The Quack Doctor has moved!

Happy new year! This blog started on 1 Jan 2009, and has developed much more than I really expected, so the time has come to move away from WordPress.com to a self-hosted site.

The new URL is:

http://thequackdoctor.com

If you are one of the many bloggers who has been kind enough to include me in your blogroll, I’d be really grateful if you updated your link. For subscribers, the new RSS feed is http://thequackdoctor.com/index.php/feed/rss/ or you can sign up on the site by clicking the button at the top of the sidebar.

I started The Quack Doctor as a way of collecting historical medical advertisements for my own interest, but am very pleased that the blog has built up a few regular readers. I hope you will accompany me to the new site and continue reading. I’m planning to add lots more material and some new features during the coming year.

Caroline

Make-Man Tablets

Make-Man Tablets

Do You Want A Vacation?
It’s Make-Man Tablets You Need.
Fifty Cents Worth of Make-Man Tablets Often Do More For A Man or Woman Than a Three Hundred Dollar Vacation.
Do you feel played out—nervous, tired, irritable, don’t sleep good, wake up every morning with a bad taste in your mouth and a dull, hot, tired feeling in your head? Of course a vacation seems just the thing—but it cannot reach the seat of your trouble.
It’s your nerves nine times out of ten that make your back ache. It’s your nerves that give you that dull, dumb headache. Your muscles are just as strong as ever, but the nerves are off tune.
They need feeding—rest is no good for them. There is some constituent—nerve constituent—the blood lacks, and Make-Man supply it.
Men and Women who have let their nerves go so long without feeding that they are pale, listless creatures, instead of strong, lively, full of vim and energy for the day’s work, have found quick results in the use of this splendid tonic, blood purifer and nerve strengthener.
Manus Bonner, 33 W. Market St., Pittsburg, believes he has found something better than a vacation:—“Since I began to take Make-Man Tablets I feel better and stronger. I have gained five pounds in weight and otherwise feel fine.”
Man-Made Tablets will make you well. You can try a 50 cent box, free, by writing—today—to the Make-Man Tablet Co. 145 Make-Man Building, Chicago, Ill. If you are already convinced that Make-Man Tablets are what you need, you can obtain them from your druggist at 50 cents a box, with money back if not satisfied.

Source: The Pittsburgh Press 14 Sept 1910

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Any woman whose cheapskate husband refused to go on holiday in favour of taking these pills would have the last laugh – the main ingredients were arsenic and strychnine.

The Make-Man tablets were an early casualty of the US Food and Drug Act. In 1910 the government seized a consignment of 360 tins, and analysis showed the presence of the poisons together with aloes, potassium sulphate, iron carbonate and iron oxide. The product was judged to be misbranded and the company was fined, but they reformulated the tablets to contain quinine and iron, and continued to promote them until at least the mid-1930s, when they were still only 50 cents a box.

Make-Man Tablets 1929

Detail from 1929 ad

1 Jan 2010 will be The Quack Doctor’s first birthday, and to celebrate I’m going to relaunch it using WordPress.org with a new design and domain name. It will therefore go a bit quiet for the next few days while I finish setting up the new site. Happy new year, see you on 1 Jan, and remember…

Headline from Make-Man ad, 1920

Headline from Make-Man ad, 1920

A Poem on Christmas Day

From the Gentleman’s Magazine, December 1766:

