How Welsh medicine helped to create America!

How is Welsh medicine linked to the establishment of a global superpower? On the face of it the two don’t appear to have much in common! As an historian of Welsh medical history it’s not often that I can make grandiose claims about Welsh practitioners. One of my colleagues once suggested that Galen was actually a mistranscription and that the supposed Graeco-Roman physician was actually G. Allen from Cardiff. Wales, and not ancient Greece, in his view, was the true seat of medical knowledge. With the subject of this post, however, Wales (and Welsh medicine) can lay claim to an important figure in the early history of the United States – Thomas Wynne of Ysceifiog, Flintshire.

Wynne was born in 1627 in Bron Vadog in the parish of Ysceifiog in North Wales, the son of a freeholder. Details of his early life are sometimes obscure. It seems that his father died when he was 11 and that, sometime after that, and perhaps even affected by it, his religious views began to shift. In the religious turmoil of the 1640s (this was the decade of the English Civil Wars and the ‘world turned upside down) he became increasingly dissatisfied with the poor quality of religious teaching. He felt that those responsible for his spiritual welfare were “of low degree” and had let him down. He was, as he later wrote, spiritually “at the mercy of the wolf”.[1]

Ysceifiog (image available under creative commons licence)

Matters came to a head in the 1650s when he underwent a profound religious experience. As he later wrote: “the heavenly power wounded as a sword, it smote like a hammer at the whole body of sin, and it my bowels it burned like fire”.  Wynne had become a Quaker – and was one of the earliest and staunchest members of the Welsh Society of Friends. He wrote pamphlets including The Antiquity of the Quakers Proved out of the Scriptures of Truth…in 1677, and was imprisoned for his Quaker beliefs. It was the persecution of the Quakers in seventeenth-century Britain that led to their search for a new land that offered peaceful settlement and the opportunity to set up a community of like-minded individuals. When William Penn was given a grant of land by Charles II in 1681, Thomas Wynne was one of twelve individuals who formed a committee to meet Penn in London. Along with John ap John of Llangollen, Wynne took up a patent for 5000 acres of land in Pennsylvania, for which he paid £100, and reputedly built one of the first brick houses in Philadelphia.[2]

Portrait of William Penn

How did Wynne’s medical practices colour his life both in Wales and America? It is possible to piece together something of his medical life from a collection of sources – perhaps most important of which is his own testimony. This quote from Wynne is reproduced from John Cule’s Wales and Medicine (1973).

“My genious from a child did lead me to surgery, insomuch that before I was ten years old, I several times over-ran my school and home when I heard of anyone’s being wounded or hurt, and used all my endeavours to see Fractures and Dislocations reduced and wounds dressed…my parents thought they had lost me forever for which I received severe correction. My Father died before I was eleaven years old and my Mother [was] not able to produce so great a sum as to set me to chirurgery…until I became acquainted with an honest friend, and good artist in Chyrurgery whose name was Richard Moore of Salop, who seeing my forwardnesse to Chyrurgery, did further me in it”. By the completion of his training he was regarded as an expert “in the use of the Plaister Box and Salvatory, the Trafine and Head Saw, the Amputation Saw, and the Catling, the Cautery, Sirring and Catheter”.

Richard Moore, from whom Wynne learned his trade, was a surgeon and fellow Quaker. He was originally from Shrewsbury and clearly regarded him highly enough to apprentice his own son Mordecai to Wynne to learn the craft of surgery.

Wynne’s was a typical story of ‘on-the-job’ training, familiar to many families of rural areas. Unable to afford the large sums needed to fund a university education, Wynne was fortunate in finding a sympathetic teacher with whom he seems to have undergone an ad-hoc apprenticeship. Describing himself as “an expert in Drills and handy in Knife and Lancet” he constructed a model skeleton of a man. Despite the fact that his studies were interrupted for nearly six years by his imprisonment, his skill in physic was enough to be considered sufficient to obtain a medical licence, although there is no evidence to suggest that he did so. Licensing in Wales was increasing by the end of the seventeenth century, but many Welsh practitioners simply didn’t see the need since the attainment of a licence was not especially valued by ‘ordinary’ people, and the lack of others with licences didn’t engender the need to get one to compete.

Where exactly Wynne practised medicine is unclear. He is reported as a ‘practitioner in physic” in London for a time. Peter Elmer also suggests that he may be the same Thomas Wynne who served as a surgeon’s mate to one Walter Thompson among English forces in Scotland in 1651. It is also clear that his pamphleteering didn’t always win him friends. In answer to The Antiquity of the Quakers Proved, one William Jones accused Wynne of being “ignorant in his very trade of Quack-Chyrurgery”.

Once settled in Pennsylvania Wynne became an important figure. He bought and erected property in Philadelphia and took several office-holding positions including speaker of the first two Pennsylvania Assemblies and a Justice of the Peace, but ultimately living in America for only nine years. He is buried in the Friends’ burial ground at Duckett’s Farm, Philadelphia.

And so it was that the boy from the tiny parish of Ysceifiog rose to prominence in the nascent American colonies. As a Welsh medical practitioner of note Wynne is remarkable enough; but as an early Welsh progenitor of a global superpower he is a figure of great historical importance.

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[1] For more on Wynne’s religious beliefs and conversion see Geraint H. Jenkins, “From Ysceifiog to Pennsylvania: The rise of Thomas Wynne, Quaker barber-surgeon”, Flintshire Historical Society Journal, 28, (1977), pp. 39-40

[2] See John Cule, Wales and Medicine (Llandysul: Gomer Press 1973), p. 13

“The infamous Dr Foulkes”: The ‘black villain’ of 18th-century physick

National Library of Wales Ty Coch 22 Add. MS 836d (also known as ‘Piser Sioned’) is, like so many other early modern ‘miscellanies’ an absolute treasure trove of information. Attributed to various authors over a period of several decades, it contains everything from family records to poems, and quotes from Tyco Brahe.

In the first few pages are records of ‘unfortunate days of the year’, alongside remedies for sore tendons and records of books that the anonymous author had lent to Arthur Jones. One of my particular remedies in the book is this one:

“An approved imparabl’d medicine to eat anie overgrown film over an eye

R;/ The green part of a goose dung fresh (or at least very juicy) it will not be fitt after 16 or 24 hours, drop the juice thereof into the Eye with the dew that falls on the first, second or third day of june, wch you must provide or procure in that season. The first does the effect, the second clears the Eye, it does nt smart at all, and nothing has been found better as yet”

Needless to say that putting fresh, “green” goose dung into your eyes is probably best consigned to the book of history. Let’s just take it as read that people at the time believed it would do them good, and leave it at that!

Elsewhere in the document, however, is a record that is starkly at odds with the more generic and haphazard notes that make up the majority. It is unsigned, making it difficult to verify the allegations being made, but appears to relate to someone who has first-hand knowledge of the events being described. First taking the form of a vernacular poem, the verse is dated 1716 and headed:

“To the infamous Dr Foulks, Dr of Physick and Rector of Llanbedr in Denbighshire”.

It is worth quoting the first two verses to get a flavour of the allegations.

