“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?!

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.

“MOVEMBER” Special: J.H. Savigny and innovation in eighteenth-century shaving

It’s ‘Movember’. Like many others I’m currently sporting a handlebar moustache for charity. Unlike many others, mine is ginger, and white at the tips. I can’t decide if it makes me look distinguished or like a third-rate drug peddler. Here’s the link to my ‘Mospace’ – you decide (and please feel free to make a donation – it’s for a very worthy cause).  http://mobro.co/4243057

If I was to be sporting this particular piece of facial topiary in eighteenth-century polite society, it is highly likely that I would be frowned upon. As I’ve detailed in a previous post, facial hair of any sort fell dramatically from favour sometime around the mid eighteenth century. The reasons for this are complex, and by no means mutually exclusive. One strong possibility is a shift in concepts of masculinity. As ‘polite’ society became refined, so fashions for men became increasingly feminised. This was the era of the bag wig, silk hose and face powder – at least for those in the upper levels of society. Facial hair connoted rough, earthy types and was not a feature of the polite gentleman’s visage.

Medicine, too, might have played a part. In the early modern period, facial hair was viewed as a form of excreta resulting from too much heat in the liver. Like any other form of bodily waste, it was being expelled and so to remove it was to rid the body of a potentially harmful substance. But another interesting point is that this period also witnessed an astonishing shift in the technologies available for shaving, mostly made possible by the potential of new types of steel – most notably cast steel, often referred to as crucible steel because of its manufacturing process. Unlike its predecessor shear steel, which could be brittle and of uneven quality, cast steel had perfect properties for the manufacture of razors. It was capable of being sharpened to an extremely keen edge and, more than this, could be polished to a mirror-like shine, meaning that cast steel razors could look beautiful, as well as being functional. But the availability of new materials was not, on their own, enough; what was needed was a new breed of technologically-savvy makers to develop new products. In fact, this was exactly what happened.

London, in the mid-eighteenth century, was a hub of technological and manufacturing expertise. But, we should not think of this in modern terms of factories or large-scale production lines. Instead, there were hundreds of individual small artisanal workshops involved in a multiplicity of trades, many of which required metallurgical expertise. Watch and clock makers, for example, required steel for their tiny components, but also in the tools needed to manufacture them. Makers of scientific instruments likewise needed precision tools to make their highly specialised products, as did surgical instrument manufacturers. It is important to note that many carried out their own experiments with metals tailored to their own individual needs, and this made London a centre for metallurgical innovation. Many trades became concentrated into certain parts of London making mini clusters of expertise.  Into this milieu we can place razor makers and some notable names in particular.

Typical of this new breed of metallurgical innovators was John Horatio Savigny of Pall Mall in London. Savigny was likely of Huguenot descent, his family coming to London in the seventeenth century. The ancestral trade of the Savignys was surgical instrument manufacture, and several others of the family were engaged in similar manufacturing trades. But John Henry, or JH, Savigny as he was often referred to was perhaps the most prominent and widely esteemed.

From his base at number 129 Pall Mall, Savigny was continually involved in the manufacture of a range of metallic goods. In 1778, for example, he advertised his new type of lancet which, he informed “Gentlemen of the Faculty” were made using “a method […] lately contrived whereby these instruments are brought to such a degree of accuracy as will greatly lessen the pain of the patient and totally remove all apprehension of disappointment in the operator”.  Notice the emphasis upon his “new method”, referring to his experimentation with steel.

In 1776, Savigny referred directly to his new methods of manufacture in another advertisement for lancets. Again addressed to “Gentlemen of the Faculty” – i.e. London Physicians, he laid special emphasis upon the fact that “he has invented a new Vertical Machine, particularly calculated for the perfection of Lancets”.  His “Cast Steel Convex Penknives”, according to a 1775 advertisement, had “received the Approbation of the most eminent Writing Masters”, and could be bought in person from Savigny at his shop near the Haymarket.

But it was razor manufacture that really made Savigny’s name and, once again, his experimentation with steel lay at the heart of his advertising pitch. By 1764, his “Razors tempered by means of a new discovered process” could also be bought from his shop. Tempering suggests the remelting and refinement of steel, a difficult and intricate process requiring specialist equipment and knowledge. These new razors were functional and attractive. More than this, they appealed to a new market of male toilette, one in which polite gentlemen were increasingly beginning to shave themselves, rather than visit a barber. A range of new products was becoming available to them, from shaving powders to soothe the face, to travelling kits and even beautifully carved and constructed shaving tables.

Shaving table from 18th-century furniture catalogue

A raft of advertisements followed, with razors often prominent among the products listed. By 1800, Savigny could boast an entire printed catalogue of products, aimed at enticing customers to browse, and hopefully to buy.

