'The Skull Beneath The Skin: The Nearness of Death in History' by Not A L Berridge

My husband has a cold. The house reeks of eucalyptus, the bins are full of tissues, and the air is loud with complaint. My sympathy of Day One has eroded into the irritation of Day Four, and it’s only a matter of time before I say, ‘Well, you’re not actually dying, are you?’ 

But of course that’s a modern luxury, and a hundred years ago I wouldn’t have dared say it. A ‘chill’ can lead to bronchitis, pleurisy, or pneumonia, and in the days before antibiotics these were often fatal. It might even be the precursor to influenza – and the pandemic of 1918-1920 killed between 3-5% of the entire world’s population. A mere cough could be the first sign of ‘consumption’, ‘phthisis’, ‘scrofula’, ‘Pott's disease’, or the ‘White Plague’ – the global killer we’ve now learned to call ‘tuberculosis’. Everyone knows that if a character in a historical drama is seen to cough, then the next scene is going to be a funeral.

'At Rest': The death of Little Nell in 'The Old Curiosity Shop' by George Cattermole

We still fear some of these things. TB is making a comeback, pandemics are always good for newspaper sales, and we are once again being advised to take precautions our grandparents took for granted. Yet the fact we need to be told to cover our mouths when we cough shows the astonishing degree of our modern complacency. The miracles of modern medicine have stripped away so many of our natural fears that we’ve come to see science as a shield against death itself.

But when we write historical fiction that shield has to be the first thing to go. There’s obviously huge variation in place and period, but awareness of sickness and mortality colours every one of them, and our characters can’t but share in it. How can they do otherwise when they’re seeing it every day?

'The Beggars' by Brueghal the Elder

And really they would be. There’ve been sick beggars on the streets since before even Roman times, and as late as the 17th century it was impossible to walk the length of the Champs Elysée and remain ignorant of the reality of blindness, paralysis, lameness, dropsy, or even disfiguring cancers. Nor was visible sickness restricted to the poor. Smallpox struck kings as well as paupers, and even Elizabeth I bore the scars of it on her face and hands as evidence that she had faced death and survived. Almost equally prevalent (especially in mainland Europe) were the terrible signs of syphilis, on which many medieval church gargoyles are deliberately modelled to show the deadly wages of sin.

Smallpox victim 1911 Illinois                 Bust of tertiary syphilis

But syphilis didn’t end in medieval times, and neither did most of these other horrors. Fast forward to the civilization of Victorian England and we can laugh at the grotesque minor characters populating Dickens’ novels – but the truth is that he was largely describing what he saw. Some deformities were caused by accidents or war wounds – eye-patches, wooden legs, and hooks for hands – but many others are immediately recognizable to doctors as the result of childhood illness or malnutrition. 

'The Internal Economy of Dotheboys Hall' from 'Nicholas Nickleby' by Phiz

Goitres were a consequence of iodine deficiency, ‘hunchback’ is kyphosis, often caused by poor childhood nutrition, bandy legs were a sign of rickets, while ‘cripples’ with atrophied limbs were probably victims of polio. Many of these conditions are still with us in the poorer countries, and when we look at those heartbreaking photographs of children with cleft lips and palates it’s hard to believe that not very long ago we’d have seen these in London too.

 

 

 All these things are an essential part of the ‘historical world’, and we often have enormous fun writing them. With In the Name of the King I was delighted to find the real character of Fontrailles was genuinely a ‘hunchback’, and only wish I’d had the space to develop the ways in which that affected his personality. I also took a hideously writerly pleasure in basing my fictional Comte de Vallon on a real-life syphilitic nobleman whose return to society was eased by Louis XIV requesting his courtiers ‘not to notice his having no nose.’ Anything out of the ordinary is grist to a novelist’s mill, and I was going to grind it all I could.

But sometimes it’s in the 'ordinary' that the real gold is buried. We can write historical novels where nobody gets ill at all, and yet the characters will still have been shaped by a world in which these things happen. Their perception of cruelty will be different, their ideas of fairness, even their concept of religion, and they will be constantly aware of their own mortality. Dreadful as they were, the hunchbacks and crooked legs were tokens of those who had survived, and served as a terrible reminder of the many who did not.

People could and did die of the most minor things, and the fact they were so imperfectly understood only added to the sense of a random destiny that could strike at any time. This 1665 Bill of Mortality raises far more questions than it answers, and while ‘sore legge’ might be tetanus, for instance, what are we to make of medical causes of death listed as ‘Bedridden’, ‘Suddenly’, or even ‘Grief’? Yet the one that brings home to me most powerfully the reality of the pre-antibiotic world is described in that ominously single word – ‘Teeth’.