CHRISTMAS DAY.
Welcome, thrice welcome Christmas day !
Let’s eat, drink, dance, and sing away:
Old England ne’er had stronger reason
To welcome in this joyful season !
Mark high and low, and all around us
And know the blessings that surround us.
Let ’em in all their pomp appear;
Sure omens of a happy year !
First, turn your eyes upon the great ;
When did such virtues rule the state ?
The country has their whole attention,
Without a thought of place or pension.
Of parts, and pow’r, no prostitution,
Of liberty, no diminution ;
Sound as a roach our constitution
Which florid grown, by over feeding,
Is now quite cool with frequent bleeding :
Great Lawyers, with our good at heart,
Now every day new doctrines start.
For freedom and for Magna Chart,
Our clergy too, all int’rest scorning,
Are teaching, preaching, night and morning ;
T o keep their flocks secure at home,
And guard them from the wolves of Rome:
So by their zeal, which never ceases.
The growth of popery decreases.
Physicians now cure each disease,
They take great pains, and little fees.
Nothing but learning, parts, and knowledge,
Can give a passport to the college :
No poison’s sold for nerves or vapours,
No quacking nostrums fill the papers—
These are the gifts the great have sent ye,
For all is concord, peace, and plenty.
The poor, as fat as brawn, we meet ,
Eating minc’d pyes along the street
No Harlots to be seen, not one,
Not ev’n the Whore of Babylon !
These times are sung by great and small
‘Tis merry Christmas for us all;
And certain ’tis, by what is past,
That the new year will match the last.

The Etherial Oil of Mustard for the Gout

Source: London Evening Post, December 27, 1755

The Dr Linden of the advert is Diederick Wessel Linden, a physician from Westphalia who came to Britain in 1747 and settled in Flintshire. Better known for his writings about spa waters, and for featuring in an amusingly earthy scene in Smollett’s Humphry Clinker, he deserves a post of his own at some point, so today I’m just going to do a round-up of a few unusual remedies for gout.

The Gout, James Gillray, 1799

The Gout, James Gillray, 1799

Should you be planning to ‘indulge in rich meats and sauces, racy wines, strong beer and cyder, and use but little exercise’ this Christmas, it might be worth keeping some of the following treatments handy:

In 1680, Sir William Temple, Bart, had published his experiments with the ancient Eastern practice of moxibustion (applying a small quantity of mugwort to the skin and setting it alight). This was still in print at the time of the above ad, though more as an historical curiosity than a source of advice:

Upon the first burning, I found the skin shrink all round the place ; and whether the greater pain of the fire had taken away the sense of a smaller or no, I could not tell ; but I thought it less than it was: I burnt it the second time, and upon it observed the skin about it to shrink, and the swelling to flat yet more than at first.

On the third burning, he was able to set his foot down without pain, but tended the burns by applying a clove of garlic and a Diapalma plaster. Temple also recounted some interesting remedies he had heard about on his travels, such as that recommended by Prince Maurice of Nassau:

…to boil a good quantity of horse-dung from a stone horse of the Hermelinne colour, as he called it in French, which is a native white, with a sort of a raw nose, and the same commonly about the eyes : that, when this was well boiled in water, he set his leg in a pail-full of it, as hot as he could well endure it, renewing it as it grew cool for above an hour together ; that, after it, he drew his leg immediately into a warm bed, to continue the perspiration as long as he could, and never failed of being cured.

A surgeon in Lorrain, meanwhile,

had undertaken to cure it by a more extraordinary way than any of these, which was by whipping the naked part with a great rod of nettles till it grew all over blistered;

(An alternative to nettles was holly – is that what’s happening to the Jolly Huntsman in the gallery?)

Origin of the Gout, Henry William Bunbury

Origin of the Gout, Henry William Bunbury, 1815 print, courtesy of the National Library of Medicine Image Gallery

In the mid 18th century, one of the free books given away by Mr Burchell of Anodyne Necklace and Sugar Plums for Worms fame intriguingly offered:

‘The Easy Way of Curing the GOUT, by Transplantation: that is, By giving it to some Good-for-Nothing DOG, or CAT, and thereby Freeing the Person from it.’

(Transplantation didn’t mean anything surgical, you just had to get the dog or cat to lie on your feet.)

A poetical correspondent to The Morning Post and Daily Advertiser on Christmas Day 1786, however, put forward a different view. Though beginning with an agonised ‘Hence, loathed Gout! most dreaded fiend to Ease,’ he weighed up the pros and cons of the lifestyle that had led to his condition, and concluded:

But what is life, without or love or wine,
Without the orgies of the mystic bowl?
Let moralists their mental joys define,
But sweeter far the midnight flow of soul.
Gout! Then attack – I’ll brave thy greatest ill,
And fall, like valiant BEVILL, on the topmost hill.

