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.

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.

Shopping and advertising in Georgian Britain

Oh Noooooooooo!

In case anyone hasn’t noticed, it’s the festive season. There are clearly two meanings of Christmas; the religious one…and the retailers’ one. This is the season when we are expected to spend, whether we are jolly, wish peace and goodwill to all mankind, or indeed whether we’ve been naughty or nice. Shops and businesses want our money and will go to almost any lengths to get it. Pity the poor guys currently standing on roundabouts near where I live, dressed as ‘comedy’ reindeer and clutching advertisements for mobile phone deals in their freezing paws. The Christmas TV advertisements start in early October, the lights are all on in the high street and it seems, as many people remark, that Christmas is getting earlier each year.

The concept of high street shopping seems like a modern invention, but it in fact has a long history. Whilst descending en masse to the Christmas sales is certainly more recent, the high streets were very much open for business in Georgian Britain. In fact, in many ways, this was a golden age of shopping, where visiting the right shops, buying the right thing and even behaving in the right way inside shops were all important matters.

In many ways, the Georgians invented shopping. This was an era where towns were expanding and also becoming more self-consciously genteel. Old tumbledown buildings were being removed and replaced with elegant neo-classic facades   - all pillars and pediments. The high street, in its modern incarnation of rows of shops began to appear in the eighteenth century. Pavements were widened to allow the well-to-do to promenade in comfort, and especially to allow them to browse far enough away from passing coaches and carts so as not to get their elegant costumes muddy. By the late eighteenth century, shoes and boots with extra thick soles were becoming available which allowed people to walk through puddles without their clothes dragging in the dirt. Browsing was a serious business.

Shop windows and interior displays certainly became more elaborate. Businesses began to use their shop fronts, and especially their window displays, as advertising spaces. Funeral directors, for example, might well display a fully decorated coffin with all its accoutrements, to show off the finery of their craftsmanship. Makers of scientific instruments might put special pieces in the window to attract attention, from telescopes to orreries or microscopes. The idea was to make the shop enticing and draw people inside to browse.

The process of ‘polite’ buying was markedly different to today, not least in the role of the shop assistant and the matter of money. The place of a shop assistant in a Georgian retailer was to serve the customer, but through a very well defined set of rules. Browsing, for example, was common and involved the seller providing a range of goods for the customer to pore over. A ‘polite’ customer was well versed in quality and fashion; their own taste and sagacity should draw them to the quality of the goods on sale. The shop assistant was full of flattery and would gently coerce to secure a sale. But, the question of money was considered too base , so it would be rare in polite premises to find an Enlightened equivalent of the ‘Apprentice’-style sales technique. Instead, any goods chosen would be sent on the customer’s house by courier, and paid for later on account, since cash transactions were not usual. The browsing session would often finish with tea being served to the customer, adding a further formal ritual to the proceedings. In some ways this has echoes in the coffee shops found in department stores today.

Another apparently modern concept is that of advertising but, again, eighteenth-century retailers were well versed in the art of distance selling. Just as today, retailers took advantage of cheap print to fill newspaper columns with row after row of goods and services. It is worth taking a look inside a single page from a typical (and familiar-sounding) publication, The Sun, from March 7^th 1793.

There are, for example, a number of advertisements for products, and medicines were amongst the most common. From Mr Moulter of 96 the Strand in London, a perfumer, could be purchased “The Devonshire Tooth Tincture and Powder”.  From Thomas Taylor in Blackfriars could be bought “Leake’s Patent Pills” for “venereal and scorbutic complaints” which, attested a certain Mr Thomas Lloyd “The taking of one box only, gave me considerable relief”.

James Rymer, a surgeon of Soho, boasted of the royal patent he had been granted  for his “Cardiac and Nervous Tincture” which allegedly cured “Disorders of the head, stomach and bowels, viz: Headach, confusion and giddiness; Indigestion and Loss of Appetite with bilious crudities and retchings; Yellowness of the eyes and skin; gripings, heartburn, colic and costiveness”. The list of potential conditions continues for another four paragraphs! Rymer included a long list of agents from whom the product could be bought and also found space to peddle his latest book A Treatise upon Indigestion and the Hypocondriack Disease.

But on the same page could be found other interesting advertisements and snippets of news. “Mr Charles, artist to his royal highness the prince of Wales” would take “A most perfect resemblance of the Face in Fifteen minutes in Miniature for Lockets, rings etc in a masterly manner”. What better present to give a loved one that a locket with a painted portrait set within it…guaranteed to set your beloved lady in a swoon! For those suffering from the discomfort of ruptures (hernias), “Dowling’s Improved Elastic Breeches” were warranted to bring relief and “fitted in the neatest manner and in the best workmanship”.

