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

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.

Norovirus and the reporting of epidemics through history

This winter has already witnessed an unprecedented increase in cases of Norovirus – the so-called ‘winter vomiting bug’. For some reason, across the globe, the infection has spread with increasing virulence and also lingered longer than normal in parts of the world now moving from spring to summer.  Norovirus is an especially durable and adaptable virus. It is perfectly suited to what it does; spreading from person to person either through airborne contact with minute particles of vomit, or through surface contact with the virus…on some surfaces it can last for up to two weeks. Given that I have a pathological phobia of vomiting, this one is the stuff of nightmares!

In Britain, the Health Protection Agency is the public face of public health and is charged with providing a virtual barometer of sickness. Their website contains a list of the current maladies doing the rounds and, in the case of flu and norovirus, weekly updates on the numbers of the stricken. The site also contains tips on how to prevent the spread of the virus and some advice (if little comfort) to those who have already succumbed.

To my mind, the information on the HPA website is extremely reminiscent of the information disseminated to the public in past times of epidemic disease – say the seventeenth-century plagues. It strikes me that authorities throughout history have had to balance the need to provide practical details of encroaching sickness with the need to avoid spreading panic. The language of sickness reporting in fact has a long history, and show remarkably similar patterns.

The reporting of the numbers of sufferers, for example, is something that was certainly an important element in the way the Great Plague of 1665 was reported. In seventeenth-century London, the so-called ‘Bills of Mortality’ gave a weekly update on deaths in the city, in the form of a published pamphlet. Information for these pamphlets was gleaned from the ‘searchers of the dead’ – people (often women) who were employed to examine fresh corpses to discern the cause of their demise. Their diagnoses were diverse. In one bill dating from 1629, the causes range from predictable conditions such as measles, cold and cough and gout to other, stranger, ones such as ‘teeth and worms’, ‘excessive drinking’ and ‘suddenly’!

As the plague increased though, the Bills of Mortality became rapidly dominated by these numbers, and Londoners pored over the pages every week to gauge the seriousness of the situation. News of the contagion was a regular topic of conversation and people were eager to learn if things were getting better or worse. The newly burgeoning cheap presses of the mid seventeenth century went into action, with everything from treatises on the causes of the plague to ‘strange newes’ about the latest outbreaks or figures and even popular cures.

The authorities were clearly worried about the danger of epidemic sickness, and took measures to try and limit its spread. One of these was to try and restrict popular gatherings such as fairs, to try and prevent the disease running rampant. This Royal proclamation from 1637, for example, entreated people not to attend the popular Sturbridge Fair that year, the king ‘Forseeing the danger that might arise to his subjects in generall”.

So, the authorities published the numbers of sufferers, took preventative measures against the spread of contagion and, in general, maintained a dialogue with the public, updating them on disease types, currency and potential ways to avoid them. The popular press also served to stir up fears, however, and perpetuated public dialogue about infection. Disease and health have always been topics of conversation but, in times of contagion, they tend to become more concentrated, and people become more engaged in dialogue about them.

Fast forward to 2013 and it is remarkable how similar the situation still is. The HPA website, for example, gives a weekly update on numbers of norovirus sufferers, not only in terms of clinically-reported cases, but of an assumption that for every reported case there are a further 288 or so unreported cases – people who simply decide to stay home and self-medicate. Indeed, at the present time, people are being actively discouraged from attending doctors’ surgeries, and hospital wards are being closed to the public. The impression is one of a wave of contagion breaking over the British Isles and, for me at least, one that is coming to get me!

There is indeed a fine line to tread between reporting facts and sparking panic. When SARS first emerged, there was a great deal of information (and misinformation), with various ‘experts’ calling it variously a massive threat to humanity, or simply the latest in the processional line of epidemics to afflict humankind.  A few years ago, a virtual global panic was instigated by the apparent mutation of avian flu, or bird flu. This outbreak made ‘pandemic’ the buzzword of the late 2000s and, again, much space was devoted (and indeed still is to some degree) on educating people on what it is, who has got it, and how to avoid it. In 2005, a UN health official warned that bird flu was capable of killing 150 million people worldwide. According to Dr David Nabarro, speaking to the BBC at the time “”It’s like a combination of global warming and HIV/Aids 10 times faster than it’s running at the moment,”. The World Health Organization, perhaps seeing the potential panic that this could cause, immediately distanced itself from the comment. The fact that the outbreak was ultimately relatively mild emphasises the problem that epidemic disease causes for health officials. How to alert people without scaring them?