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Wishing you all a very happy and gout-free Christmas!


Dr Carter Moffat’s Ammoniaphone

Dr Carter Moffat's Ammoniaphone

Source: The Graphic, Sat 25 October 1896

The format of this one makes it a bit tricky to type out, but if you click on the advert, you should then be able to zoom in and read it. The Ammoniaphone was an instrument designed to help singers and public speakers improve the quality of their voice. It also claimed to cure consumption and other lung problems.

It consisted of a slender metal tube 25 inches in length, with decorated handles and a push-button valve on each end. As well as the picture below left, you can see a photo courtesy of the Science Museum, here. The instructions for use were as follows:

Unscrew the centre cap or nozzle two turns. Take hold of the Ammoniaphone, press the end valves, bend forward, place the lips tightly over the centre cap, and inhale very slowly but deeply.

Within the tube was a wick-like material soaked with hydrogen peroxide, ammonia and peppermint oil. The ingredients don’t sound very appealing, but the inventor, Dr R. Carter Moffat, described the vapour much more romantically as ‘Italianised Air.’

Italy was a destination for consumptives seeking a warm climate, but not only that – it also produced excellent tenors. While visiting the country, Carter Moffat (who was an eminent Scottish chemist, certainly no amateur enthusiast) had analysed the air and found the presence of free ammonia and peroxide of hydrogen – a combination he believed was unique to Italy and therefore likely to be responsible for the inhabitants’ operatic ability.

Shortly after its introduction, the rights to the Ammoniaphone were bought for £2000 in shares by the Medical Battery Company, run by Cornelius Bennett Harness. Dr Carter Moffat stayed closely involved, giving promotional lectures about his invention. The product was well-received by the press.

Not everyone, however, was convinced. In the Ladies’ Column of the Bristol Mercury (written ‘by one of themselves’), the correspondent described a musical evening where the Ammoniaphone was the object of much interest:

Several guests present took long whiffs from the ammoniaphone, but I discovered no obvious change in their tone or compass of voice. I suppose the experiment has to be frequently tried to produce any effect. I remarked that if the inhalation of free ammonia and peroxide of hydrogen is so good for the voice, it seemed scarcely necessary to enclose these ingredients in an expensive flute-like case to test their powers, and the fact of doing so and calling the vapour they give off “artificial Italian air” savours to me of quackery.

The manufacturers would have agreed that results only came from regular use. The instruction manual advised taking two inhalations a day and then doing vocal exercises – the voice would be ‘permanently improved in every way after one year’s use of the Ammoniaphone.’

The company’s promotional activities included commissioning an Ammoniaphone song – very apt, considering the target market. It told of the plight of a young man who wanted to propose to his sweetheart but lost his voice.

Ah! well for him and for the fair,
He’d heard that pure Italian air
Might be inhal’d, imparting tone,
Through Moffat’s famed “Ammoniaphone”

In the early 1890s a pocket version of the inhaler was introduced, but this was short-lived. The Medical Battery Company, whose main products were electro-magnetic belts, went bust in 1893 after getting into trouble with the courts for fraudulent claims. That, however, is a story for another post.

The Cordial Balm of Rakasiri – part 2

For part 1 of this article, click here. There’s also a transcript of an 1818 Rakasiri advert here.

In 1828, a ‘nervous young man’ who had wasted more than 10l. on the Cordial Balm of Rakasiri went to a magistrate and succeeded in getting his money back. During the proceedings, the Balm’s proprietors, Charles and John Jordan, threatened to make it public that he had venereal disease, but he stuck to his guns and they backed down, claiming that they were returning the money out of respect for the man’s character and not because they were guilty.

