A long-term illness and what they would call it during the Regency era

One of the reasons why tuberculosis is so overused was because of the Victorians themselves---

By the mid-1800s, tuberculosis had reached epidemic levels in Europe and the United States. The disease, now known to be infectious, attacks the lungs and damages other organs. Before the advent of antibiotics, its victims slowly wasted away, becoming pale and thin before finally dying of what was then known as consumption.

The Victorians romanticized the disease and the effects it caused in the gradual build to death. For decades, many beauty standards emulated or highlighted these effects. And as scientists gained greater understanding of the disease and how it was spread, the disease continued to keep its hold on fashion.


“Between 1780 and 1850, there is an increasing aestheticization of tuberculosis that becomes entwined with feminine beauty,” says Carolyn Day, an assistant professor of history at Furman University in South Carolina and author of the forthcoming book Consumptive Chic: A History of Fashion, Beauty and Disease, which explores how tuberculosis impacted early 19th century British fashion and perceptions of beauty.


During that time, consumption was thought to be caused by hereditary susceptibility and miasmas, or “bad airs,” in the environment. Among the upper class, one of the ways people judged a woman’s predisposition to tuberculosis was by her attractiveness, Days says. “That’s because tuberculosis enhances those things that are already established as beautiful in women,” she explains, such as the thinness and pale skin that result from weight loss and the lack of appetite caused by the disease.

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So, obviously a 50yo man would be less likely to be as romantic a tuberculosis patient as an 18yo girl--- gout was more of the stereotypical default chronic illness for older men--- but just being a man wouldn't keep him from catching it.

Out of curiosity, is a poisoning subplot not an option?

Hmmm, his fifties would be too early for some type of dementia, but what about accidental poisoning like lead or mercury? Both were in very common use at the time for paint, cosmetics, serving dishes, hat blocking (mad as a hatter), etc. Do you want his condition to be reversible?

Gout was also fairly common, caused people to have to sit, but I don't know if that caused the cognitive issues you mention. As well, anemia of some sort could cause some of the symptoms, but I don't know if all. I also think some STIs (gonorrhea, syphilis) could be pretty nasty if untreated, as it would have been at the time.

It's interesting, because gout (a form of arthritis) has a lower risk of Alzheimer's, but has a 17-20% increased risk of dementia.

Parkinson's was named after James Parkinson for his 1817 essay-- he called it "paralysis agitans" and the essay was titled "An Essay on the Shaking Palsy." I don't know how much cognitive impairment comes with it--- it's generally mild, with an emphasis on decline of the motor skills, but it's something to consider.

Strokes were called "apoplexy". 30% of stroke victims develop dementia within a year of their stroke, but it can also affect memory/attention/linguistics/etc.

Gout is long term and requires sitting about but it tends to come and go, and he wouldn't be chair- or bed-ridden all the time.

Do you want him to recover? He could have a stroke and the doctor wants him to go to an asylum. That's expensive.

As lonestarlibrarian said, consumption is so common because it was so common. It killed more people in Britain in the 19th century than measles, smallpox, typhus, whooping cough, and scarlet fever combined.

Palsy could be caused by all sorts of diseases from Parkinson's to muscular dystrophy, The doctor could be urging a stay in Bath for a cure. (Same with rheumatism.)

It could be cancer with the doctor urging an expensive operation and recovery period.

If you search for articles on Regency era medicine, that should lead you to some books that will give you leads to more books. For example this one.

Do you want him to get better?

Heart issues, perhaps as a result of a past bout with rheumatic fever, might be worth looking at. I'm pretty sure that was a known thing at the time.

rosehips said:

Adding poison would overly complicate the plot, plus there's no one with a motive to poison this particular guy (another guy, maybe...).

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Not saying poison would work for your manuscript, but there's a long and varied history of *accidental* poisonings. e.g. Lead poisoning due to everything from alcohol production techniques to paints. And in the Victorian era there was arsenic everywhere.

I suppose secret alcoholism would be out of the question? If he used to be more careful, it might have slid by un-noticed. After all, he's a man in his fifties, he has a drink now and then. Only he admits one drink and is actually having half a dozen.

Mercury was definitely part of the Regency-era pharmacopeia. It was most frequently prescribed for syphilis, but it might be a component of many other medicinal compounds & patent medicines. As might any number of other potentially toxic or noxious ingredients, including antimony and lead. In addition, the more foul-tasting a medicine, the more efficacious it was assumed to be, so nasty things might be added to an otherwise banal mixture because the patients expect value for their money.

A couple of terms to start further research: "blue pills" and "black draughts." Both very common medicines in the early 19c.

Another thought: if your man has any touch of the hypochondriac, it would have been very easy to lower himself into actual illness by overdoing the purging and bleeding -- both standard medical treatments, often indulged in prophylactically by the well-to-do who considered their health delicate, and easy to overdo if the patient is insistent, or resorts to multiple doctors when one doesn't give him enough medicine for his liking.