Coincidentally, if you had visited Baker’s Coffee House in Exchange Alley in London in March 1793, you could also have encountered  one Robert Withy, perhaps a forebear of mine, who offered “Opinion and Advice on Money Business” and sought to rescue the unenlightened from “The many frauds daily committed by advertising money lenders”. It appears that the problems of unscrupulous money lenders and ‘payday loans’ are equally nothing new. Amongst the other notes were a programme for ‘Longman and Brodrips Comic Opera” called “Hartford Bridge or the Skirts of the Camp”, then playing at the Theatre Royal, Covent Garden.

It is surprising how modern much of this indeed sounds. Georgian shoppers, just like us, could head out for the high street, dressed up to the nines, to browse, to see and be seen, and to buy. Although the mechanics of shopping and buying have changed, the basic structures of shop display, the use of shop space to encourage browsing, and the role of the assistant in guiding purchase were all present. Advertising was very much in vogue and eighteenth-century consumers were bombarded with advertising and puffery, all desperate to entice them to part with their money.

As we dodge the charity muggers, the ‘comedy’ reindeer, the dreadful music, the bands, the ‘Gluhwein’ stalls, the “quality wrap, fifteen sheets for a pound” and the constant dialogue of advertisers, it’s worth remembering that much of this is not a modern plague…we can blame our eighteenth-century advertisers.

And Christmas IS getting earlier every year!

Lady Elinor Stepney and the Georgian ‘Heroine Pill’

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

Buwchllaethwen House – ancestral home of Elinor Stepney

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

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

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

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

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

Richard Mead (1673-1754)

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

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

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

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

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

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

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

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

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

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

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

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

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

‘For Mrs Bridges

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

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

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

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

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

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

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

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

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

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

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

Concocting Recipes: The early modern medical home.

It has long been argued that the early modern home was a medical hub. And, in many ways, so it was. Sickness was first and last a domestic experience. It was almost always treated in the home and, given the range of potential conditions, the presence of one or more sick members of the family was doubtless a fairly regular occurrence.

In the main, it was women who were expected to take responsibility for medicating the household.  Women were assumed to be natural carers, and also to have acquired some skill in the preparation of medical recipes, and their application, by the time they reached the age of consent to marry. There were books dedicated to schooling literate women in the art of physick, many including what was effectively a ‘starter’s collection’ of remedies to enable them to treat a large number of common conditions. Indeed, medicine was part of the wider role of ‘housewife’, and ‘huswifery’ meant looking after the inhabitants, as well as maintaining the living space.

The role of men in household medicine is far less defined. There were, for example, no books specifically written to help men cope in the case of domestic illness. And yet they clearly did cope. Diaries, such as those by Phillip Henry of Broad Oak in Flintshire, and Robert Bulkeley of Dronwy, Anglesey, both note sickness episodes of their wives, and suggest that they played a part in caring for them. It is also clear that men played a part in the acquisition of ingredients, often keeping records of where they found herbs for sale cheaply, or which apothecary they regularly purchased from. In this sense, medicine still fitted in to the patriarchal male family role, since it involved a broader input into the physical care and support of the family.

One question that remains largely unresolved, however, is that of how well equipped the early modern home was to cope with sickness. The contents of domestic recipe books suggest not only that a very broad range of skills were needed to be able to concoct remedies, but also that a range of equipment would also be necessary. How well equipped were ‘ordinary’ homes to meet these needs?

One body of sources that lets us peer back inside the early modern home are probate records. When a person died, the probate process often required a list of their household contents to be made to allow their estate to be valued. For the study of the material culture of this period, these sources are incredibly valuable. They are, however, often frustratingly vague, and all depends on the diligence of the individual surveyor. For example, a detailed record might list every individual possession, room by room, including furniture, ornaments, valuables, but also sometimes even book titles and foodstuffs held in storage. Much depended on the intrinsic value of the goods; if they had a resale value, they might be worth including. In less detailed inventories, however, a whole room might be listed under a single entry, with a generic term like ‘household stuff’.

In terms of medical items, this causes a problem. Things like herbs and, perhaps, individual jars of ointments or medicines were too impermanent to list, so don’t appear in the inventories of ‘ordinary’ households and very seldom even in elite household inventories. Equally, finding any equipment that can be definitely be classified as ‘medical’ is problematic, since many had dual usage. Nevertheless, it is still worth speculating based on available evidence, to see if any hints about the material culture of domestic medicine can be gleaned from these sources.

