the list. Thus, the record of ‘grief’ as a cause of death is not necessarily medical ignorance, though it raises a smile now.

One of the most vague terms to appear in historical death records, alongside ague (fever) and plague, is ‘brain fever’, which we find in English and North American death records in the 19th century. Retrospective diagnosis is always risky, but historians now speculate that brain fever may have been viral encephalitis. At any rate, its very vagueness made it a notoriously common plot device for 19th century novelists. Sometimes it feels as if it’s almost impossible to read a book by a Victorian author in which no character develops brain fever. Brain fever was a very useful literary device. It was relatively easy to introduce, as it tended only to be the reaction to a severe emotional shock, perhaps combined with having spent too long in the rain. It was an exciting disease, being always potentially fatal with a ‘crisis point’ to induce thrills in the reader, yet it was not contagious, so there was no danger of having to kill off any other characters. The high delirium into which it threw a character for several weeks meant that important secrets could be betrayed by the raving patient, which would introduce new intrigues and move the plot forward. To name only a few literary victims, Pip in Great Expectations, Cathy in Wuthering Heights and Marianne in Sense and Sensibility all suffer brain fever.


The rise of the industrialised city


Water supply was never particularly clean or reliable in cities, but in the 18th and 19th centuries, with the huge expansion of increasingly industrialised cities in Europe and North America, the problem of finding clean water became more acute than ever. The inadequate sewage system of the typical newly- industrialised city, together with the crowded and unsanitary living conditions, led to the rise of the water-borne diseases which would become terrifying killers until the 20th century, most notably cholera and typhoid fever. Aside from the poor water supply, the overcrowded, unhygienic conditions of the slums and tenements made contagious diseases such as diptheria, scarlet fever and typhus all too common. In the 19th century, American and British social reformers started drawing attention to slum areas, with the result that they were gradually cleared up by the authorities.
A Glaswegian slum in 1871. Cramped conditions and a conspicuous lack of adequate sewage and water supply systems ensured that such areas were rife with diseases such as cholera, typhus and typhoid fever
A Glaswegian slum in 1871. Cramped conditions and a conspicuous lack of adequate sewage and water supply systems ensured that such areas were rife with diseases such as cholera, typhus and typhoid fever


Death in the 20th century

The great shadow over the first decades of the 20th century was influenza, centering of course around the devastating Spanish Flu epidemic of 1918-19. Influenza was actually nothing new – its symptoms were clearly described by Hippocrates around 2,400 years ago – but it was from this period onwards that the illness was referred to by that name. Influenza is still listed as a cause of mortality in CDC Historical Data for the 1990s, though it is no longer the deadly, virtually untreatable threat of a hundred years ago. The mortality rate has greatly decreased, perhaps thanks to the availability of vaccinations and antivirals.

Other causes of death in the 20th century death records include tuberculosis (which faded away in the second half of the century), motor accidents, nephritis (inflammation of the kidneys), pneumonia and cerebrovascular diseases. Over the past few decades, the list of potentially fatal illnesses has narrowed considerably, and the majority of all illness-related deaths are now due to heart diseases, cancer, and to a lesser extent, diabetes mellitus. Sometimes these illnesses are treatable, but all too often they are still fatal.

The post was written from a western perspective as I was relying on English and North American death records. However, I must stress that many people in the developing world are still dying of diseases which Europeans and Americans imagine extinct, or ailments which are generally no longer fatal for us. In September 2011 there was a huge outcry over a 24-year old man from Cincinnati who died from toothache because he couldn’t afford the medical insurance which would have given him the antibiotics required to cure him. No such outcry is made every time someone in Africa dies of toothache, of cholera, or of childbed fever.