Thou Holy letcher thou religious cheat

How shall I halfe thy horrid guilt repeat

Now but my colours strong enough to paint

The blackest villain in a seeming saint

Doe lay thee open to a publick vicar

For greater crimes than ever Judas knew

Thou art, what shall I say, thou art alone

Whose sins epitome, all sins in one

…

And yet

Thou art too vile to live too bad to die

Nor canst thou from deserved vengeance fly…

 

by philtrers force and sympathetick charms

Oh! Black physician to the fernal Tribe

Who canst for soul and body to prescribe

But such designs thy medicine impart

That both are ruined by the cursed art

 

“Quick, Strait, begone from Wallia, Fruitful Isle

To some far distant unpregnated soile”

 

Strong stuff. “The blackest villain in a seeming saint”, “Black physician to the [in]fernal tribe”. Clearly he was a notorious figure in Llanbedr. But who was this “Dr Foulks…and what had he done?

The Reverend Robert Foulkes of Llanfrothen, Merionethshire, was indeed an M.D. who had graduated from Oxford in 1725. This Dr Foulkes was a correspondent of some of the most eminent physicians of his day and, in 1718, had set up his own physic garden at Cambridge. He wrote to Welsh luminaries such as Edward Lhuyd (then at the Bodleian) on the subject of botany, and was considered to be an authority in his field. Reportedly of delicate health he died young. All in all, this does not sound like the sort of man to inspire the vitriol of the ‘Piser Sioned’ author.

By incredible coincidence, however, there was another Robert Foulkes, also a vicar and physician, at roughly the same time, and it is this man who is the more likely candidate. The Reverend Robert Foulkes of Llanbedr Dyffryn Clwyd, Gwynedd, indeed seems to be the subject of the poem but he is a shadowy figure. Little can be found about either him or his medical practice so we have only the poem to shed light. What had he done to elicit such contempt? Luckily for us the poet left a few lines of narrative to fill in the blanks. At the very end of the poem, written in the margin, is the following note:

“The subject is now too well known but futurity may drown it in oblivion, unless it be commemorated in writeing as thus,

The s(ai)d doctor was guardian to the young ladies of Llanerch in Flintshire with(?) the Davises. He debauched one at 13 years of age and gave her physick to prevent conception. He lay with her 15 or 20 years, at last she refuted physick and conceived, she was delivered privately, he disowned the childe, but s(ai)d he had to do with her mother and did not know(?) but the child might be his grandchild – a black villain”

 

So Dr Foulkes’ sins were laid bare. It is unclear whether this poem was ever published but it would fit the sort of libel that could be distributed around a local area or pinned up in prominent places. Since the “subject [was] now too well known” it seems that Foulkes already had a soured reputation. That he was a vicar, entrusted with the moral and spiritual health of his parishioners, would have been difficult for them to accept. That the sins occurred with young women with whom he had been entrusted with their care would surely have been worse. Even when faced with the allegations and the presence of an illegitimate child Foulkes seemingly refused to take responsibility.

I’m still on the hunt for information about this ‘black villain’ and it would be interesting to find out more about him. Vicars who practised medicine were not uncommon, but those who inspired such venom as did Dr Foulkes certainly are. Sadly, it seems that figures of authority or fame who used their positions to exploit or abuse others are not just a modern phenomenon.

Eighteenth-Century fashionable diseases, and the dangers of crowded rooms.

“Fashion, like its companion luxury, may be considered as one of those excrescences which are attached to national improvement; Whilst one part of a polished nation is assiduously engaged in cultivating the arts and sciences, another part is not less busily employed in the invention and regulation of its fashions”.

So wrote James McKittrick Adair in 1790 at the beginning of his Essays on Fashionable Diseases. Adair was a medical luminary. According to the blurb at the start of his book he was variously a member of the Royal Medical Society, a Fellow of the Royal College of Physicians of Edinburgh, Physician to the Commander in Chief of the Leeward Islands and colonial troops, a judge on the Court of King’s Bench…the list went on.

As a physician to the wealthy Adair was in prime position to observe the types of conditions that afflicted his clients, but also the types of conditions that were becoming fashionable. The eighteenth century was perhaps the golden age of the ‘trendy’ disease. Where once sickness had been something feared and malign, some conditions were now becoming if not desirable then not unwelcome either. This was the age of the ‘heroic sufferer’; letters became filled with narratives of illness, commonly with the writer fashioning themselves into the role of embattled victim, wrestling with almost overwhelming symptoms and constantly surprised that they even had strength to hold a pen. These were the types of people who seemingly darkened the door of McKittrick Adair’s consulting rooms.

Of the evil influence of ‘fashion’, Adair was in no doubt. No longer was it just contained to dress, but influenced manners, politics, morals, religion and, worst of all in his view, even medicine was becoming enthralled to the “empire of fashion”. Whereas fashion had long influenced people in their choice of doctors, it was now influencing their choice of diseases too. This is how Adair explained the rise of fashionable diseases.

When doctor and patient were both persons of fashion, the patient would enquire of the doctor what condition their symptoms displayed. The doctor, not wishing to offend the polite patient’s ear with a lengthy medical discourse (or perhaps even not knowing!) gives the symptoms a general name – e.g. nervousness. As sickness and symptoms are a popular topic for discussion, the patient speaks to others and ascribes similarities where, Adair argued, none exist, but soon the condition becomes widespread…and fashionable!

In the early part of the eighteenth century “spleen, vapours or hyp was the fashionable disease”. Thirty years previously, a treatise on nervous diseases had been published by a professor of physic at Edinburgh. “Before this”, Adair argued, “people of fashion had not the least idea they had nerves”. At some stage an exasperated apothecary of his acquaintance, bowed under the weight of symptoms from a wealthy patron exclaimed “Madam, you are nervous!”. As Adair put it “the solution was quite satisfactory, the term became fashionable and spleen, vapours and hyp were forgotten”.  But the process didn’t end there…

The ‘faces’ of nervousness and biliousness. (Courtesy of Wellcome Images

“Some years after this, Dr Coe wrote a treatise on biliary concretions, which turned the tide of fashion: nerves and nervous diseases were kicked out of doors, and bilious became the fashionable term. How long it will stand its ground cannot be determined”.

In many ways Adair was forward looking, and questioned the role of his fellow practitioners and their ministrations. He was particularly frustrated by the old Galenic practices of bleeding and purging, which still clung on in the late eighteenth century. “The idea of bleeding and purging each spring and fall, to prevent fevers and other diseases, was formerly very general in this country”. This was due to the “ignorance and knavery” of rural medicators who, he argued, feathered their nests by “disciplining whole parishes” in this way.

Worse still, many patients who only suffered slight complaints were now given to violently purging themselves using an array of potent substances from magnesia, salts and rhubarb to James’s purging pills, which destroyed the very health that they were trying to preserve! Adair’s point was that people were simply overdoing it with medicines. Instead of the odd purge, potion or pill, people were taking them every day, ill or not, to the extent almost that the cure became the kill!

Adair had other words of warning for the fashionable, in terms of their continued attendance at packed society balls. In places like Bath, where Adair had his practice, fashionable functions were everywhere and life for the well-heeled was a constant round of parties, balls and visits. Danger, however, lurked in this lifestyle.

