16 March 2011

Health in the early Cape

The French Huguenots who settled at the Cape in 1688 and 1689 were eventually afford to buy slaves or hire the Khoi and the refugee women and their children interacted with the “other” women as household servants, or to assist with births or during emergencies. Without doubt life was extremely difficult for these Huguenot women, beginning with the rigours of sailing across or down the Atlantic.

Respiratory diseases, “fever” (undiagnosed beyond that) and malnutrition were afflictions that passengers and crew alike suffered from during these voyages. The longest voyage (by a few days) on which the refugees departed, took place from March to August 1688 on the Berg China. This ordeal resulted in the deaths of 30 of the refugees, including six women. Interestingly, Pierre Joubert left the Netherlands married to one woman and arrived at the Cape married to another, leaving us with the assumption that his first wife had died en route.

Earlier, the Oosterland, carrying 29 passengers, 107 seamen and 105 soldiers, saw the loss of a woman, but witnessed the birth of a child during the voyage. The child’s mother was fortunate in that her husband was the surgeon, Jean Prieur du Plessis. Another baby was born on one of the ships that were moored in Table Bay. In that case, one may assume that the other women on board assisted with the delivery, aided perhaps by the ship’s doctor (who would have been a barber-surgeon). Jean De Bus was onboard the Oosterland which arrived in the Cape on 25 April 1688.

Records indicate that deaths on t’Wapen van Alkmaar, numbered 37, with 104 survivors placed in the VOC hospital on arrival. It is known that some of the dead as well as some survivors were French Huguenots. As noted earlier, the new arrivals suffered from weakness, if not fevers and malnutrition, as a result of the hardships and deprivations experienced during the months under sail. Add these disabilities to the pre-existing weaknesses that prevailed among the majority of the refugees – they had endured the hardships of hunger and whichever type of temporary lodging they could find, often in woods or, if they were fortunate, in lean-to shelters as they made their way out of France into the New Netherlands or to the western coast, where they hid away on various types of small vessels in order to get to England. Once the majority of the refugees were safe from their French pursuers, they had little money to secure decent lodging or work in their respective places of exile, which is why most of them elected to sail on to the Cape. Thus one may postulate that many of them were not in robust health when they set off on the long voyages to these remote frontier settlements.

After the refugees had survived the rigours of the long voyage and were relocated, they had to adjust to a new and different climate. The climatic changes were dramatic in comparison with what they had experienced in Northern Europe. The disease environment, too, was different. In those days diseases were closely associated with climate, and diagnoses were often made based on the prevailing conditions. At the Cape, the seasons were reversed - rain fell heavily during the winter as a result of westerly winds meeting with a warm front, and also causing piercingly strong, chilly winds. This rain and wind often produced respiratory illnesses. The summers were insufferably hot for the little band of French Huguenots, yet this was the season when the crops had to be gathered, vegetable gardens cleared of produce, canning and preserving done, as well as the demanding labour associated with grapepicking (many of the Huguenots engaged in viticulture).

Typical of the weather, was an entry in the diary of Adam Tas, which reads that in early January 1705, a “north wind blew on the 5th... still raining with no let up on the 8th” and part of a neighbour’s crop – that of a refugee – had been destroyed.

Medical care was inconsistent. Huguenot surgeons were few and the language barriers separated especially the women in terms of seeking treatment from respectively English- or Dutch-speakers. Jean Prieur du Plessis had arrived at the Cape in 1688. He was followed by Paul Lefevre, an employee of the VOC and thus based in Cape Town where very few of the refugees were close enough to avail themselves of his services. Gideon le Grand had arrived at the Cape by 1698 and was based in Stellenbosch. Last among this group was Jean Durand, who settled on a farm by 1690, but seems not have been active in practising medicine, preferring instead to engage in farming and local administration. Le Grand kept a journal regarding his practice. Only partial entries survive, but it is known that he treated French Huguenots, including Maria Jeanne du Pré, plus various children of the refugees. He, Gideon recorded, in January and February 1710, bled “Jeanneton”, a daughter of Jean du Buis. There are, however, no baptism records available for her. Many records where lost early in the 18th century, which could explain why no record was found; alternatively it could be possible that she died while still very young. It’s also possible that the “Jeanneton” to which Gideon referred was Johanna Terrier (Jean’s step daughter) because Gideon also saw “Suzon”, who he documented as the daughter of Jean Du Buis. The “daughter” he referred to was the step daughter Suzanne Terrier. Gideon le Grand lived in Paarl and passed away some time in 1710.

