William Buchan’s Domestic Medicine, or the Family Physician was first published in 1769, and for more than a century its various revised and updated editions were the medicinal bible of the British household.
Buchan (1729–1805) took the view that the physician’s job was as much about keeping people in health, by encouraging what he calls regimen and we would now call a healthy lifestyle, as about dishing out medicines. As he says in the ‘advertisement’ to the first edition: ‘regimen seems to have been the chief, if not the only medicine of the more early ages, and, to say the truth, it is the most valuable part of medicine still’.
He also criticises the medical men of his time who want to keep knowledge of diseases and cures as ‘professional secrets’ from which they can profit, firstly because ‘Had physicians never affected mystery, quacks and quackery could never have existed’; as it is, ‘they have over-run all Europe’. Furthermore, ‘No art ever arrived at any considerable degree of improvement so long as it was kept in the hands of a few… The interested views of a trade will always obstruct the progress of a science.’
‘There is no doubt but the more mercenary part of the Faculty, whose ideas of medicine never rise above the sordid views of a trade, will do all in their power to discredit’ publications like his book. On the other hand, Buchan does not suggest that everyone can be their own physician: ‘But where something must be done, and no medical assistance can be had, it is certainly better to direct people what they ought to do than to leave them to blunder on in the dark.’
The first section of Domestic Medicine deals with the care and rearing of children. Buchan is indignant at the fashion for upper-class women to hand over their new-born children to wet-nurses, and then to leave their upbringing to household staff, but, interestingly, pours equal scorn on their husbands, who are perfectly happy taking charge of the raising of their young horses and hounds, but take no notice at all of the upbringing of their own children.
Buchan provides a succinct summary of his lengthy arguments for children’s welfare in 25 points, ‘as many people can understand the meaning of a short rule, who are not able to attend to a chain of reasoning’. He emphasises simple, non-sugary foods, loose clothing, cleanliness, lots of outdoor exercise, and not sending children to school too early: all remarkably ‘modern’ …
The ‘science’ on which Buchan’s advice is based – that the four humours in the body must be kept in balance, and imbalance leads to ill-health – is straightforwardly wrong; and some of his specific beliefs (for example that illness strikes through the soles of the feet – something, incidentally, which my grandmother always used to say) now seem quaint. But no twenty-first century physician would disagree with his proposed regimen for healthy adults. Plenty of vegetables, plenty of exercise in fresh air (‘golff’ is recommended as a good exercise, but has to be explained in a footnote), frequent breaks from sedentary occupations, sensible amounts of sleep, keeping yourself clean and avoiding excessive amount of meat and strong liquors – all sound advice.
The second half of the book is concerned with the treatment of illnesses. A great deal of attention is paid to the different kinds of fevers, and their appropriate treatments, among which ‘Peruvian’ or ‘jesuits’ bark’ (quinine) is prominent. For consumption, removal to a warmer, drier climate, drinking lots of asses’ milk and horse-riding are recommended – an option not available to the majority of sufferers. For smallpox, he describes in great and gruesome detail the care of both children and adults, but also argues strongly in favour of inoculation, which he believes would be more widespread if it was not kept in the hands of physicians: he gives various suggestions for do-it-yourself vaccination.
Other medicines carry less conviction: crushed woodlice infused in a pint of white wine for the chin-cough (whooping-cough), while to ease the coughing while the woodlice take effect, ‘a little of the syrup of poppies’ is recommended. For heartburn (in which I personally am currently interested), good old milk of magnesia (can one still get it?) is recommended, but also two or three cups of camomile tea a day, with 15-20 drops of elixir of vitriol in them: the latter is sulphuric acid, mixed with alcohol and ginger or cinnamon…
Mental illnesses, including nightmares, melancholy and madness, are dealt with: Buchan’s suggestions are anti-restraint and coercion, and in favour of a gentle regime of lots of vegetables, soothing music, and conversation – a pre-Freudian talking cure. There are separate sections at the end of the book on women’s problems (pregnancy, childbirth and barrenness) and specific illnesses of children, including thrush and teething. Finally, a short section deals with events likely to need surgery, from wounds, dislocation and breakage of bones to ‘ruptures’. Here, inevitably, the amount that can be done in a domestic setting, but there is advice for ‘bonesetters’ and also on aftercare.
In over six hundred pages, Buchan gives clear and simple advice for those trying to deal with the multiple health hazards of an age with contaminated water, inadequate sewage and no grasp of the importance of either personal or community hygiene. The striking elements of his work are his initial common-sense emphasis on maintaining health, and the similar emphasis on maximising the comfort of the patient during treatment. Our image of illness and disease in the eighteenth century is usually a distressing one of pain and suffering often followed by death, but having the thoughtful and compassionate Dr Buchan appear at one’s bedside must have been a great reassurance.