Just as blacksmiths, bakers and glassmakers were weakened by the excessive heat of their trades, he argued, so the cramped, airless fug of the ballroom was deeply injurious to the human body. Heat and fire could only hurt the delicate constitution so, once again, in their quest to be fashionable, the dandies and fops of Bath society were putting their health in danger.

Part of the problem was the noxious air that became trapped in crowded rooms. The smell of sweaty, unwashed bodies mixed with stale perfume, alcohol and coal smoke to produce a toxic miasma that threatened to overwhelm those delicate constitutions. The very atmosphere of Bath made the whole situation worse, surrounded by hills and therefore trapping the residual warmth and creating a cauldron-like atmosphere. The steam from the hot baths added to this, as did the fires caused by so many visitors in their lodging houses. Bath was the modern Babylon as far as McKittrick Adair was concerned.

His book is interesting as it sits right on the cusp of change. He was ‘modern’ enough to see the changes in medicine and disease, but still essentially rooted in ideas of the past, e.g. the concept of bad airs and heat. He wrote as a professional who criticised other professionals but still took the same position as did elite physicians of the 16^th and 17^th centuries, who complained constantly about quacks and empiricks.  Most of all Adair’s book fizzes with Enlightenment style and language, but also seems oddly familiar in tone. Even at 200 years distance, it feels like we could hold an interesting conversation with this man.  What stories would he be able to tell us about his clients?!

The English Priest’s Powder: A 17th-century quack doctor’s advertisement

The marketing strategies of 17^th and 18^th-century quack doctors are now familiar territory. As Roy Porter’s outstanding book Quacks did so well to bring alive, early modern Britain was a vibrant medical market, a panoply of colourful characters and dubious remedies. They were, to use Porter’s phrase, “a ragtag and bobtail army of quacks”.

Taking advantage of the newly-available cheap print, quack doctors produced reams of advertisements to peddle their wares. Ranging from brief, straight to the point details to more sophisticated means of selling, quack doctors were often skilled wordsmiths; in many ways they needed to do something to stand out from the crowd. With so many different medicines and vendors jockeying for position, they needed to be innovative. This might include elaborate descriptions of the virtues of their medicine. They often included testimonials from those who, they claimed, recovered through the use of their pill or potion. They might use imagery to embellish their advertisements. Occasionally, though, some particularly innovative strategies can be found. One of my favourite is the clever tool of selling without appearing to sell. One of the ways this was done was by disguising the advertisement in the form of a book. A case in point is the engagingly titled Riddles mervels and rarities: or, A new way of health, from an old man’s experience, published in 1698 by Thomas Mace.

Title page from ‘Riddles and Mervels’ – availble on EEBO (copyright)

At first glance this appears to be a typical ‘self-help’ book, a genre popular in the period. In his opening preamble, Mace sets out his philosophy that age and experience are better than any university-trained, licensed physician. Anticipating howls of derision from the faculty, Mace acknowledged that “I am no physician either by education, graduation, licence or practice’. And yet, he argued, a man like himself of 80 years knew his own body better than any young man of 20 or 30 who had merely spent 5 years reading books in a university. Compelling stuff!

The first hint that all might not be as it first seems occurs early on with the inclusion of the following:

“TO Prevent all Frauds, know, That This Rare Power, known by the Name of the English PRIEST’S-POWDER, is to be had No where but at These few Places Following, viz. By the Author (Tho|mas Mace) at his House in St. Peter’s Parish in Cam|bridge, near the Castle; And at Mr. Daniel Peachcy’s in St. Buttolphs Parish there: And in London, by Mr. Adam Mason at his House in Old Bedlam near Bishops|gate; And by Mr. William Pearson, Printer, at the third Door in Hare Court in Aldersgate-street near the Meet|ing House; And by Mr. John Vaughan, Milliner, at his House in Grivil-street near Hatton Garden; and by Mr. Will. Benson in the Old Baily”

Indeed, advertisements in ‘proper’ books were not unusual, but the alert reader will no doubt note the name of the creator and seller of the powder…one Thomas Mace – the man who claims to be no physician. Disguised within an ‘explication of the title page’, the sell goes on…

“Universall-Physical-Me|dicine, for all sorts of Constitutions, and all sorts of Maladies, Sicknesses, and Diseases, is a Chymical Prepar’d Powder which for some late years past I have Publish’d in the Name of the English PRIE                         T’S POWDER, and which it self is never to be Taken, either Inwardly (as Physick) nor Ap|plyed Outwardly to any Wound, Sore Scab, Bruise, Swelling, Pains, Aches, Head-Ach Rheumetick-Sore-Eyes, &c. All which, and many more, tis most Ad|mirably good for.) I say, it is never (it self) to be us’d or Apply’d (as Me|dicine) But (only) a lycture, which It sends forth, into some Certain Li|quors; into which it is to be Infus’d, for some certain Hours: And Those Li|quors, (Retaining its Virtue) are only to be us’d; And (as Physick) are to be taken, into the Body, in the way of Potion; [...]ther for Vomit, Purge, Glister, or Sweat; But in the way of Chirurgery, are only Outwardly Applyed, by Washings or Bathings &c.

As the book progresses, it seems to revert to the ‘every man his own physician’ style. Mace assured the reader that his intentions were honourable and that he only wished to “Accommodate the Meaner sort of Men; but more especially the Poorest of all, who stand most in Need of Help and Comfort in their Sicknesses, seeing no Great and Skillfull-Physicians, will so much as look after Them, or scarce think of their Miseries; so that many Thousands live in Misery; Languish and Dye, for want of That which every ordinary House keeper might Easily Purchase, and not only have the Benefit of it for himself and his whole Family, during his Life, in all common Sicknesses, and Disea|ses, but might also be assisting to all his Poor Sick Neighbours round Him”

There follows a discourse on the Philosopher’s stone, including several pages of what can only be described as vernacular poetry. A short stanza should suffice:

MUch Talk has been of The Philosophers-Stone,
From Ages past; That by its livge alone,
‘Twould turn Inferiour Metals into Gold.
A Glorious Worder sure, if True; but Hold!
Where is’t? Who has’t? we no such Thing can see;
‘Tis surely Folded up in Mystery

There is even a page of music to allow the reader to literally sing the praises of the remedy!

EEBO (Copyright)

But the next sections of the book, although clothed in a discussion of the miraculous effects of the philosopher’s stone, are in fact a shining example of pure quack rhetoric. On first glance it seems that Mace is merely reporting the effects of the ‘philosopher’s stone’ on a range of conditions. But, looking more closely, his ‘priest’s powder’ has been cunningly woven into the narrative. A clue comes in the title to his first section – “The admired use of this powder (or stone)”…which one is more prominent?!

The real clincher comes in the “Eight eminent stories” of the power of the “powder (and stone)”.  Ranging from the dying man who could not sit upright but recovered almost as soon as he had taken the powder, to the cured leper, to the woman suffering from yellow jaundice, whose “foul, corrupt stomach” was poisoning her food, all were miraculously brought to recovery not only by the mysterious priest’s powder but by the personal intervention of the ubiquitous Thomas Mace…who, as he was no physician but knew his own body, clearly just happened to be passing!