  • John Gaunt’s table of casualties in London (1629-1660)
  • Record of births and burials at Christ Church and St. Peter’s Church in Philadelphia (Dec. 25 1768-Dec. 25 1769)
  • Portsmouth, N. H., 1801 Bill of Mortality
  • Boston 1812 Bill of Mortality
  • Massachusetts mortality rates (1856-95) from “Mortality Changes in Amercia: 1620-1920”, Human Biology, September 1984. Vol. 56, No.3, pp.559-582
  • CDC Historical Data for 1910, 1920, 1930, 1940, 1950, 1960, 1970, 1980 and 1990


Filth, disease and Dickens: Jacob’s Island, a London slum

In my last post, on English and North American death records from 1647 to the present, I briefly mentioned how the development of the industrial city in 19th century Europe and North America changed patterns of disease and mortality. The dreadful overcrowding in the slums, together with a lack of adequate water supply, particularly encouraged contagious diseases such as cholera, typhus, scarlet fever, diptheria and typhoid fever. Slum districts were periodically ravaged by epidemics. The wealthy were of course also subject to epidemics, but they were probably in less danger as they lived in more sanitary conditions, had access to doctors and enjoyed a better diet.

As the 19th century wore on, more attention was drawn to the living conditions of the urban poor. The Victorian age saw an astonishing outpouring of philanthropic activity alongside the rise of political and social reform movements. In England, social reformers such as Henry Mayhew set about documenting poverty in an effort to bring the plight of the metropolitan poor to the public’s attention. In literature, Charles Dickens often portrayed the struggles of the urban underclass, most famously in Oliver Twist with its depictions of grim workhouses, child labour and London’s criminal underbelly.

Charles Dickens in 1839, shortly after the publication of Oliver Twist
Charles Dickens in 1839, shortly after the publication of Oliver Twist
Social reformer Henry Mayhew in 1861
Social reformer Henry Mayhew in 1861

One of the most infamous slums in London was Jacob’s Island in Bermondsey. The area was notoriously squalid and was described as “the very capital of cholera” by the Morning Chronicle in 1849. Both Mayhew and Dickens visited Jacob’s Island and were appalled by what they saw. Dickens was taken there by the Thames Police, with whom he would occasionally go on patrol. This gave him the inspiration for the ending of Oliver Twist; the principal villain, Bill Sykes, meets his death there in the stinking mud. Dickens describes Jacob’s Island in evocative terms:

“Crazy wooden galleries common to the backs of half a dozen houses, with holes from which to look upon the slime beneath; windows, broken and patched, with poles thrust out, on which to dry the linen that is never there; rooms so small, so filthy, so confined, that the air would seem to be so tainted even for the dirt and squalor which they shelter; wooden chambers thrusting themselves out above the mud and threatening to fall into it – as some have done; dirt-besmeared walls and decaying foundations, every repulsive lineament of poverty, every loathsome indication of filth, rot, and garbage: all these ornament the banks of Jacob’s Island”.

Jacob's Island, c. 1840. This photograph doesn't really reveal how terrible the living conditions were, so we are lucky to have Dickens' and Mayhew's descriptions
Jacob’s Island, c. 1840. This photograph doesn’t really reveal how terrible the
living conditions were, so we are lucky to have Dickens’ and Mayhew’s descriptions

Henry Mayhew also described Jacob’s Island in a letter to the Morning Chronicle in 1848. Whilst perhaps less poetic than Dickens, Mayhew is more exact in his description, with a focus on the scientific aspects of the problem:

“On entering the precincts of the pest island the air had literally the smell of a graveyard, and a feeling of nausea and heaviness came over anyone unaccustomed to imbibe the moist atmosphere. Not only the nose, but the stomach told how heavily the air was loaded with sulphuretted hydrogen; and as soon as you crossed one of the crazy and rotten bridges over the ditch, you knew, as surely as if you had chemically tested it, by the black colour of what was once white lead paint upon the door posts and window sills, that the air was thickly charged with this deadly gas.

“The heavy bubbles which now and then rose up in the water showed you whence at least a portion of the metaphitic compound issued, while the open doorless privies that hung over the water-side, and the dark streaks of filth down the walls, where the drains from each houses discharged themselves into the ditch, were proofs indisputable as to how the pollution of the ditch occurred.