None of this is helped by the press who, like their seventeenth-century counterparts, are keen to give the largest mortality figures, or emphasize the spread of diseases. In June 2012, for example, Reuters were still warning that a global bird flu pandemic could happen at any moment.  http://www.reuters.com/article/2012/06/21/us-birdflu-pandemic-potential-idUSBRE85K1ES20120621

The same pattern is now happening with the norovirus – although clearly this does not carry the same levels of danger. Here we are talking about contagion, rather than mortality.  Let’s take the headline on the Western Mail newspaper of 20^th December though: “Norovirus: Now more wards are closing as hospitals in Wales hit”. The breathy style of this banner line emphasises its rapidity, not just a straight report, “NOW” it’s coming. What purpose do these reports ultimately serve? Put another way, why do we need to be told? Logically, if preventative measures are possible then it makes sense to tell as many people as possible. But often this is not the purpose of newspaper copy in times of sickness which, to me, almost seems at times to be deliberately provocative.

The answer seems to be a deeply-set human interest in sickness, ultimately linked to our own mortality. Even in this apparently scientific and modern age of medicine, there are still many things which are incurable, and many diseases which have the ability to wipe us out at a stroke. It is this uncomfortable reality which perhaps continues to fascinate and frighten us. We live in an age of control, but some things are still beyond our control, and it is perhaps this innate fear of disease – of our own transience – which makes these headlines ultimately so compelling.

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.

The early modern remedy that should have been!

Just a little light relief to stave off the joint miseries of man flu and a rainy day.

(Dis)ability? Living with impairment in early modern Britain

It is perhaps too easy to view disability in terms of what a person cannot do, as opposed to what they can. Even the terminologies used to describe people (DISability, INcapacity, impairment) all carry negative connotations or suggest a deviation from an ideal or ‘normal’ body. Where sickness or congenital conditions have altered the fabric or capacity of individuals’ bodies, something is implicitly (or often explicitly) assumed to have been ‘lost’, whether physically or functionally.

Looking back at the sickness experiences of individuals through history, it is also too easy to assume that people simply gave up in the face of sickness, or that they were incapable of carrying out a normal life once sickness, injury or old age had afflicted or altered them. In the early modern period, it is highly likely that impairment far more visible than today. In fact, it could be argued that a (by today’s standards) ‘normal’ body would have been highly exceptional.

Given the ubiquity of potentially disabling conditions through sickness and poor diet, for example, skeletal deformities would probably have been much more common, with childhood conditions such as rickets being caused through lack of calcium and vitamin D. Any form of lameness was largely untreatable, except by crude support devices, leaving sufferers to make the best of what they had and, in severe cases, rely on the support and charity of others. As old age set in, the ability to work became restricted and decline could set in rapidly.

Life in pre-industrial society was also highly dangerous in terms of the potential for accidents. Any idea of a bucolic, rustic idyll is shattered by accounts of horrendous accidents caused by seemingly innocuous tasks. In the diary of the puritan minister Philip Henry of Broad Oak, Flintshire, in the mid seventeenth century, for example, is the account of a labourer killed when the man he was working next to swung his pickaxe backwards and took the man’s eye out. The young son of William Bulkeley of Dronwy, Anglesey, called Theophilus, had both of his legs broken when stacks of hay tumbled down on top of him. Theophilus was taken to see specialist bonesetters in Anglesey, but likely walked with a limp for the rest of his life.