And of course we have to show this awareness in our writing. We can’t have characters say modestly ‘It’s just a scratch’ when everyone would have known that a scratch could kill. We can’t even give them a quick bout of toothache and then forget about it. Ridiculous as it is, we even have to let most of our characters believe it’s possible to die of a broken heart.

But the risk that would have affected most people sooner or later is that of pregnancy, and we can’t ever take that lightly. Even today we know of the risks of miscarriage, and many couples won’t officially announce a pregnancy until the first three months are safely passed – but in the case of Louis XIV’s brother Philippe, the Queen was never acknowledged to have even been pregnant until the child was born and had stayed alive a full calendar month.

Madame de Sevigne by Lefebvre

The risk to the mother was almost as great, as we see in that figure of 23 childbed deaths in a week. In 1671 the famous French letter-writer Madame de Sévigné began a letter to her married daughter in this rather cryptic fashion:

 

'Today is the sixth of March. I beg you to tell me how you are. If you are well, you are ill, but if you are ill, then you are well. I hope, my child that you are ill, so that you will be in good health for at least some time to come.’

The mystery is clear once we realize the daughter was due to menstruate, and what her mother feared more than anything was another pregnancy.

But what I actually find most fascinating about that letter is the way phrases we now use as mere formulae had real meaning in the past. ‘Tell me how you are’ is not the standard ‘How are you?’ with which we greet each other today, usually hoping we won’t be told the answer. Those of us over a certain age still tend to begin letters with the polite ‘I hope you’re well’, but this has already come to signify a broader enquiry in which health plays little part.

1864 Civil War letter with standard opening

It was different in the 19th century. I included a letter in Into the Valley of Death which began with the then-standard phrase ‘I hope this finds you well as it leaves me’, but it wasn’t until a reader asked me about it that I began to see its real significance. Outside London, a letter could take days to reach the recipient, and the writer’s awareness of time reveals a very real concern for the risk of ill-health. The most they’ll commit to is ‘I’m well at the time of writing’, because they know perfectly well that in a week or so they may not be. This seems strange in a time when even the most deadly disease usually gives the sufferer at least a few more months of life – but in 1854 a man who wrote ‘I am well’ on Monday could be dead by Friday. It’s true the phrase is a standard one and would often have been used without conscious thought, but behind it is a mindset that knows the sword of Damocles can fall at any minute.

And this one phrase exemplifies two of the things I love most about writing historical fiction. The first is the everyday reality of a bygone world, which can give us not only great texture but also the kind of plot development unthinkable in a contemporary work. 

 My favourite example is in Pride and Prejudice, where Jane Bennet walks in the rain to a dinner with two desirable bachelors, and quickly develops a cold which makes her return impossible. The house is only three miles away from her own home, but she is of course too ill to be moved, and in such a condition that requires her equally marriageable sister Lizzy to come and attend her.

This is brilliant. True, if Jane’s cold had been anything like my husband’s then her hosts would have bundled her out of the house in two minutes flat, but if we assume the phlegmier stages were passed invisibly in the bedroom, then the plot mechanics are perfect – and I challenge anyone to devise a contemporary narrative which would achieve such a result.

But, as usual with Austen, there’s far more going on here than plot. Jane’s mother deliberately sent her daughter out in the rain in the hope of engineering this very situation, and Mr Bennet is only half-joking when he hopes she’ll find it a comfort if her daughter dies following her orders. Austen is of course writing about her own time, but she uses those perceptions to create both story and character unique to that age, and I'd love to be able to emulate her.

But the second aspect I love is the Sword of Damocles itself, and the way in which awareness of death gives an extraordinary intensity to life. Our own lives are too safe to imagine it easily, but I’ve found the most useful comparison is to wartime. When living through war we’re all at once back in a time when life is cheap, death can strike without warning, and the only moment there might ever be is now. We might normally find incomprehensible the religious fervour of bygone ages, but even an atheist prays when the house they’re sitting in is being bombed. We might laugh at the superstition of the past, but from verbal rituals to ‘lucky socks’, you’ll find no people more superstitious than soldiers in even a modern war.

Everything is more concentrated and intense. The friendship forged between men who face death together is far deeper than that between those who use the same coffee machine, and when time is short, then love and passion soar as never before. And people take risks. Mad, exhilarating, even heroic risks – because there is so little to lose. Live through war, and we begin to understand some of the heroic lunacy of even sixteenth century peacetime, when men and women risked their lives for power, for politics, for religion, and for love.

It's no coincidence that the most passionate romances are often set in war

I write war in my novels anyway, but I’d still want to study it for the insight it can give us into the past. War is a magic door that can take me right back in time, to a world where death lurks round every corner - and where there are far worse things to deal with than my husband’s cold. 

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Well, OK, I am A L Berridge really, just filling in a gap in the schedule. And I hope you noticed I didn't mention Crimea even once...