“The water was covered with scum almost like a cobweb, and prismatic with grease. In it floated large masses of rotting weed, and against the posts of the bridges were swollen carcasses of dead animals, ready to burst with the gases of putrefaction. Along its shores were heaps of indescribable filth, the phosphoretted smell from which told you of the rotting fish there, while the oyster-shells were like pieces of slate from their coating of filth and mud. In some parts the fluid was as red as blood from the colouring matter that poured into it from the reeking leather-dressers’ close by”.

Although the authorities were at first reluctant to do anything about Jacob’s Island – a policeman once tried to deny the very existence of the place when questioned by Dickens – by the early 1850s the ditches were filled and the area redeveloped as warehouses. Jacob’s Island was heavily bombed in World War Two and has undergone such considerable regeneration in recent decades that it is almost impossible, looking at it today, to imagine what a centre of pestilence and poverty it once was.


Quack medicine: the “Grape Cure”

The number of quack cures peddled by doctors and salesmen over the ages never ceases to amaze. Most of the mixtures marketed were at best ineffective, and at worst poisonous enough that prolonged use could prove fatal (lead, arsenic and mercury all spring to mind). In order to make their product more attractive, producers would often advertise it as a cure-all solution.

Quack medicine: an 1890 advert for 'Hamlin's Wizard Oil', claiming to cure rheumatism, neuralgia, toothache, headache and diphtheria
1890 cure-all for rheumatism, neuralgia, toothache, headache and diphtheria

I recently came across one such cure which, whilst probably not harmful, seems dubious at best. Whilst browsing an 1892 copy of the Baedeker guide to the Rhine, I was intrigued by the mention of something called the ‘Grape Cure’. Considering the region’s longstanding reputation as a wine-growing area, I assumed that it involved the time-honoured ritual of drinking of large quantities of wine in order to miraculously cure one of all ailments, both mental and physical (at least temporarily). However, it turned out that the Grape Cure literally involved gorging on a prodigious quantity of grapes. Here is what the guide’s editor has to say about it:

Grapes when eaten in moderate quantity (1-2 lbs. daily) have a soothing effect on the mucous membrane, and in conjunction with a generous diet contribute materially to restore the strength of convalescents. When eaten in greater quantities (3-8 lbs. daily), the vegetable acid and salts produce an effect similar to that of mineral waters containing Glauber’s or common salt.

The grapes of the Rhenish Palatinate (‘Gutedel’ or ‘Junker’, and ‘Oesterreicher’ or ‘Sylvaner’) are large, thick-skinned, and well-flavoured, and hence this district is the centre of the ‘Cure’…good dessert-grapes may be procured almost everywhere on the Rhine, and the grape-cure may be undergone at Honnef, the Laubbach, Boppard, St. Goarshausen, Ruedesheim, Wiesbaden, Badenweiler, and numerous other summer resorts.

View towards the Marksburg, Rhineland-Palatinate. c.1890-1895
View towards the Marksburg, Rhineland-Palatinate. c.1890-1895

The Grape Cure, which was according to the Baedeker guide a “very popular Continental institution”, spread to America in an altered, more readily marketable form. In 1892, William Kelsey, the owner of a printing press in Connecticut, began marketing a patent remedy called ‘Dr. Baker’s Grape Cure’. He maintained that several “fat and jolly Germans” had discovered that eating nothing but grapes cleaned out their digestive system, made their liver healthy, and substantially improved their general health. The advertisement went on to claim that “our own Dr. Baker studied this wonderful medicine, and reduced it to an extract” which Kelsey sold for $1 a bottle. The formula contained water, fortified wine, glycerin, herbal extracts, and 80 grams of acetanilide (a pain remover), together with the “secret ingredient” so ubiquitous in quack medicines.