Image from Savigny’s instrument catalogue, 1800

But Savigny was keen to diversify beyond instruments, and evidence from patent records shows that he introduced a range of other products. In 1800, Savigny proposed a steel tourniquet to stop bleeding “more effectually than has hitherto been done”. In 1784, he proposed “  A METHOD OF MAKING OF SKAITS, AND PARTICULARLY FOR FIXING THEM ON WITH MORE EASE, SAFETY AND EXPEDITION THAN HATH HITHERTO BEEN DISCOVERED.

Savigny was rapidly becoming an authority on steel, so much so that his expertise was sought by the Birmingham manufacturer and luminary Matthew Boulton, of the Boulton and Watt company. Boulton sought Savigny’s advice on the quality of some new types of steel that he was purchasing from India. Indeed, it was not only in metallurgy that Savigny was seemingly making a name for himself. These adverts suggest that he was an amateur actor, perhaps of less talent than his main business!

All this adds up to a picture of a man who was typical of the new enlightened breed of manufacturers, interested not only in their own businesses, but in the possibilities and opportunities of their age.

In 1789 he attempted to patent his own steel razor. This is an extract from the patent (BL Patent 1716):

“A RAZOR OF AN ENTIRE NEW CONSTRUCTION, FOR THE SHAVING THE FACE AND HEAD WITH MUCH GREATER EASE AND SAFETY THAN ANY OTHER RAZOR OR INSTRUMENT HITHERTO FOUND OUT, INVENTED OR DISCOVERED”

…In the manner following:- Of the purest steel that can be procured, which is to be forged (with very moderate and often repeated immersions in the fire, so that its substance may receive no injury from a separation of its particles by excess of heat, but on the contrary be rendered as dense as possible), into the form of a razor, differing in form from all other razors heretofore made in the cutting part of the blade”.

The problem with innovation is that it can be copied. Whether Savigny ‘invented’ the cast steel razor is unclear, but he certainly had competitors.  Amongst these was John Stodart another London razor maker. In 1788, Stodart himself was forced into some measure of quality control:

“STODART begs gentlemen who send for the above articles, will be so obliging as to observe that his name is stamped on the Blade. This caution is made necessary, by his having had Repeatedly razors sent to be exchanged which never were purchased at his shop. It is with infinite satisfaction, he is able to add, that since the above method of tempering, he finds no difficulty in supplying Gentlemen with Razors, which with the assistance of a good strap, perform at all times agreeable to their wishes. “

The razor market was becoming highly competitive by the late eighteenth century, and many other makers rose to prominence, such as James Stodart, Benjamin Kingsbury and Daniel Riccard, all of whom used the ubiquitous newspaper advertisement columns to push their products. Others, like Edward Greaves of Sheffield in 1804, continued to develop the razor, this time suggesting springs to create three lockable positions, making the razor more functional and adaptable.

But the salient point here is how far facial hair, and specifically its removal, carried significance in the eighteenth century. Much time, energy, money and advertising space was expended by manufacturers keen to make their products most prominent. The process of shaving was loaded with social significance; to be facially hirsuite, as I have said, was undesirable. It could therefore be argued that the humble moustache or beard played a central role in spurring metallurgical innovation in Georgian Britain. Far from being a mundane everyday experience, the history of shaving can actually reveal much more about past societies than we might usually think.

If you enjoyed this post, a pre-publication draft of my new academic article on the history of shaving and masculinity during the Enlightenment can be viewed in the papers section of my Academia.edu page here: http://exeter.academia.edu/AlunWithey

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.

Seeing History: The rise of spectacles in early modern Britain.

The percentage of people in the UK requiring either spectacles or contact lenses has risen over successive decades. It is difficult to put exact figures on this; some estimates suggest that over 68% of the population in Britain currently wear glasses or lenses, and this varies dramatically within age groups. Around 29% of 16-18 year olds require some sort of visual aid; a 2005 report put the figure for the age group 65 and above as high as 98%. It seems that spectacles today have largely shed their pejorative connotations and even become desirable, helped by many high-profile celebrity spec-wearers. Indeed, opticians have even reported a growth in sales of spectacles with blank lenses over recent years, to cater for those who see glasses as a fashion item. This apparent love affair with spectacles is not consistent, however.

A prosthetic eye, possible 17th century.