This was selling by not selling. The reader, perhaps expecting a list of cures and remedies for all ailments, and lulled by the promise of being able to cure themselves of all maladies without the need for physicians, surgeons or apothecaries, was instead subject to stealth marketing. Mace provided everything about his powder, including where to buy it and how to use it, but disguised it in a discussion of the ‘Philosopher’s stone’ to try and locate his ‘Riddles and Mervels’ as a scientific discourse. Clearly this was an advertisement, but it shows the innovation of medical retailers, and the lengths to which they went to sell their goods. Little is known about Mace. By his own admission he was an old man, but was he someone with a genuine concern for his fellow man, or just another medical entrepreneur, out to make a fast buck. You decide.

A Welsh doctor, Sir Hans Sloane, and the disappearing catheter!

**WARNING: CONTAINS SOME GRAPHIC DESCRIPTION OF A PARTICULARLY UNCOMFORTABLE SURGICAL TECHNIQUE**

In 1720, Dr Alban Thomas was something of a high-flyer. The son of a Pembrokeshire cleric and poet, Alban first matriculated from Oxford in 1708, became librarian of the Ashmolean museum, assistant secretary of the Royal Society and, if that wasn’t enough, obtained his doctorate in medicine from Aberdeen in 1719. At a time when Wales was still a largely rural country, with no medical institutions of its own and fairly poortransport and road infrastructures, these were exceptional achievements for a boy from Newcastle Emlyn.Also unusual was that Alban appears to have returned to Wales to set up his medical practice; many Welsh practitioners who had trained in Oxford or London chose not to return, choosing the potentially more lucrative market of the larger English towns. Nonetheless, especially in and around the growing Welsh towns, there was still a relatively wealthy Welsh elite to cater for and some, like Alban, positioned themselves to serve the denizens of large estates and houses.

It is clear, though, that Alban still had connections. One of his correspondents was no less a luminary than Sir Hans Sloane, the Irish physician to the fashionable and, indeed, the royal and, later, president of the Royal Society. Surviving letters from Alban Thomas to Sloane suggest that theirs was a fairly regular correspondence, with Sloane acting in an advisory role for particular cases. It is one particular case that interests us here.

Sir Hans Sloane

In November 1738, Alban Thomas wrote to Sloane regarding a patient, Sir Thomas Knolles of Wenallt, Pembrokeshire, who was causing him concern. Knolles, although “a person of great worth, candour and humanity” was also “a person of very gross habit, of body an unusual size and make and about 20 stone weight with an appetite to his meat but very moderate in his drinking”. Knolles enjoyed exercise but, due to his size, this was often done on horseback.

At some stage, Knolles had become ‘dropsicall’ and suffered from swollen legs. The doctor used a combination of diuretics and tight, laced stockings to countermand this with, he reported, some success as Knolles returned to health, requiring only the odd purge as a ‘spring clean’. About four years previously however Knolles had begun to complain of a swelling in his scrotum, which Alban Thomas assumed to be hydrocele – a condition causing grossly swollen testicles (sometimes treated by injecting port wine into the testicles). After drawing off “about a quart of limpid serum” from the stoic Knolles testicles, followed by a dressing and strict recovery routines, the doctor hoped that he had cured the condition for good. This proved to be premature.

A selection of bladder stones and calculus

When Knolles began to complain sometimes of not being able to pass urine at all, at others a few drops and occasionally losing his bladder control entirely, he took it upon himself to get a second opinion from an unnamed doctor in nearby Haverfordwest. This physician prescribed a ‘Turbith vomit’ which wrought well and even caused Knolles to void a stone about the size of a kidney bean. Rather than being put off by this occurrence, Knolles was encouraged and began to pester Dr Thomas to give him more of these treatments. Unimpressed and undeterred,Thomas decided on a more proactive course. After putting Knolles on a course of diuretic medicines, liquors and balsams for a week he brought in to his consulting room. What happened next highlights the particular horrors of early modern surgery.

When Knolles arrived, Dr Thomas first applied a Turbith vomit, hoping that “so rugged a medicine” would clear the blockage without the need for more invasive procedures. It didn’t. In fact, the symptoms grew worse. It was at this point that Dr Thomas reached for his catheter and introduced it into the unfortunate Sir Thomas’s member. Expecting some resistance, he was surprised to find that the catheter went in without resistance. “On the contrary it seemed to force itself out of my fingers after passing the neck of the bladder as if it was sucked in, which I thought was owing to the pressure of his belly, the crooked end was now upward”. Yes, you read it right. The catheter was ‘sucked’ out of the doctors fingers and upwards further into the bladder! Now, any male readers may want to cross their legs!

In an attempt to probe for the stone that he feared was lurking in the bladder, and to release some water, Dr Thomas decided to turn the catheter around. At this point, the poor patient “cryed out with some violence…TAKE IT OUT I CAN BEAR IT NO LONGER”. Happily for Knolles the catheter came out “with as much ease as it went in without one drop through it or immediately after it”.

Three months later, the patient was still suffering, with the addition of great pain, defying all attempts for his relief. Despite being a “hail, hearty man having good lungs but lyable to hoarseness” and the occasional cold, Alban Thomas perceived him to be a healthy man. His efforts to treat Knolles had so far failed and he appealed to the eminent Sloane to help him “form a right judgement in this case”.

And so we leave the story there. What happened to Knolles is unclear, but the pain of his condition can only have been matched by the pain of his treatment. Suffering a succession of violent vomits, pills, electuaries and, finally, a wandering catheter, it is almost amazing to think that he ever went near Dr Alban Thomas again. Such (uncomfortable) cases remind us of the situation facing patients in the early modern period. For some the decision to see a doctor must have been a balancing act between bearing their illness or facing treatment.

Appreciating the doctor in early modern Britain!

What was the position of the practitioner within the seventeenth-century community?  How did people regard both them and the services they provided? It has often been said that doctors were unpopular. It was, after all, the local doctor’s prescriptions that commonly made you either violently sick, gave you diarrhoea or otherwise left you similarly disadvantaged or distressed. ‘Damn the Doctor’ ran the title of one seventeenth-century satire. Advice given to Lord Herbert about his health in 1681 suggested that he “never see a damn’d doctor again as long as ye shall live”. According to the poet Bernard Mandeville, “Physicians value fame and wealth/above the drooping patient’s health”. Were doctors really disliked that much?

(Courtesy of Wellcome Images)

In fact, there is much evidence to show that people appreciated the services of their local practitioners. This was, remember, a world of sickness. Danger lurked in bad airs, unwholesome environments, noisome streets, unwashed bodies and verminous bedding. It has even been argued that most people felt ill in some way for most of the time.  The local doctor was by no means the answer to all of this; but, (s)he was one weapon in the continuing war waged upon sickness and disease.

It is difficult to access ‘ordinary’ people’s views about practitioners. One way we can do this is through their testimonies in prosecutions, giving a rare chance to hear the actual voices of patients. But, obviously, these only tell us of cases that had gone wrong. Finding testimonies to practitioners who had obviously done well is more challenging. One possible way to do this, though, is through the surviving records of community testimonials to the skills of their local practitioner.