Kelsey is near-forgotten today, but the legacy of the Grape Cure’s most fervent advocate, Johanna Brandt, lives on. Johanna Brandt (1876-1964) was a South African propagandist of Afrikaner nationalism, spy during the Boer War, and writer on controversial health subjects. In her book, The Grape Cure (published 1928), she claimed that following a grape diet had managed to entirely cure her of stomach cancer. There is actually no evidence to suggest that she ever had cancer, let alone that she was cured of it by eating grapes. Doubtless hoping to boost her credibility, Brandt maintained that “books on this wonderful Nature Cure have been published in all the various languages of Europe” as far back as 1556. Her variant involved a strict regimen of fasting followed by a grape diet. For particularly weak patients grape juice could be used as a substitute, while for external cancers she recommended a grape poultice or a grape juice compress. Her explanation of the scientific workings of the cure is as follows:

The grape is highly antiseptic and a powerful solvent of inorganic matter deposits, fatty degeneration, morbid and malignant growths. It acts as a drastic eliminator of evil while building new tissue. Abnormal growths, cancers, tumors, ulcers, abscesses and fibrous masses seem to be dissolved by the powerful chemical agent in the grape. The secret of the Grape Cure in wasting diseases is to be found in the rich proteid supplied by the grape. Grapes are the most magnetic food, as every tendril of the grape is a living receiver of cosmic magnetism.

Johanna Brandt (1876-1964), advocate of the Grape Cure
Johanna Brandt (1876-1964), advocate of the Grape Cure

Brandt also maintained that the grape cure had demonstrated effectiveness against arthritis, diabetes, gallstones, cataracts, stomach ulcers, tuberculosis and syphilis; but it is its reputed effectiveness in curing cancer which has remained influential. It is not supported by any scientific evidence, yet a search for the Grape Cure on Google throws up a surprisingly large number of results. Brandt’s book is still selling on Amazon with a high proportion of 5 star reviews. The Grape Cure’s credibility is, however, rather undermined by the fact that it is frequently featured on sites with titles such as ‘Vibrational Healing’ and ‘MysticalPortal’.

Manlike monsters in medieval manuscripts

From Giovanni Boccaccio's book' De claris mulieribus'
From Giovanni Boccaccio’s book’ De claris mulieribus’


What exactly is a monster? According to the Oxford English Dictionary it is an ‘ugly or deformed person, animal or thing’. The narrator of the 14th century The Travels of Sir John Mandeville categorises a monster as ‘a thing deformed against kind, both of man or of beast’. Given society’s changing standards of beauty and ugliness, it’s interesting to see such similarity in definitions of the monstrous which are separated by over 600 years. Medieval manuscripts contain illustrations of all kinds of strange monsters, but the monsters I’ll be looking at in this post are the humanoid ones; that is, half-man, half-beast creatures. Illustrations of manlike monsters can appear in the most unusual places. Not only are they featured where they might be expected – in bestaries or books of travels – but they sometimes sneak into breviaries, books of hours and psalters.

Manlike monsters in medieval manuscripts take on many different forms. The main types are man-beast hybrids, those with too few human features and those with too many. A good example of the first type is the manticore. It was a creature of Persian legend which found its way into medieval bestiaries via Pliny’s Naturalis Historia (a text which seems to have been an important and apparently unquestioned source for medieval writers). Manticores were thought to have the body of a lion, a human head with three rows of sharp teeth, and a trumpet-like voice. They could have horns, wings, or both, and they would paralyse and kill their prey – which they devoured whole – by shooting out poisonous spines.