(Have you read the Aubrey-Maturin series by Patrick O'Brian? They are extremely well-researched novels set in your period, primarily at sea but not always, and one of the main characters, Dr. Maturin, is a learned and well-respected physician who treats his patients according to the standard of care of the day -- no anachronistic modern attitudes or cures here.)

Another vote to stay away from anachronistic attitudes. If you want to make it clear to the reader what's going on, that's perfectly cool--- but to give yourself a character in 1820 who's 50-100-200 years ahead of his time--- I find those books difficult to read, because if you're going to write a time period, take it for the good and the bad and for what it was.

A lot of medical advances happened after the American Civil War, and again, after WWI and WWII. But if you remember your US Civil War history, back then, doctors in general didn't worry about being sanitary or hygienic, because it showed what important, busy people they were... not realizing that they were carrying infection and contamination to every person they interacted with... and those attitudes were still 20-40 years in the future from where you are. At the same time, there were other doctors who did understand that santiation and hygiene were important, even if they didn't understand exactly why. Their mortality rates reflected their practices, but it wasn't systematic, if that makes sense? You washed your hands because you were taught by a guy who told you it would benefit your patients if you kept clean, and you didn't wash your hands if you were taught by a guy who took pride in dirty = busy. But that's just an example of something as basic as handwashing being controversial for a period of time--- let alone "oh, everyone knows you don't eat mercury." Dental amalgam (which uses mercury as an ingredient) was invented in 1819. In 2020, there are people with it in their mouths, and whether it's harmful or not is controversial is still debated... it's safe for your mouth, but if you want to dispose of it, it gets treated as toxic waste.

That's not to say that the doctors of your era are totally medieval. And even cavemen could successfully do brain surgery/trepanning. But Regency medicine is going to be its own field of research--- surgeons =/= general practitioners =/= apothecaries, country doctors =/= fashionable doctors =/= consulting physicians, and so on. And a physician who's tending to his patients in 1820 might have had a vastly different education if he had only been licensed to practice starting in 1818, vs if he had been practicing for 50 years. Not necessarily a better education--- a lot of their success depended upon experience and "common knowledge" that got passed around--- but there was an important Act of Parliament that was passed in 1815 that touched on requirements for would-be physicians, apothecaries, and other medical students.

I usually write Victorian period stuff, but I really enjoy reading things published during my time period so I know that real-life Dr. X is recommending a diet of alcohol-and-opioids for situation Y, or that in the case of Ailment Z, Dr. A has found good results prescribing rest and country air. See what you can find, written within your time period, give or take 5-10 years, and use that approach for a model.

But yeah, I'd probably avoid having a magically astute doctor. Instead, you might research how long it takes to recover from the toxicity of (ingredient), and have something happen to his medicine so that he's accidentally off of it for a period of time, and discover that he feels infinitely better without it than he did with it, even in light of whatever it was supposed to be curing. (Mercury is probably a little toooooo slow to release from the body to be part of a snappy timeline.)

Would not necessarily need to be the assistant, just someone who was a friend of the doctor and talked to him a lot at the time of the poisoning.

If the details of the father's illness aren't really material to your story, it may not be necessary for you to bog yourself down in them. This was an era, after all, when a large number of people suffered from very vaguely-defined illness, of short or long duration, and conditions were generally seen & addressed in terms of symptoms, not a deep investigation of root causes. Diseases were defined by their symptoms, in fact (with the effect that conditions that had similar presentation but different causes were lumped together under one name, with a common treatment, while diseases that might have different presentations at different times or in different individuals were considered to be different from each other, even though they have since turned out to be aspects of a single thing.) Trying to nail down a particular clinical diagnosis for your man's malaise is an anachronistically modern approach! And also a writer's rabbit-hole. Lots & lots of yummy research to lose yourself in till you forget why you started...

Naval ships mostly didn't have actual doctors, they had surgeons. (O'Brian's Dr. Maturin is a highly anomalous exception, as the books make clear.) And often not highly-educated ones either (nor well-paid), though in practice the good ones had keen observational skills and learned by experience how to handle all sorts of injuries and ailments on a ship. The assistants to the surgeon (or doctor) were there to do things like hold the patient down while the surgeon amputated their limbs, clean up the blood, sharpen the tools, grind the powders, change the dressings... they were servants or at best apprentices to a manual trade, not gentlemen, and would not have been hanging around with officers. "Surgeon's mate" was a recognized function in the crew. "Loblolly boy" was too, somewhat lower in the pecking order -- if the surgeon died or was incapacitated, a surgeon's mate was expected to step up and do the job, but a loblolly boy just did the scut work.

I'll also point out that mercury was a completely normal part of medical treatments at the time, and the elemental mercury involved in the Triumph incident was not what would generally be found in medicinal use. Only a crackpot would be arguing against a routine use of mercury on that basis, and nobody would pay attention to them (especially before the report was even published).