Shortly afterwards, a well-to-do young woman, Miss May, consulted them for asthma and ended up 15l. worse off, some of which amount she had to borrow from her sister. Finding her breathing worse and the fiery medicine affecting her stomach, (as mentioned in the previous post, it was highly concentrated alcohol) she heard about the young man’s success and also asked for her money back. The Times reported in early 1829 that

To this, the “doctors” answered, that if Miss May attempted to take any such step as that young man had taken, that they would disclose the real nature of the complaint she was labouring under to her friends, which would ruin her character.

Far from being horrified into silence, Miss May said her friends knew very well she had a cough arising from asthma, and they would now also know “the threat that you have dared to utter.” She got her lawyer, Thomas Cox, on the case and went to the same magistrate who had ordered the young man’s refund. He told her to apply to the Middlesex Sessions for a bill of indictment for fraud. This was refused and the Jordans’ lawyer, Mr Adolphus, published a notice in the Morning Chronicle titled “Base and Malicious Charge of Fraud Refuted,” which referred to Miss May and Mr Cox as ‘infamous calumniators’ and said:

Who ever heard of a person making a purchase, using the article so purchased and then, forsooth, demanding their money back, much less make a charge of fraud against the tradesman so refusing? The attempted fraud was on their own side, and a gross attempt it was.

The doctors challenged Miss May and her lawyer to repeat their accusations, at which Cox wrote to them – a letter that was printed in the Chronicle – inviting them to meet him and his client before the magistrate for that very purpose. The Jordans said they would only respond if summoned by the magistrate himself, and didn’t turn up. “Was it not monstrous,” Mr Cox said,

that such imposters as these men, who were literally a pest in society, and the direct enemies of the human race, should be rolling in their carriages and wallowing in wealth, while men of high education, who had laboriously, and at great expense, studied their profession and made themselves masters of medical knowledge, were living, in many instances, in obscurity, and scarcely able to supply the means of living respectably.

The more cynical among us might be tempted to say welcome to real life, Mr Cox, but as the doctors realised that Miss May was really going to start court proceedings for libel, they got nervous. (‘Notwithstanding the anti-nervous powers of their medicine,’ commented the Monthly Gazette of Health.) They settled out of court, refunding Miss May’s money, paying her legal expenses and giving her £100 compensation. They also agreed to publish a notice in the papers saying that their previous statements were without foundation.

It would be nice to finish with the Gazette‘s conclusion:

To Miss May, for her heroic conduct, and Mr. Cox, her solicitor, for the firmness with which he conducted the proceedings, the thanks of the public are due. They have completely knocked up the Balsam of Rakasira (sic) trade, than which a more infamous traffic has not been carried on in the most barbarous country.

But we all know real life ain’t like that, and this was not the end of the Jordans’ Rakasiri racket. They continued advertising as before until 1840, when they suddenly dropped the M.D. qualification and became Messrs Jordan and Co, Surgeons, with premises in Bristol as well as London. Later in the 1840s, a medicine called Balm of Rakasiri was being sold by Messrs Henry & Co, Liverpool, with a very similar advertising style to the Jordans, and in the 1850s Messrs Lewis were the proprietors. The name finally changed to Dr. Lucas and the remedy was still burning the oesophagi of the credulous at the end of the 1860s.

The Cordial Balm of Rakasiri – part 1

Source: The Morning Chronicle, Saturday 12 December 1818. For transcript, click here.

On this site I include anything medical or surgical provided it was advertised, so not all the remedies were considered quackery in their time. Some were endorsed and prescribed by reputable doctors, and many were no worse than the orthodox medicines then available. Others, while inefficacious, were produced by honest people who believed in the power of their product and did not set out to rip people off.

The brothers Jordan, however, were a right pair of dodgy coves.