The second type of humanoid monster includes monopods and blemmyes. Monopods, dwarf-like creatures with a single foot extending from one leg centered in the middle of the body, were first mentioned in Aristophanes’ play The Birds (413 BC). Pliny reports that monopods have been spotted in India, a piece of (mis)information which might have derived from sightings of Indian sadhus, who sometimes meditate on one foot. The blemmyes are perhaps even stranger. Blemmyes were believed to be headless cannibals living in North Africa and the Middle East, whose eyes and mouths were located on their chests. The name comes from an ancient African tribe based in what is now Sudan; perhaps something about them or their dress made European travellers think that their heads were in their chests, although science fiction author Bruce Sterling writes about a Blemmye during the Crusades who turns out to be an extraterrestrial, so who knows…


A manticore, from the Rochester Bestiary
A manticore, from the Rochester Bestiary
A monopod, from the 1493 Nuremberg Chronicle
A monopod, from the 1493 Nuremberg Chronicle
A Blemmye, also from the Nuremberg Chronicle
A Blemmye, also from the Nuremberg Chronicle
So why this fascination with half-man, half-beast figures? For one thing, they were a way of interpreting the world and drawing allegories. They could be used as satire in order to portray common human faults; the first illustration in this post looks suspiciously like a parody of a group of courtiers. Yet I have a feeling that there was another reason that illustrators could, and would, draw such monstrous figures. In the medieval period, you would come face to face with disfigured people everyday; plague victims, lepers, children with birth deformities, and so on. Taking leprosy as an example, the effects were so horrible as to make people lose almost all semblance of humanity. It progressed very slowly, over a matter of years. As time went on, you would typically lose sensation in your hands and feet, your body hair would fall out, the bridge of your nose would collapse, throat ulcers would leave you incapable of doing much much than croaking, you would develop ulcerations and nodules all over your body, and you would eventually become blind.


Modern medical descriptions of leprosy symptoms are very bland; your fingers and toes falling off becomes ‘loss of digits’, and they hurriedly go on to say that if treated soon enough, antibiotics can cure the leprous infection very effectively. Obviously this is because they don’t want sufferers to panic, which is a laudable aim. Yet in the medieval era, leprosy was doubly terrifying because there was no sure explanation and no treatment. Because of this, it doesn’t make sense to think of medieval leprosy in a sanitised way. It was a horrible disease and you were almost certainly condemned to lonely exile when people found out that you had it. The Third Lateran Council of 1179 decreed that lepers must shroud themselves in a cloak and ring a bell wherever they went, so that people knew not to come near them. Perhaps it wasn’t such a huge jump from witnessing ill and horribly disfigured people to imagining the manlike monsters which people medieval manuscripts.
Smallpox victims
Smallpox victims
Monstrous births depicted in the Nuremberg Chronicle
Monstrous births depicted in the Nuremberg Chronicle
Today, Western society has a horror of anything which does not live up to the perfect physical ideal, or at least to the ‘acceptable’ norm. Partly because disfiguring diseases have become much more rare in our society, we set an impossible standard of physical perfection, and disfigurements are shunted away into dark corners where they can’t offend anyone. Although medieval ladies worried about cosmetics and hair dye just like women now, I think that they would have had a much better sense of perspective than today, where shamelessly gendered advertisements act as if nothing worse can happen to a woman than getting wrinkles or cellulite.


Our post-Enlightenment society is also unwilling to believe in the possibility of manlike monsters. We’ve trivialised these figures. In C.S. Lewis’ The Voyage of the Dawn Treader, Lucy’s reaction to the Dufflepuds (a race of monopods) is to simply exclaim ‘oh, the funnies!’. Centaurs have become largely nonthreatening mainstays of childrens’ fiction, and the mermaid has turned from the traditional image of a fatally attractive siren into the cheerful subject of sugary Disney films. I don’t believe that medieval manuscript illustrators were drawing for children, and this brings us to the eternally popular view of ‘gosh, weren’t those medieval people crazy?!? How did they believe in such weird things?!?’. This is an unproductive approach to history, particularly to medieval history. We can’t hope to even begin to understand the past if we don’t make an effort to lay aside our own prejudices.
Whatever the motivations and beliefs behind them, medieval depictions of manlike monsters are fascinating to look at. We have room enough to marvel at their creativity and comicality (no one could accuse medieval people of lacking a sense of humour!) without having to make negative judgements about the illustrators and their readers.