For some doctors, to achieve some level of legitimacy (perhaps more for themselves than their patients) meant obtaining a licence to practice from either the Royal Colleges, the Archbishop of Canterbury or one of the various diocesan bishops. In theory, and indeed in law, all physicians should have obtained a licence, but this was neither practical nor easy to enforce beyond London and its surroundings. Nevertheless, one aspect of applying for a licence was providing some sort of proof of good, charitable or successful practice in a particular neighbourhood.

(Picture courtesy of Wellcome Images)

When David Davies of Llangurig applied for a licence to practice from the Bishop of Bangor in 1749, no less than three local vicars testified that the “said David Davies is a very usefull person in his neighbourhood, has performed several cures in surgery, and (as far as we are judges) we think him a person worthy to be licens’d”.  (National Library of Wales MS Bangor Episcopal B-SM-2).  The supporters of Richard Davies of Llanynys stressed that he was a “person of good character” and “hath performed several cures in surgery”. (NLW MS Bangor Episcopal B-SM-3). When Benjamin Powell of Brecon applied for a licence in 1708, a list of local parishioners supported his application, stating that he was “a p(er)son who is commendably instructed both in the art of Phisick and Chirurgery and is very much Experienced in both the sayd arts, as being one who hath undergone and p(er)formed severall great and desperate cures”. (NLW, Church in Wales Diocese of Llandaff episcopal 1, MS 1194).

It is worth mentioning too that it was not only men, nor ‘orthodox’ practitioners who could rely upon the support of their communities. In fact, where an unlicensed practitioner faced prosecution, the people of Ledbury in Herefordshire intervened and petitioned the Bishop of Hereford to try and save her from prosecution:

“Sir,

The bearer is an honest poor woman of ye parish of Ledbury, who is as far as we are informed, cited into your court for practising surgery. She sometime ago cured a pauper of our parish who had at that time seven small children of a sore breast, without any prospect of reward; and ye parish, hearing of ye service she had done them, ordered ye overseers of ye poor to give her five shill: wch is ye only act of this nature of we can hear she ever did. This matter being so very malitious, we request the favour she may be discharged. She is very poor therefore we hope it may be with as little expence as possible…” (NLW Bodewryd (2), MS 380)

In terms of financial gain, not all doctors were out to fleece their patients. It was not uncommon for practitioners to tailor their bills towards the financial means of their patients. A poor patient might even be treated free, or for a few pennies; a wealthy yeoman might have to spend a few shillings. Also, the local parish authorities could intervene to either bring a practitioner to attend to a sick parishioner or, alternatively, send a parishioner to a large town to secure the services of a well-known or well-respected doctor.

It is worth mentioning too that early-modern people had perhaps a different level of expectation with regard to what the doctor could do. Today, we go to the doctor and expect to be diagnosed – instantly – and sent on our way with a prescription for a ‘cure’. This worked slightly differently in the seventeenth century. When people went to the doctor, they engaged in a two-way dialogue to agree diagnosis and secure a receipt or preparation. Once this was obtained it is questionable whether the early-modern patient expected to be cured. Rather, they hoped to be cured but, if this didn’t work, there were plenty of other doctors and receipts to try – often gleaned from friends and neighbours. If they did recover, naturally they might attribute that recovery to the doctor and his preparation. This would then be retained for future use as a ‘probatum’ (proven) remedy. In this sense, the doctor might easily escape sanction if his cures failed, as the patient was only using his services as one of a range of options in any case.

Before we write off early-modern practitioners as figures of distrust, dislike or ridicule, it’s worth remembering that they were often valued members of a community whose efforts to help their fellow parishioners were appreciated. Often treating the poor for free, and providing an important source of medical knowledge and goods, they offered some degree of comfort in a world where sickness was ubiquitous.

Lady Elinor Stepney and the Georgian ‘Heroine Pill’

In many ways, Lady Elinor Stepney of Llanelly, Glamorganshire, (born 1702) had everything going for her. She was the only daughter, and therefore sole heiress, to the fortune and lands of her father John Lloyd of Llangennech, including the picturesque house of Buwchllaethwen near Llanelly. She married John Stepney, heir of the wealthy patriarch Sir Thomas Stepney of Llanelly, and together they had five children; Margaretta (b. 1718), Justina (b. 1719), Maria (b. 1721), Thomas (b. 1724) and John (b. 1726).

Buwchllaethwen House – ancestral home of Elinor Stepney

By the late 1720s, perhaps unsurprisingly, given that she bore so many children in such a relatively short space time, Elinor was somewhat delicate and prone to bouts of illness. But these were no attacks of fashionable nervousness or fainting; she was chronically ill. Information about her ailments is sketchy, but a series of letters from Elinor, her husband John, and some prominent medical practitioners, can help us to recreate what was an increasingly desperate situation.

It is difficult to say, from nearly 300 years’ distance what was wrong with Elinor, although a common theme seems to have been chronic stomach pains and fits. In January 1729, for example, she was suffering from “Colical pains”, and had regular fits which left her debilitated and weak. According to her husband, after having “escap’d her fits from Tuesday to Sunday” but then was stricken with terrible pains that “seized her in her stomack, side, back, gut…with a palpitation of the heart & thence it dispers’d itself in to her stomack as before, then to the back and both the sides, the violence of which would throw her into small fits, & her stomach very much swelled”. Even down the centuries, this account of the “violence” of her pain is striking.

It is clear from other clues that Elinor’s sickness had an impact on the family’s life. It was said that the Stepneys rarely left Llannelly House, preferring the peace and solitude of a country life. But, clearly worried about his wife’s deteriorating condition, John Stepney was determined to seek out the best medical advice that money could buy, and this often took he and his wife outside their native countryside and to one of the most busy and cosmopolitan cities in Georgian Britain.

One of his Stepney’s correspondents was Dr John Powell of Carmarthen, in many ways an unusual Welsh practitioner. Powell was distinguished from his many unlicensed and unorthodox colleagues by having gone to Lincoln College in Oxford, achieving a BA, MA and MD. He was licensed by the Bishop of Llandaff to practise medicine in the diocese of Llandaff, Hereford and St Davids and letters testimonial to his skills were signed by several medical luminaries, including the president of the Royal College of Physicians in London, Thomas Witherley.  Unusually, given that many Welsh doctors who left the Principality to train subsequently set up practice outside Wales, Powell returned to Carmarthen and counted a number of wealthy Welsh gentry amongst his clients.

But Powell also seems to have taken advantage of the popularity of the newly fashionable city of Bath, and especially its growing reputation as a place of healing, as it appears that he sometimes held a practice there.  Even more interestingly, his consultations were not always held alone; letters suggest that he occasionally held court with another rising medical star – Richard Mead. Mead was a celebrated Whig physician and medical author who had attended Padua and Leiden, and studied under the famous Herman Boerhaave. He was a fellow of the Royal Society, fellow of the Royal College of Physicians and was physician to George II. Amongst the exclusive clients who made their way to Bath to consult these two luminaries were Sir John, and Lady Stepney.