In terms of medical knowledge, almost all of the authorities believe that these men at the Cape and in Carolina were barber-surgeons. By the 1670s, the French Protestants had been virtually shut out of universities. France had a guild of barber-surgeons dating from the thirteenth century. They were broken down into two categories – that of "petit bourgeoisie" or the lesser "barbitonsores". There is no way of knowing into which category these men fell, or if they were divided between the two.

How informed they were regarding modern medical knowledge at the time, is unknown. It would depend to some extent on personal and professional relationships between university-trained physicians who were Roman Catholic, and the dissident barber-surgeons in their respective provinces.

Bachelor Peter Kolbe (an astronomer) judged that the women at the Cape gave birth much more easily than in Europe. Swedish physician Carl Peter Thunberg, who as far as is known, never delivered a baby at the Cape, also made this same assumption. These stereotypes are contradicted in part by a contemporary obstetrician who noted that the more children a woman bore, the more likely a quicker and often easier labour would be. On the whole, the Huguenot women were prolific in childbearing and they tended to produce, on average, a child every two years, with some women bearing eleven to twelve children in total.

It was a French Protestant doctor who first opened a school of midwives in sixteenth-century Europe and it was Ambroise Paré who insisted that women take to the bed to deliver. It is not known if the refugee women delivered on a bed, used a birthing stool, or assumed any of several positions – from kneeling to squatting – to aid the child down the birth canal. At the Cape both Kolbe and Thunberg found that women nursed their own babies, although when the mothers died or were incapacitated, the children would be farmed out to other nursing mothers, including perhaps the “other” in both places.

Records of the number of still births and mortality among infants at either of these frontiers are lacking. Published genealogies at the Cape, which account for less than half of the number of refugee families, bare hints of childhood mortality. Bachelor Kolbe noted that European women at the Cape who breast-fed their children were “most grievously afflicted with sore breasts... their breasts are frequently very cruelly pained and their nipples are almost always the same”. As a result he thought that they weaned their children too fast.

Du Plessis returned to Europe within a few years after his arrival. His first wife died there, and he returned in 1700, married to midwife Maria Buisset. She was the only French-speaking midwife at the Cape. Surely Buisset was kept busy, but most of the births at the Cape were presided over by female members of the family and neighbours (including those who spoke no French).

One may assume that the rigours of successive child-bearing took the life of Ann Retief, who had borne four sons and six daughters at the time of her death in 1710, when she was only thirty-nine. Jacquemine des Prez died at thirty-six leaving behind eleven children. Complications from child-bearing included breech births, haemorrhaging and puerperal fevers. In addition there were holes and tears to the wall and mouth of the vagina. Those who survived the fevers and damage done to their bodies, would have required time to heal, but in most cases women were up and about very quickly – some even on the very day they gave birth. One aid to the pain of childbirth was a bit of brandy, and it was common practice during labour to rub the body with oil, or to provide women with a variety of herbs to consume.

In this era many medical authorities believed that the uterus was the source of conditions such as hysteria among women. No doubt many held this view at the Cape, where it was commonly believed that conception could only take place when a woman achieved orgasm along with her male partner. The dual pleasure theory held that the female egg was released from the uterus at orgasm while the male sperm was sent out to join it through copulation. There is no hyperbole in Peter Kolbe’s statement that women at the Cape were “generally modest, but no flinchers from conjugal delights. They are excellent breeders.

It is unlikely that the devout French Huguenot women resorted to abortion. Deformed babies were thought to result from indecent sexual relations. These included any position for coitus except with the man on top, burrowing into his vagina field as he might otherwise sow his crops from above. At the Cape at least two children were probably crippled at birth. These were Stephen, son of Martha Rousseau and Francois du Toit, and Jacob, the son of Susanne Gardiol and Abraham de Villiers. Babies were taken to breast on demand. At which age solid food was introduced, is not known, but the timing no doubt depended on the inclination of the mother. Weaning in France (and Northern Europe) ranged from twenty-one to twenty-four months in the seventeenth century, to ten months in the eighteenth. Children ate what was served at the table as soon as they were able to chew. Prior to that, in what will seem unhygienic to modern readers, mothers would often partially chew the food and then pass it on to their babies.

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