There were any number of conditions that could hamper daily life, from skin conditions, lumps and excrescences, to painful and debilitating illnesses, from gout to cancer. With medical treatment for these conditions largely ineffective (at least in biomedical terms), the sick and afflicted were essentially left to shift for themselves. But evidence also suggests that, rather than simply giving up and taking to their beds, many people lived remarkably ‘normal’ lives in the face of seemingly insurmountable physical difficulties. In fact, the resilience of ‘disabled’ people through history is often remarkable.

There are accounts of people, for example who, despite their conditions, endeavoured to carry on regardless, even in the face of severe illness. An entry in Philip Henry’s diary in February 1680 records that he preached twice one Sunday despite the fact that he ‘quakt of ye ague from 8. to 11’ and could not eat or drink in-between. In September 1661, he went to Chester where he developed severe ‘cold and tooth-ake” but still managed to “assisted in study, blessed bee God’. His daughter, also a diarist, noted in one 1692 entry that her elderly father ‘notwithstanding his illness…went on Sabbath June 12, limping to the pulpit’, clearly still intent on carrying out his ministerial duties.

But others in his community displayed a similar stoicism. Henry recorded, for example, the case of Matthew Jenkyn, a local conformist minister who, suffering from ‘a pining sickness…preacht to the very last, being carry’d in a chaiyr from his house to the pulpit’. It was not only religious figures who were keen to defer their opportunity to submit to sickness, perhaps even viewing the adoption of a sick role as inviting misfortune in the same vein as superstitions regarding the making of wills. In 1728, for example, Thomas Edwards, a bailiff from Llanfechell on Anglesey, was ‘indisposed…tho’ getts up every day, yet can hardly crawl from his room to the house & back agen immediately upon the bed’. Despite his obvious pain, Edwards clearly felt obligated to continue his duties and not withdraw from public life.

By the latter half of the eighteenth century, a raft of popular accounts attested to the often astonishing abilities of severely impaired or disabled people. In the 1720s and 30s, one Matthew Buchinger, the “famous little man” of 29 inches high, and born without hands, feet or thighs, made a living by performing a range of tricks and acts including writing, painting and playing musical instruments.  Thomas Pinington could reputedly shave himself despite having no hands, feet or legs, as could John Sear of London. William Kingston of Somerset had no arms, but instead used his feet for everything from shaving to boxing. Handling a lethally sharp blade without injuring oneself was difficult enough, and demonstrating the ability to do so with severe impairments required astonishing dexterity. Perhaps the emphasis upon shaving in accounts of such men as Sear and Kingston was a deliberate tactic given its potential danger, and introduce a frisson of danger, but the overall picture was one of surprise, and even admiration, at the dexterity and capability of such men.

Matthew Buchinger. (For a great blog post on Buchinger, see http://modernconjurer.blogspot.co.uk/2010/04/little-man-of-nuremburg-matthew.html)

The figure of the doddering, elderly fool was a comic staple in early modern Britain as elsewhere, and people expected that age brought loss of facility. Even for the elderly, however,  it was often remarked upon how much they were able to do, rather than how little. Consider the ‘old grandfather’ of the Reverend Arthur Charlett of Oxford in 1716, who noted that the old man could still “shave without spectacles, crack nuts and make his bed” despite his advanced years.

 Such examples remind us that the terminology of ‘disability’ is often unhelpful. Firstly, in contemporary times, it is an often unhelpful and even patronising term. The problem lies in finding something neutral or, perhaps better still, removing the distinction. Secondly, however, such terminologies shift over time. People have understood physical impairment, sickness and deformity differently over time, and it is a mistake to back-project current ideas onto our forebears, or to assume a common experience. As these examples show, living with an impaired body, or an acute medical condition, certainly bore its own troubles, but sufferers adapted and, in many cases, lived normal lives.

By way of conclusion, I heartily recommend a new book, Disability in Eighteenth-Century England (London: Routledge, 2012) on this subject by my friend, and former PhD supervisor, Dr David Turner of Swansea University. Many of the themes and issues I’ve raised here are covered in far more detail in his book and other recent articles for History and Policy. http://www.historyandpolicy.org/papers/policy-paper-130.html

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.