In 1816, C.J. Jordan of Cannon-street-road started placing ads saying he could cure ‘a certain disease’ without using mercury. At this point he referred to himself as a surgeon, but by 1818 he had adopted the qualification M.D. and was calling the remedy The Cordial Balm of Rakasiri, or Nature’s Infallible Restorative. His business was the East London Medical Establishment, but this might as well have been the East London Nose-Picking Establishment for all its professional credibility. With the medicine selling at 11s a bottle (33s for family size), the business was lucrative, and in August 1821 it became the Surrey and West London Medical Establishments with premises in Great Surrey Street, Blackfriars and in Berwick Street, Soho.

In early 1823, the adverts started referring to ‘Drs. C. & J. Jordan.’ The Monthly Gazette of Health, with its usual entertaining indignation, introduced the new partner as

Dr John Jordan, who, from the rank of distributer [sic] of handbills has lately been raised to the dignity of M.D. by leaping, we suppose, over a broomstick.

Balm (otherwise Balsam) of Rakasiri was, in theory, a resin from a tree species native to the Americas. It was said to have stimulant and tonic properties, and had briefly been known in Britain in the early 18th century before its limited popularity had fizzled out. The Jordans’ adverts recommended it for a variety of conditions, including consumption and scrofula, but like its inspiration, Solomon’s Balm of Gilead, the main targets were venereal disease and ‘nervous’ disorders supposedly caused by masturbation. The natural source of the resin not being available in the UK, the Jordans formulated their own version – spirit of wine (rectified ethyl alcohol) flavoured with rosemary oil and sugar.

Both The Monthly Gazette of Health and The Medical Adviser campaigned against the Jordans during the 1820s, and while these publications are far from dispassionate, they make for entertaining reading. According to the Adviser, the Jordans had started out as pencil-sellers before taking the Cannon-street-road premises and setting up their medicine business.

One would think to see these two fellows, standing at their door with their hands in their pockets, their hair powdered, their sleek countenance and suit of black, that they really were medical men; although to a discerning eye a peculiarly roguish cunning, and an expression of innate ignorance, are labels on their front…

Of the Doctors’ fancy carriage, the Adviser continued:

…we fancy their seat the back of an hypochondriac ; their foot-board a grave-stone: their wheels a compilation of human bones; their chariot-rim decked with diseased livers ; their reins the intestinal canal; their side lamps two bottles of Rakasiri; and their whip a long bill! with which the two black longtailed horses most awfully harmonize.

The Adviser – without much relevance, perhaps – also accused the Jordans of stealing a pig, then rather childishly printed their purported reply:

I wont to no what you meen by tacking my karacter as you doo you rite in your book that I mede awey with a milkmans pigg but I wood ave you to no sir that sich like slander shall not be suffered to pass. You also say that I was a pencel pedlar this I despise and say it is a ly. I never hokd pencels I only took orders for em, and even if I did it is no affere of yours I got my bred onnestly.

To the people who had fallen for the scam, however, the Balm of Rakasiri wasn’t  so funny. In part 2 of this post, we’ll see how a young woman stood up to the quacks.

Letter from An Old Surgeon

A brief interlude from the usual style of post today, as I’m still attempting to erase the Yankee Rubber Baby from my brain. The following letter was printed in The Monthly Gazette of Health in June 1821. A surgeon, not the most modest fellow in the world, gives an explanation for quackery – it’s all the fault of tightwad patients…



I am in practice as a consulting surgeon, and admire the spirit with which you lash quackery, both regular and irregular; but you must allow me to shew that patients themselves are the cause of Empiricism, as I think I shall convince you and your readers, by the following instances.

I have attained considerable celebrity, and in some particular complaints, can justify my pretensions to a niche in the Temple of Fame, by affording instant and permanent relief. This I feel great pride and pleasure in performing, whenever such cases occur. One, amongst many, was a gentleman, who came from the West Indies on purpose for my advice, called on me in his carriage, was cured on his second visit, and paid me, with abundance of compliments, a fee, which of course I could not look at till he had departed, when I found it was ОNЕ POUND!

Another, a very old gentleman, who was relieved in the same speedy manner, and was equally LIBERAL! but probably, he means to remember me in his will.

