In November, Sheelagh James visited us once again to give one of her lively talks. This time she introduced us to the horrors of 18th century medical practice.

Next time you feel like moaning about the treatment available at your local NHS Accident and Emergency Department, consider this: how would you feel about the application of a hot iron to your shaved head as a means of reviving you? Would you fancy being given a smoke enema? Perhaps you would like to be wrapped in a sheep's entrails. All these practices featured amongst the range of emergency options to which your 18th century physician might resort.

Bloodletting too was very popular and was practised on many occasions. It might, for example, be used to reduce fever. A certain Dr Mead claimed it valuable in the treatment for rabies. His prescription involved repeated river immersion and bloodletting. He claimed that this procedure saved hundreds of lives, though we have only his assertion to rely on!

At this period many doctors still tended to believe in the concept of the Four Humours (which were identified as phlegm, blood, yellow bile, and black bile). These were thought to determine a person's temperament, and it was believed that an imbalance between them could lead to sickness. Many of the approaches followed by doctors were, therefore, aimed at addressing the causes of such imbalance, with a view to restoring equilibrium. Emetics and other means of purging were often employed with this object in mind.

Another theory still prevalent at this time was the notion of a "miasma", or noxious bad air, which it was thought would cause diseases. The disadvantage which could sometimes follow from this idea was a reluctance to open windows to admit what might be some much-needed fresh air into the sickroom.

During this period, some potentially lethal substances were often being tried to address serious ills, arsenic and mercury being just two. Venereal diseases were then very common, and people were desperate to find remedies to combat these.

Sadly, physicians prescribing a drug had no concept of how to judge a suitable dose and were frequently reckless in the quantities they administered. Laudanum (a tincture of opium) was often given, even to babies! Of course, it had its uses for painkilling and aiding sleep, but many people will have become addicted to it.

In addition to various what we now regard as peculiar ideas, the 18th century did, however, see the gradual emergence of some significant medical advances. If there was one which has provided a profound long-term benefit, that must be vaccination/inoculation.

Smallpox was a scourge in the 18th century. It killed many, and those that survived were usually disfigured by it. Dr Samuel Johnson was one of the many to suffer this scarring.

Lady Mary Wortley Montagu, travelling in Turkey, became aware of the Turkish habit of deliberately introducing their youngsters to the variola virus. The result was that they experienced a mild form of the smallpox disease and consequently thereafter had a long-term immunity to smallpox. Lady Mary immunised her own child and brought the knowledge back to England. Once King George III's wife Queen Charlotte had had her children undergo the "variolation" procedure, numerous other members of the gentry followed suit, setting a fashion. It was not a process without risks (two of the Queen's own children died), but many people were successfully inoculated and owed their lives to the procedure.

The term "variolation" applies only to giving protection against smallpox. Subsequently, other vaccination processes were refined, so that people ceased to risk death. The ultimate result is that smallpox is now deemed to have been eradicated worldwide. Numerous other types of disease have been also subjected to vaccination processes.

On the lighter side, variolation led to some notable cartoons by Gilray. It had been noticed that milkmaids who caught cowpox tended to escape the more lethal disease of smallpox. So, when variolation became popular, the cartoonist could not resist the urge to draw portions of cows emerging from the arms or other body parts of those who had been variolated. No doubt some foolish souls took those pictures seriously!

Based on notes provided by the speaker