Richard Mead (1673-1754)

Powell first corresponded with John Stepney, their letters discussing Elinor’s health, and mentioning the consultations in Bath, the prescriptions given and offering further advice. At this point it seems that Elinor was the third party. John Stepney seemingly took responsibility for ordering the many medicaments that Powell prescribed, generally including purges, vomits and various electuaries, pastes and juleps. In January 1729, for example, Powell recommended “a paper of cordial powders” to help with her stomach pains, as well as a “stomack plaster to spread and apply to her stomack”. If she found herself “bound”, she could take “2 ownces of purging tincture” to relieve her symptoms. From Dr Mead came the advice to take chalybeate tincture, and drink “bitter decoction” and peppermint waters. These were well-known digestifs and were clearly targeted specifically at her symptoms.

A common theme in the letters is that of the sheer amounts of medicines that Lady Stepney must have been taking. So much so, in fact, that she frequently ran out and even, on occasions, depleted local supplies so much that emergency doses had to be obtained from Powell in Carmarthen, but even from London. In September 1725, there was even a note of irritation in Powell’s letter to John Stepney regarding the increasing demand. “Had your lady spoken to me that she would have her things made by our apothecary here” he wrote “I would have sent them to her by the first carrier when I came home”.  As a result, he chastised Stepney, “she has lost a pretty deal of time both in takeing the medicines & drinking ye waters”. Powell immediately sent for another batch of medicaments, including a “fresh cargo from London”, including “a Vomit, 2 Doses of Purging Pils, a Paper of Ingredients for a bitter wine, anchovies, Garlic Electurary” and a “Antiscorbutic Electuary”.

By 1730, Powell was corresponding directly with Elinor herself, and it seems that her treatment had now included visiting Bath again to take the waters, although the sulphourous liquids did little to ease her discomfort. In June 1730 Powell noted that her stomach “acted indifferent” to most types of food and that she should stick to drinking asses or goats milk until such time that she could bear to take the waters again.

It also seems that Powell was becoming increasingly concerned about Lady Stepney’s apparent habit of staying indoors.  It was imperative, he argued, that she “use exercise to get out into the air more or less everie other day, if not everie day”, and for three to four miles every morning, whether walking or on horseback, or even in a coach “if it be inclement weather”.  This, he argued, would “restore your lost Stomack and Appetite and cause all ye animal functions to perform their proper office”. Such themes of natural, animal constitutions, vigorous exercise and fresh air, were common in eighteenth-century medical thought.

But one of Powell’s prescriptions to Elinor stands out particularly from the page. On returning from a consultation in Bath in May 1731, Powell made reference to some prescriptions from Richard Mead, and to one pill in particular. These pills were made from “Russia Castor, Goa stone & wild valerian, with the syrup of compound peony”.  These pills were designed to ‘loosen’ the constitution, and be taken in conjunction with a cordial julep. The pills, Powell stated, “I call ye heroine pills”. Not to be confused with the Class A drug, it is interesting that the use of the name predates the latter use by 250 years. Perhaps Lady Stepney was one of the first in history to partake of a dose of ‘Heroine’.

Unfortunately there is no happy end to this tale. Elinor died in 1734, at the young age of 32. Her memorial reads:

“Near this place rested the body of Mrs Eleanor Stepney wife of John Stepney Esquire, and daughter of John Lloyd of Llangennech, Esquire. She was a most obliging, endearing wife, a most tender but prudent Mother; happy in all valuable endowments, religious and moral; constant in her devotions to God, ever sincere to her friends, charitable to the poor, just and benevolent to all, a pattern truly worthy the imitation of her sex. In her husband’s affectionate esteem she still lives and as an instance of that esteem this monument is erected to her memory. She died the 3rd of January 1733/4. Aged 32 years”

Despite the best efforts of her husband, family and some of the most prominent medical practitioners and treatments of her day, Lady Elinor was ultimately helpless in her ongoing battle against her unknown malady. The striking accounts of her treatments and suffering provide us with a useful, if ultimately tragic, account of the experience of sickness in eighteenth-century Britain.

Medicine by Post: A 17th-century doctor’s directions

Medicine in pre-industrial society was loosely structured. Finding a possible practitioner to minister to your ailments wasn’t difficult; they were virtually ubiquitous. From village tooth-drawers, bonesetters, diviners and wise women across to trained, apprenticed or licensed physicians, the range of potential choices for the early modern patient were legion. And yet, this very ubiquity often serves to mask the most basic element in these encounters; what actually happened. What did the doctor say or do? What was the relationship like between treater and treated?

Early modern doctors could not necessarily command authority. Unlike today, where we go to the doctors to find out what it wrong with us, the seventeenth-century patient effectively self-diagnosed. They told the practitioner what the complaint was, and expected them to prescribe accordingly. In Galenic medicine, people knew their own humoural constitutions and largely determined – through their own knowledge and by reference to others – what this problem was.

Nevertheless, the doctor could claim to have esoteric knowledge about how the body functioned. As far as learned physicians were concerned, while the sufferer might well know what was wrong with them, they did not have the necessary understanding of the body to be able to treat it safely. It was therefore only the trained and licensed physician who was qualified to treat the sick properly…at least that was the claim of the trained and licensed physician!

One means through which we can get an idea of the early modern equivalent of the ‘doctor’s appointment’ is through the occasional letters written to patients by practitioners after such encounters. One such letter I encountered during my PhD research, and is located at Glamorgan Record Office, MS D/DF V/202. It is a letter from 1628 addressed to a ‘Mrs Bridges’ but is (extremely frustratingly) anonymous, since the last portion of the letter is missing. Below is my transcription:

‘For Mrs Bridges

When yow come home yow may begin with the Physick wch yow have from hence so soon as yow will: taking it in a manner following, Provide the like Possetale as you did here. To a reasonable draught of that Posetale yow may put two spoonefull and an half of the opening wine. Mix them and put a little sugar to them to relish them: and so drinke it in the morning fasting. Walke, or use some good exercise after it for the space of an hour and halfe, and fast after it for the space of three howers: then make a light meale of boyled meate. The like yoe may do a little before foure of the clock in the afternoons and observe the like course.

But because your body will be apt to be bounde upon the use (of) this physick, therefore I have set you down some syrupes in a glasse, wherof I would have you to take three spoonefull mixed in the former draught any morning when you please.

And, the day after that the full course of the opening wine is finished I would have you take five spoonefulls of the syrupes to a draught of the former posetale and so drinke them warme. And two houers after take a draught of warm thin broth. And at any time when you are costive you may use a suppositorys made with honey and salt boyled to a height and put a little fine powder of Aniseeds and fenell seeds to it when you make it up.

Be carefull in your diet. Eat noe meatte but flesh as is of an easy digestion: as mutton, veale, lambe, capon, chicken or the like: Avoide all raw salletts, or fruites: But for sallets use capers washed in warme water. And sallett of broome budds, or Asparagus or the topps of young hopps are good. Or Cowslipp flowers candiyed and mixed wth a little vinegar. Or rosemary flowers wth a little vinegar and sugar.

