Tuesday, April 5, 2011

The Agony of Age

I haven't written for a while, mostly because my 87-year-old mother, who suffers from dementia and cataracts, has broken her right leg for the second time in four months and is now recovering from major surgery. All of which has led me to think about (among other things) the indignities and unpleasantnesses of hospitalization, then and now.

By "then" I mean, of course, about 200 years ago -- the late 18th and early 19th centuries, the period I researched for my first novel, A More Obedient Wife, and that I'm currently researching for my novel-in-progress. Because one of the characters in the current novel (based on a real historical figure) is a doctor, I've been reading up on the history of medicine.

As with so many things about the past, the more you know about medicine back then, the luckier you feel to be alive now. Sure, things go wrong in modern hospitals: no one tells you the doctor you've been waiting for for two hours has decided not to come after all; the nurse takes forever to answer an urgent call for help; what seems like a steady stream of people invade your room and ask you the same questions over and over again. Even my mother, who has trouble remembering what happened five minutes ago, can tell that she's been asked these same question many times before -- and to show her annoyance she often refuses to answer, which doesn't help matters any.

But at least she doesn't lose all access to food the next day, which is what might have happened to an uncooperative patient in the 18th century. According to a book on 18th-century medicine, appropriately entitled The Age of Agony, patients at London's Guy's Hospital who engaged in cursing or swearing, or were "found guilty of any Indecency, or commit any Nuisance," were to lose "their next Day's Diet."

Not that their "next Day's Diet" was liable to be all that enticing. My mother has a menu of food choices from "room service" that she finds overwhelming -- or would find overwhelming if she could see well enough to read it. Maybe the hospital kitchen wouldn't win any stars from Michelin, but at least there's more variety than was to be found at St. Bartholomew's Hospital in London, where the menu was restricted to bread, boiled beef, "milk pottage," and beef broth. On the other hand, each patient also received a daily allotment of a pint of "Ale Cawdle" at night and three pints of beer. That might have made things a little more tolerable. Nevertheless, patients at Guy's and other hospitals routinely slipped out to nearby "Publick-Houses" and "Brandy Shops" and came back to the wards drunk. As a result of which they forfeited "their next Day's Diet," which was apparently an all-purpose disciplinary measure.

You can kind of understand the patients slipping away to get drunk when you consider that there wasn't much for them to do in the hospital. No TV, certainly, which is the only thing that seems to keep my mother's mind off her pain and relieve her of her general disorientation (she always finds comfort in the world of Turner Classic Movies). In some hospitals there was group Bible-reading on Sunday evenings, led by "some sober Person in each Ward" (assuming, I suppose, they could find one), but not much else in the way of entertainment. Patients at Guy's who were able-bodied were kept busy taking care of the weaker patients and helping to clean the wards and fetch coals. If they shirked those duties -- well, you can probably guess the punishment. But for a second offense they would actually be discharged from the hospital.

Not to mention that there was very little the hospital could do for you, other than warehouse and feed you. In fact, a hospital was likely to make you even sicker than you were when you came in, given that -- before the advent of germ theory -- you would be kept in close proximity to all sorts of pathogenic organisms harbored by your fellow patients. Other drawbacks included the noxious smells from the lack of sanitation and the intense discomfort due to infestations of lice. In 1765 a surgeon at Guy's remarked that in London hospitals "bugs are frequently a greater evil to the patient than the malady for which he seeks an hospital." No wonder hospitals were reserved for the poor. Wealthy invalids preferred to do their suffering at home.

I suppose all of this should make me feel much more appreciative of the modern comforts and conveniences at my mother's disposal. But it's a sad truth that no matter how much we understand, on an intellectual level, that we're really a lot better off than many others -- including those who lived in the past -- it's our present distress that looms larger in our consciousness. Should I tell my mother she should feel lucky that her hospital bed isn't full of lice -- or that she has a private toilet, even though at the moment there's no way she can get to it? It would probably only add to her general confusion.

The truth is, two hundred years ago my mother and many of the other elderly inmates of the rehabilitation facility where she is currently housed wouldn't have lived long enough to suffer the ailments of old age. Their lives would have ended before their bones grew so brittle and their eyes so dim. We can thank modern medicine for that. And sometimes, I suppose, we can also curse it.

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