Tuesday, April 22, 2014

Anglo-Saxon medical practice

From: Eva

First off, I just finished Hild and absolutely loved it. It's the first work of yours I've read, but I think I'll have to go read some more--after pausing for a while to let Hild settle down in my head. Jumping into another world too quickly would feel wrong.

Anyway, my question! It's sort of an odd one, I think. I really enjoy historical fiction, and when I read it, I'm often curious about how the things described in historical terms line up with modern concepts or knowledge. I also have a particular interest in illnesses and medical problems in times past (I blame a book I read about the Black Death when I was in middle school). When Hild was examining Angeth and her pregnancy, there seemed to be a rather specific list of symptoms she was experiencing. Do these correlate to a specific condition?

I should admit right now I know next to nothing about pregnancy or childbirth. As a lady married to a lady, neither of whom has any interest in getting, being, or unbeing pregnant, it hasn't really come up in practical terms. I did a bit of searching around online, and my best guess is preeclampsia--is that correct? And if so, do you have any information on what it was called or how it was viewed at the time?

Thanks for your time and indulgence!
I'm delighted you liked the book. I worked long and hard on figuring out exactly how to draw readers in--how to immerse you, to write my software on your hardware. I had strenuous discussions (with Kelley, with my editor, with other readers) about the advisability of using all those difficult names and unfamiliar-to-most spellings. As a result I did a lot of work to clarify names (people, mostly, but also places) without getting simplistic. I added what felt to me like tedious exposition but which everyone else told me was not enough. But there came a point where I wasn't willing to do more.

The way I see it, not every book works for every reader. With Hild, if you're not hooked by p.50 it probably isn't the novel for you. I wasn't going to fuck up the possibility of giving some readers magic in order to coddle the kind of readers whose minds are not suitably geared for this book.

To be clear, I'm not talking about IQ but mindset: are you willing to be swept away? Are you willing to take that great leap into the unknown? Some readers are not. They like to proceed logically with all narrative depths and colours and turns clearly sign-posted and classified. And that's cool, we're all different. But as a reader I would suffer from that lack of risk, that loss of what feels like magic; I crave the kind of experience I hope to give readers of Hild.

This, of course, is one of the reasons I began with Hild as a child, so the reader could learn as Hild learnt: by absorbing the mores and languages, the patterns and sounds of Early Medieval Britain (or at least Hild's part of it), let them seep in naturally to bend your worldview before you know it. I wanted a reader to live and breathe the seventh century to such an extent that when you look up from the text to find yourself in the twenty-first you feel momentarily disoriented.

Anyway. Angeth. (I suppose I should point out to those who care about such things that what follows could be regarded as a spoiler.) Yes, she suffered pre-eclampsia and then eclampsia. In my on-going research I've seen no mention of any such a thing in any records of the time (there again, there are no records about women or women's lives from that time and place) but my own view is that Anglo-Saxon women would have been familiar with the problem. (Arguably, pre/eclampsia results from an autoimmune response--the mother's system starts to treat the foetus as an invader. Possibly because of some incompatibility with the father's sperm. This means of course that she wouldn't necessarily respond so badly to the sperm of other men--which could lead to interesting dynastic drama...)

So how would Hild treat eclampsia with the tools of the time? Given that she has always used observation I devised a series of simple diagnostic indicators: Headaches pointing to high blood pressure? (She wouldn't think of it that way, of course, but I did.) Skin pitting indicative of Ĺ“dema? (Pressing the hand isn't foolproof but lots of people have used it for a long time.) Protein in the urine? (I've no idea if foamy urine is diagnostic of proteinuria but I thought it might be.) Blood in the urine? (This can be a sign of kidney failure, and so possibly other organ failure. Lots of other things, too, of course, but given that Angeth wasn't brutally hard-worked it wouldn't be an exercise-related sign, it couldn't be menstrual blood, if it were cancer there's not a lot Hild could have done about it, etc.)

I never bothered to work out what Hild might have called eclampsia but she would have learnt to recognise it. If she recognised it early in the pregnancy there's a possibility that magnesium sulphate might help (I'm just guessing; I'm not medically trained). So if she had access to Epsom Salts--and knew what to do with them--she might have tried that. But I doubt it would have been enough for Angeth.

The way I see it--certainly the way Hild saw it--the only sure treatment for Angeth's condition was to not be pregnant. Hild hoped that Angeth, given the trauma of her recent travels, might miscarry. (I'm guessing that many malnourished, stressed, traumatised women with an extreme immune response would do so.) But Angeth does not, perhaps because of her elite-level diet and general care. Hild then offers an abortion. Angeth refuses. And dies.

I made up Angeth; I invented everything to do with her pregnancy. There's no data to support any of it. Nothing. I just did writer stuff based on possibilities. Could it have happened that way? I like to think so.* But I'd love to hear from medical practitioners on this.

Perhaps Hild will one day be to blame for some young reader growing up to devote her/himself to solving pre/eclampsia. That would make me very happy.
At some point I might write a blog post about my thoughts on the accepted wisdom--which I don't really agree with--around Anglo-Saxon medical practice. If anyone out there can point me to recent research (I haven't been paying attention for a couple of years) I'd be grateful.
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