I could give you many instances where my conduct has been thus honourable, although I might have kept these patients under my care for months, and then have cured them; yet so inconsiderate, and I will even say dishonourable has been their conduct. I do not mean to assert that I am more honourable than all other professional men, for I hear the same tale from many who have ability to relieve, but who, like me, have thus suffered for their generous behaviour. Men of no principle in the profession will guard against their patients’ parsimony; and those of no ability will of necessity oblige their patients to be visited frequently; but I would wish to ask you and your readers, whether the treatment I have described, and which professional men are often subjected to, does not hold out an incentive to quackery and imposition? I certainly think that a person of fortune, receiving speedy and permanent relief from a distressing complaint, at the hands of a man who has devoted a large portion of his life, and considerable expence, to acquire competent abilities, should offer a reward proportionate to the benefit the patient derives; and if this plan were more generally adopted, empiricism would receive its death-wound. I am, Sirs, Yours, &c.

AN OLD SURGEON.

Allan’s Anti-Fat

Allan's Anti-FatSource: The Belfast News-letter, Tues 3 June 1879

This ad is unusual in appealing not to the potential consumer but to her weedy, emasculated little husband. (Presumably he’s her husband, because he seems stuck with her.)

Most ads for Allan’s Anti-Fat, however, were aimed directly at people wishing to lose weight. (N.B. the spelling ‘Allen’s’ above is an error that crops up occasionally.) Where images were included, they showed women, as in the one below, but the product was very much aimed at corpulent men too.  Some adverts claimed it also cured dyspepsia, palpitations, rheumatism and gout, and prevented heart disease, apoplexy and paralysis.

The nostrum, costing 6s 6d per 6½ fl oz bottle, was a fluid extract of Fucus vesiculosis (bladder wrack), which had been the original source for the discovery of iodine back in 1811. It is therefore a forerunner of modern iodine-containing weight loss supplements, and while in appropriate quantities it might have assisted people with hypothyroidism, it wouldn’t have done much good to any random person taking it indiscriminately in order to shed a few pounds.

Another 1879 ad gives the following testimonial from Windsor physician Thomas Fairbank:

I gave some of this extract (Fucus Vesiculosus) to a very corpulent lady, who in three months lost three stones in weight without any change of diet. Since then I have frequently given it for reducing weight depending on the accumulation of adipose tissue, and have never found it fail. I may state that a patient who has been lately taking it as an anti-fat, and who always suffered very much from from rheumatic pains about the body, has been entirely free from such trouble while she has been taking the extract, a fact which she quite independently noted.

Fairbank was a genuine doctor and the Botanic Medicine Company certainly did not invent his testimonial, but in his original letter to the BMJ, he is clearly referring to Fucus vesiculosus in general, and had never prescribed Allan’s Anti-Fat. The case of the ‘very corpulent lady’ had occurred 15 years before. He also said how easy it was to make Fucus pills – a handy hint that the Anti-Fat proprietors understandably left out. Various opinions were printed in the BMJ over the next few months, with some correspondents, like Fairbank, broadly in favour of Fucus as a weight-loss aid.

Irish physician A T Carson, however, was not convinced:

Some who are paying expensively for the remedy may be surprised to hear that the Fucus Vesiculosus is here largely used as a food for pigs, and that it in no way interferes with their growth. It will require a number of well-reported cases to convince me that what fattens a pig will make a Christian lean. BMJ, 19 July 1879

William Murrell M.D. prescribed generic Fucus pills for a man. ‘C.G.’ who had enquired about the remedy, and asked him to keep a detailed diary of progress. The patient enthusiastically obeyed the instruction, leaving nothing to the imagination:

June 25th. Weight, 15 stone 6¼ lbs.; three pills; food and exercise as usual; had two motions.—June 26th. Weight, 15st. 6½ lbs.; three pills; four motions; urine very copious (not often, but when about it felt as if I was never going to leave off), smelling like some old horse, and very dark coloured.—June 27th. Weight, 15st. 6½ lbs.; three pills; five motions; much urine; appetite much increased; felt as if I had a tape-worm.