Until the seventeenth century, eye complaints were troublesome and painful, and effectively seen as a form of disability. The virtual plague of ophthalmic conditions in early modern Britain is attested to by the ubiquity of remedies for eye complaints in remedy collections. Common were remedies for sore eyes, which were often treated (in line with the ‘doctrine of sympathies’) by using substances of a similar constitution to the eye. Remedies using snails were popular; one common example was to impale a garden snail on a pin and let the juice run into the eye. Another recommended using fresh goose dung, its gelatinous consistency resembling the watery eye. Yet another suggested the blowing of dried hen’s dung into the afflicted party’s eye just before they went to sleep. For more on the uses of animal substances in remedies, see Lisa Smith’s excellent blog post on the subject. http://www.wondersandmarvels.com/2012/05/the-puppy-water-and-other-early-modern-canine-receipts.html

Opthalmic surgery was also in its infancy, with a procedure known as ‘couching’ or ‘cooching’ being one of the most invasive operations undertaken, being used for the treatment of cataracts. Here, a small silver instrument called an itinerarium was passed into the sufferer’s eye. The intention was to physically push the cataract film back away from the lens of the eye and thus clear the vision. This was doubtless uncomfortable and seems almost impossible to imagine – bearing in mind the patient was awake and conscious at the time. We shouldn’t assume that it was necessarily dangerous though. The seventeenth-century diarist Walter Powell of Llantilio Crossenny, in Monmouthshire, endured the procedure three times and still carried on with his diary afterwards, so presumably his vision was little worse if it wasn’t much better.

The wearing of spectacles was certainly known in Tudor times. Most typically, these were armless and sat on the bridge of the wearer’s nose. There were other types of device that could be used. Fearing he was losing his sight after years of close working in extremely bad light, Samuel Pepys tried a revolutionary new device in 1668 (the “tubespecticall”) which involved reading through three-inch long paper tubes, which eliminated glare and excess light.  Essentially, however, these were items connected with a physical disability – the same as prosthetic limbs, bandages or trusses.

The 17^th century, though, witnessed the beginning of a shift towards people being more comfortable with what was essentially a form of disability, and this was especially noticeable in portraiture. Fashion was a factor to some extent. In previous blog posts I have noted the use of steel as a desirable material, and shining steel spectacles represented a desirable fashion item. As such, steel spectacles could also be a mark of literacy and wealth.

Eighteenth-century spectacle makers also needed to adapt to the times, and produce items that could fit with current fashions. One of the most important exponents of this, and indeed in many ways a forefather of the modern spectacle designs, were ‘Martin’s Margins’, invented by the London maker Benjamin Martin. These were fairly revolutionary. Rather than sitting on the wearer’s nose, they had spring-loaded arms which enabled them to adhere seamlessly to the head, with less chance of falling off and being damaged.

Martin’s Margins

The eighteenth century was in fact an age of innovation in opthalmics. The optical instrument maker James Ayscough invented frames with long, folding arms to reach around the head, also known as ‘railway spectacles’. ‘Wig spectacles’ were designed with arms to slide into the fibres of a wig, and keep them in place – especially important given the increasingly ebalorate coiffeurs of the elites. The gradual introduction of steel springs in nose-pieces also helped fitting. The lenses of spectacles also developed through the eighteenth century. Around a third of the lens in a pair of ‘Martin’s Margins’, was filled with ox horn, to restrict light. Other developments included D-shaped spectacles in the 19^th-century, which had side visors which provided protection from dust and light. A self-portrait by Sir Joshua Reynolds depicts him wearing a pair of wig-spectacles:

Reynolds Self Portrait © PCMAG

To be depicted in spectacles drew attention to the eyes, and the vision of the subject, perhaps literally or notionally. Conversely, though, spectacles could also be used in morality paintings to emphasise undesirable traits, such as miserliness. This portrait of Benjamin Franklin shows him squinting to read a document through his new-fangled spectacles:

There was also a medical aspect to the use of spectacles: too much light was seen as potentially injurious to vision, and spectacles were sometimes designed to restrict the amount of light entering the eyes. Tinted lenses, especially green, were considered to be therapeutic in the 17^th century (note the green lenses in the ‘Martin’s Margins’ above too).

So today’s fashion for spectacles has a long gestation, and it is interesting to see how perceptions of eye complaints have shifted over time. In fact, opthalmics has tended to move away from a strictly ‘medical’ field; the optician is now a common feature of the high-street and eye-tests and fittings can be done virtually on a drop-in basis. It is also interesting to note that the wearing of spectacles for fashion is not new. I heartily recommend a visit to the MusEYEum in the Royal College of Optometrists in London, where there is a fascinating library of artefacts and books about the history of spectacles, as well as some rare portraits of spectacle-wearers through history. The blog of its curator, Neil Handley, can be found here: http://www.college-optometrists.org/en/knowledge-centre/news/blog/index.cfm/id/199E66BA-4091-4C98-A53907402DE66669

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.