I am afrayd your body will not endure the use of wine: but if you use any Let it be onely a draught of mulled claret wine with a sprigg of rosemary, and sweetened wth sugar, and take it in the middle of your meale.

All salt meates and baked, or spiced meates are nought for you: and milk or milky meates are worse.

Yow must endeavour to be cheerefull and avoyde all passions of fear, anger or melancholye.’

There are a number of interesting elements to this letter. Firstly, it is clear that Mrs Bridges visited this practitioner. The letter itself is virtually a follow-up to the appointment, containing some record of the encounter but, more importantly, a full set of instructions and directions for her recuperation. This suggests that the face-to-face encounter was one stage in a process. Where, today, one generally leaves the doctor’s surgery armed with a prescription, this encounter was holistic, and involved a further stage. Put more simply, the ‘appointment’ didn’t end when Mrs Bridges left the physicians premises. This, too, is an important point. In this case – somewhat unusually – she has visited the doctor, rather than the other way around. He mentions her returning home, and also the physic he sent ‘from hence’.

Also noteworthy is the emphasis upon lifestyle, much of which would seem familiar in today’s health-conscious society. Here, the advice is to eat certain foods at certain times, and then in moderation, to ‘be carefull in your diet’ and, crucially, to stay cheerful, stoic and calm. It is worth noting too that the practitioner is ‘afrayd’ that Mrs Bridges’ body would not tolerate wine, although he did leave the door slightly open for the odd tipple.

In early-modern parlance, this was known as ‘regimen’. As surprising as it might seem, given their seeming predilection for dangerous or disgusting remedies, this was a very health-conscious society. Good health was something to be cherished and maintained. It was far better to prevent illness than to treat it. Mrs Bridges’ practitioner took pains to understand her humoural makeup, and based his comments directly upon this. Medicine, in this sense, was individualistic. It is one of the many contradictions of humoural medicine that a remedy meant for one individual should not theoretically have treated another. In practice, people shared and accrued recipes vigorously.

But what this letter gives us most is a little window into the consultation process itself. It gives us some insight into the processes of consulting a practitioner, albeit at probably the upper reaches of society. Bearing in mind that the vast majority of people couldn’t write, the very fact that this letter survives marks it out as exceptional. As more of these fascinating documents are uncovered, we may start to learn more about the early modern doctor’s ‘appointment’, at other levels of society, and with other types of practitioner.

What is a ‘remedy collection’?: Recording medical information in the 17th century

What exactly is a ‘recipe collection’? The most obvious answer is something like the example shown below, a formal ‘receptaria’ book of medical receipts and remedies. In the early modern period, and across Europe, these types of collections were fairly common, and especially in wealthier households. These were often carefully constructed documents, containing indices and sometimes containing groups of remedies according to various types of remedy, or parts of the body. In many ways these were the high-end of domestic medicine.

But were such formal collections necessarily representative? In other words, did everyone (or at least everyone capable of writing remedies down) collect their medical information this way? No. As a great deal of recent work by historians is revealing, the committal of recipes to paper was often a much more haphazard, and far less regimented, process.

For a start, paper was an expensive commodity in the early modern period. It could often be bought easily enough; apothecaries often sold reams or ells of paper, as did other retailers from merchants to haberdashers. But it was nonetheless quite costly. Unlike today, where scribble pads and notebooks can be bought for pennies, the buying of paper, or a bound book of notepaper, would have been something out of the ordinary, especially for those on low incomes.

Firstly, the recording of remedies was an expedient and often pragmatic process.  Remedies usually spread firstly by word of mouth, with people passing on their favourite receipts to friends, neighbours and acquaintances. As Adam Fox’s work on early modern oral culture has shown (Oral and Literate Culture in England, 1500-1700 (Oxford: Clarendon, 2000)) people had a strong ability to commit information to memory, and this made sense at a time when the majority of the population couldn’t read or write. Nevertheless, for those wishing to record the remedy accurately for future use, there was a need to do so quickly, and often using whatever was to hand.

As such, many ‘remedy collections’ are little more than assemblages of roughly scribbled notes, sometimes on torn bits of paper, sometimes on the back of unrelated documents, and sometimes even including a variety of other information on the same page. In fact, the very survival of many remedies is probably attributable to the fact that they have been incorporated into other, non-medical, documents.

Nevertheless, the recording of remedies in certain types of document was often a more deliberate decision. In Wales, for example, there were several instances of medical remedies being written on notepaper purloined from a church. In one sense this was pragmatic and reflected the simple availability (and probably abundance) of paper, given the needs of the church to keep records. But some were written inside church documents. In parish registers, for example, it was not uncommon to find receipts. A common example was that of a ‘receipt for the biteinge of a mad dogge”, often originally attributed to the register of Cathorp Church in Lincolnshire, but which seemed to move around the country. An example of the remedy, occurring in the Monmouthshire church of Llantillio Pertholey, can be seen here: http://www.peoplescollectionwales.co.uk/Item/7637-a-recipe-to-cure-the-bite-of-a-mad-dog-llanti

In another sense, though, putting remedies in amongst religious verses, as often occurred in commonplace books and notebooks, was a way of allying the remedy to the power of religion. If it was next to God’s word on paper, perhaps it would have more power?

Above all, for the remedy to be of any use, it had to be easy to find when needed. Some, for example, kept remedies within the pages of their business ledgers. Here, the regimented layout perhaps suited ease of future reference. But perhaps most common was to keep remedies within the pages of personal sources. Many diarists noted down examples of favoured remedies, especially when they had suffered from an ailment and attributed their recovery to the taking of a particular remedy.

Commonplace books, notebooks and copy books were also common places for the jotting down of useful information, and could be easily referred to if needed. It was not uncommon to put remedies within pages of miscellany, including accounts, quotes, poetry and family records, locating it firmly within the context of ‘useful’ information. Many literate families also kept letters. Health was a regular topic of conversation amongst letter writers, and it was common to fire off a few missives seeking potential remedies from within one’s social network. When a reply duly came, here was a ready-made receipt that could be kept without needing to write it down again. Prescriptions and directions from practitioners might be especially prized as they represented a virtual consultation, specially tailored to the recipient’s humoral constitution.

One often-overlooked method, however, were medical almanacs. It’s worth looking at a typical example of how these sources could be used. Cardiff Public Library MS 1.475 is a small memoranda book dating to around 1708, and seemingly originating from London, with the names John and Elizabeth Price prominent. A little list of family notes inside the front cover reveal a touching and tragic tale.

“February 10^th 1708/9

Married then to the pretty, the charming Mrs Elizabeth Price by the Rev’d Dr Typing of Camberwell.

My daughter Anne was born the 17 of April 1712 about twenty min(utes) after eight in the morning and baptised the 1. of May

She was a very beautifull, lovely child but God was pleased to take it May 3. 1712”

Much of the document, however, is actually drawn on the reverse side of copies of almanacks. These were part-astrological, part-magical and part-news documents which contained everything from prognostications and predictions to religious dates, weather information and medicine. The first almanac in this document is ‘Merlinus Liberatus, being an alamanack for the year of our Blessed Saviour’s Incarnation, 1708…by John Partridge, student in Physick and Astrology at the Blue Ball in Salisbury Street in the Strand, London”. Partridge was clearly an entrepreneur; the very next page of his almanck is dedicated to ‘Partridges Purging Pills, useful in all cases where purging is required”!