The next day he had ten motions, in case you really wanted to know. ‘C.G.’ briefly got down to 15st 5½ pounds, but only continued the treatment for 10 days. He concluded:

Towards the end, I fancied that I exhaled a kind of fusty odour from my whole body, but my feet and breath were stern facts. I have just weighed, and am 15st 7lb. If you think the liquid preparation will act I will try it, but the other seems (to use a vulgar expression) to be making me as rotten as a pear.

This, of course, has no specific reflection on Allan’s Anti-Fat – Murrell, C.G.’s doctor, had prescribed the pills himself and there is no way of knowing his formula. A subsequent correspondent, signing himself  ″A Very Broad Church Parson,” replied that Fucus had caused him to lose a stone in a month, without any unpleasant side effects.

Fucus was a component of many similar weight loss products in the later years of the 19th century. The media today likes to compare us 21st-century bloaters with our healthy pre-McDonalds, non-computer-game-playing forebears, but the market for these quick-fix remedies suggests that anxiety about weight is nothing new.

Laxora

Laxora for Constipation

Source: The Graphic, Sat 23 August 1879

Laxora was introduced to Britain by its French proprietor, P. Guyot, in 1877, and at once attracted positive attention from the medical press. It sounds a pleasant medicine to take – The Medical Times and Gazette described it thus:

They consist of a core, or centre-part, of compound of manna, cassia-pulp, and other like laxatives, we believe, enclosed in a crystalline chocolate crust; are not at all unpleasant to the taste, and will, we doubt not, be readily taken by children as well as by adults.

Certainly more appealing than the Rectal Dilators or the Aperitive Vase!

In the 18th century, William Buchan (Domestic Medicine), had said that constipation ‘may proceed from drinking rough red wines, or other astringent liquors: too much exercise, especially on horseback,’ but by the mid-19th century many medical writers (particularly in the US) were putting it down to the sufferer not getting into the habit of ‘going to stool’ every day. You had to be regular, and if you weren’t, it was advisable to go anyway, and sit and wait until something happened. Thomas Hawkes Tanner in 1866 estimated that the normal output of a ‘properly fed man’ should be 4 or 5 oz daily. For those with time to kill, Samuel Sheldon Fitch advised:

Let the costive person, exactly at the same time every day, solicit an evacuation, and that most perseveringly for at least one hour, should he not succeed sooner, at the same time leaving off all medicine.

Should the costive person fail at their solicitation, there were numerous remedies to be introduced – by mouth or otherwise. Rhubarb and castor oil were well-known as purgatives, and clysters of castor oil, lukewarm water or, more drastically, tobacco-smoke (as advocated by Thomas Sydenham two centuries earlier) might do the trick. One recipe for a clyster comprised castor oil, turpentine and half a pint of gruel, which I imagine went a long way. If the condition proved stubborn, one US writer said:

When the feces are impacted in the rectum, the assistance of the finger, a scoop, spoon-handle, or some similar instrument, introduced per anum, becomes necessary to break up and discharge the solid mass.

More unusually, an 1854 book by James Smellie described the action of galvanic apparatus as an aid to getting the bowels moving – the positive electrode was to be placed in the lumbar region, the negative to the rectum. With extreme cases, it was necessary to ‘employ the galvanic friction, and sometimes to draw sparks from individual points.’

The emphasis on being regular makes it debatable whether all supposed sufferers really had a problem. ‘Costiveness’ could be diagnosed – and treated quite aggressively – just on the strength of the patient not having defecated for a couple of days, which is hardly a medical emergency.

Ultimately, however, much constipation advice focused on diet, for prevention as well as cure. Strong coffee, too much white bread, especially that contaminated with alum, and the fashionable habit of over-indulging at one late meal rather than eating little and often, were all thought to contribute to the condition. Thankfully for patients daunted by the more drastic remedies, there was the option of beef tea, figs, prunes and tamarinds, molasses, porridge, and plenty of fresh fruit.