A second almanac pasted into the book is “The Country Physician; or a choice collection of physic fitted for vulgar use: Containing 1) a collection of choice medicaments of all kinds, Galenical and Chymical, excerpted out of the most approved authors 2) Historical observations of famous cures collected out of the works of several modern Physicians 3) A Cabinet of specific, select and practical chymical preparations in two parts, made use of by the Author, by W. Salmon M.D”

This sort of document was a cheap means of buying a ready-made remedy collection, complete with the latest thinking and couched in terms of the layman. There were many self-help volumes of family physick available, but these cheaper almanac and chapbook style documents were easier to read and easier to keep. It is also clear that the spaces on the back of pages were useful places to note down other remedies as they accrued.

For example, the Prices noted down a number of receipts on the back pages, including a receipt “To prevent a return of the ague”, another for the “dead palsy”, including mistletoe, oak and saffron, and another for “flushings in the face”.  Here, then, the printed and the written remedy intertwined to become a completely distinct and individual family collection. In many ways this was as formal a collection as a ‘receptaria’, and probably included many of the same sorts of remedies, but in a different form.

The recording of remedies, and the idea of a ‘remedy collection’, therefore, shouldn’t necessarily be limited to a single, formalised and regimented document. These were organic documents, sometimes constructed carefully, but often just growing as collections of rough notes. Remedies might be deliberately placed within documents, or they might be the result of a roughly-scribbled note. Equally, people might keep ready printed or written remedies, and simply add their own notes as required. In this sense, there is no single ‘remedy collection’ document; instead, there are a myriad different ways in which people collected remedies.

Reviving the ‘apparently dead’ in Georgian Britain

In the course of my research, I often come across great sources which, although they might not be directly relevant to what I’m looking for at the time, make great ideas for future topics. One that I encountered recently, while looking into the history of steel surgical instruments, was the following:

Charles Kite, An Essay on the Recovery of the Apparently Dead (London: 1788) containing “A Description of a Case of Pocket Instruments for the Recovery of the Apparently Dead”.

The question of whether it was possible – and indeed ethical – to revive the dead was certainly a hot topic towards the end of the eighteenth century. On the one hand, an increasing interest in the possibilities created by scientific and technological advances was increasingly rendering the impossible possible. This was the age of technological innovation and artisanal skill. Industrial luminaries such as Benjamin Huntsman, Josiah Wedgewood, James Watt and Matthew Boulton were all investing massively in new technologies, and their creations – from steam engines and pumps to everyday household items – were themselves heralding a new age. Scientific societies offered prizes to inspire would-be inventors to create useful products. Useful, in this case, often meant something that could advance agricultural or military prowess. But, with the creation of the Royal Institution, and an emphasis upon experimentation, endeavours towards the advancement of science for its own sake were also promoted. Science, it seemed, had the potential to unlock many of the mysteries of life and the universe…even death.

On the other hand, however, there was still a lingering tension between science and its relationship with religion. Could, and indeed should, man interfere in the natural processes and cycles of life. In many ways he already did. At the most basic level, medicine itself sought to prevent or delay death, or at least to palliate symptoms. There was some degree of uncertainty about when death actually occurred, and how to discern the point beyond which revival or resuscitation was possible.

Charles Kite’s book was part of a new interest in the question of death, approached from a scientific and essentially detached point of view. Among the types of death that men like Kite were interested in preventing were those caused by drowning. There was, indeed, even a whole society dedicated to the subject!

Accidental drowning represented a large percentage of causes of death, whether by accident or intention. It was also recognised, however, that this was a state that had the potential to be reversed. The opening sentence of Kite’s book reveals something of attitudes towards death by drowning.

“THAT the principle cause of the want of success in the recovery of the apparently dead, is the length of time that elapses before the proper remedies [my emphasis] can be applied, will admit of no doubt. It is equally certain, that this too frequently depends on circumstances wholly out of our power to prevent: but it is no less true, that cases terminating unfavourably often occur, to which, if proper and timely assistance could have been given, it is extremely probable they might have had a more fortunate conclusion”

It is firstly interesting to note that death is something potentially to be “remedied”; this immediately places it out of the metaphysical and into harsh corporeal reality. It is reversible. But more importantly, as Kite recognised, time was of the essence. If speedy assistance could be rendered, then more people could be saved.

The answer, as Kite saw it, was a device that could restart the respiratory process. Such devices were already in existence. In 1775, one “Dr Cogan” had contrived an apparatus and brought it to the attention of the Royal Society. According to Kite, “it soon came into common use and has remained so until the present day”. The problem, though, was one of size. Cogan’s apparatus was unwieldy and the delay in moving it from place to place often meant that the patient was dead (properly dead!) by the time it arrived. It involved, for example, an ‘electrical machine’ which was too impractical to use in the field and could not be scaled down. This image of the proposed apparatus highlights the problem!

Kite’s answer was a set of ‘pocket-sized’ instruments that could be carried from place to place with more ease, reducing the delay and thus raising the chances of successfully reviving the drowned person. Standard practice involved taking blood from the jugular vein of the patient but, depending on the length of time they had been in the water, getting blood from their rapidly deteriorating venal system could be tricky. The solution was to use Kite’s handy small instruments along with anything else at hand – even coffee cups – to draw off the requisite amount of blood, which was seen as the first stage in the process of revival.

Secondly, and more interestingly, though, was the recognition that the “suspended action of the lungs” had to be reversed. This was “of the utmost importance in our attempts to recover the apparently dead, let the original cause be whatever it might”. But how was this to be achieved?

Kite suggested an elastic tube, about twelve inches long, which had an ivory or silver mouthpiece, or bellows, attached to a conical screw. The other end had an ivory appendage to allow it to be passed into the deceased’s nostrils.  One person was to be stationed at the head of the body to insert the tube into the nose, and then to blow air “with force” through the tube. It was the job of the other person (the “medical director”) to keep the deceased’s mouth closed whilst also maintaining pressure on the windpipe to ensure that the air went into the lungs, rather than the stomach.

What is essentially being described here is artificial respiration. Perhaps less conventionally, however, Kite recommended the use of tobacco as a stimulant to further jolt the person back to life. This could be administered either as smoke passed through the tube and into the lungs, or passing it in solution to the stomach.

What can we learn from this source? Firstly, it highlights the sometimes remarkably ‘modern’ attitudes towards the body, and of reviving the dead, thought about and adopted by eighteenth-century medical practitioners. The application of sustained scientific enquiry into the body, together with the knowledge gained from anatomical studies was beginning to have a profound effect on medicine; some see this as the change to a ‘medicalised’ view of health and the body.

Secondly, though, it is a fascinating glimpse into an eighteenth-century medical treatise, written by a practitioner for practitioners. The sharing of essential knowledge, the questioning of accepted truths and the willingness to test new theories all come together to make the eighteenth-century a rich and absorbing period in the history of medicine.