Whilst writing my PhD thesis, to try and address this question, I looked at over 1300 inventories from 82 parishes in the county of Glamorgan in South Wales. I decided to look for two items of equipment in particular – the pestle and mortar, and the brewing still. Many seventeenth- and eighteenth-century self-help books extolled the virtues of a well equipped kitchen. For the seventeenth-century medical writer Thomas Brugis, top of the list of items desirous for those people wishing ‘to compound medicine themselves’ were ‘a great mortar of marble and another of brasse’. A long list of other items were included, from ‘copper pannes to make decoctions’, ‘glasses for cordiall powders’ and a range of medical implements. The popular medical author Gervase Markham, also entreated his idealised English housewife to ‘furnish herself of very good stills, for the distillation of all kinds of waters…for the health of her household’, and the emphasis all round lay firmly with a well-equipped kitchen, able to minister autonomously to sick family members within a household.#

As a baseline test, over 91% of the inventories contained at least one item of kitchen equipment, including pots, pans, crocks and so on. Overall, the suggestion was that the vast majority of homes had at least the ability to concoct basic remedies. As Elaine Leong has recently noted, for example, boiling was needed in around 20-30% of early modern remedies.

But what of more specialised equipment? The results were interesting. Out of 1248 inventories, only 148 (11%) had listed a pestle and mortar. Before 1635, there were no occurrences whatsoever, and a peak of ownership didn’t seem to occur until the early eighteenth century. Whilst this figure of 11% should definitely be taken as a bare minimum to allow for inevitable under-recording, this still seems surprisingly low. What was also clear, though, was that the item was more common in better-off households, and also in urban areas. The pestle and mortar would have been a basic utensil for grinding herbs and spices into powder. Whilst not owning one certainly can’t be used as evidence to say that a home wasn’t ‘medical’, its lack of appearance is still noteworthy.

Turning to the ‘still’ or ‘limbeck’ the results were even more striking. A still was a multi-purpose item, which could be used for home brewing, as well as the distillation and fermentation of substances for medical recipes. It has recently been calculated that around 10% of remedies required a still in this period. Despite this, the Glamorgan inventories yielded a total of only 41 references in 1248 inventories, giving an average of less than 3%. Here again, ownership was general limited to wealthier households.

[A full statistical analysis, including comparisons with other Welsh counties was included but, for the sake of brevity, it’s not detailed here. See Alun Withey, Health, Medicine and the Family in Wales, 1600-1750 (Swansea University, Phd Thesis, 2009)]

It is also worth noting (albeit perhaps unsurprisingly as noted earlier) that no inventories contained any reference to medical remedies, ingredients or substances, and only a bare few contained items which could be construed as ‘medical’, such as a blood dish in one home, and a ‘nurseing chayre’ in another.

What do these results tell us? They certainly don’t tell us that early modern homes did not manufacture their own medicines, nor that they were incapable of doing so. Even the most basic of utensils could be used in this process, and the majority of homes possessed these.

They also don’t reveal much physical evidence of medicine, such as a ‘storehouse’ of remedies or ingredients, but this is, in many ways, entirely logical. Medicine was transitory and pragmatic. Recipes were often concocted as and when needed. Some, like ointments, could last for years and be kept, but many were too impermanent to keep. Also, just because they weren’t listed, doesn’t mean they weren’t there. Whilst some historians are beginning to question the extent to which each household physically grew its own herbs, it’s plausible that many did.

But what is also interesting is the availability of ingredients for remedies in even the smallest rural shops. People could purchase exotic herbs and spices from their village shop, as well as compound remedies such as plague water and Venice Treacle. It is entirely possible that the extent to which domestic production was intertwined with the medical marketplace has yet to be appreciated.

In any case, there is a need for more studies into the material culture of early modern domestic medicine. If the early modern home was indeed a medical hub, a wider study should give us a broader understanding not only of what medicines people used in their homes, but how they made them.

Social Networks and the spread of medical remedies in early modern Britain:

Much recent work by historians has highlighted the extent that medical knowledge was part of a ‘knowledge economy’ in the early modern period. Put simply, health and medicine were regular topics of conversation, whether in person or by letter. Just like today people told each other of their symptoms, suggested favourite remedies or recommended particular doctors. In some ways too, early modern people were perhaps more sensitive to their own bodies than we are today; they understood their bodies through a framework of the four humours, and had some idea of their own particular humoral balance. Also, they monitored their health constantly, ever vigilant for potentially unusual or dangerous changes.

With less easy access to medical practitioners for many of the population, self-medication was the first recourse in times of sickness. It made sense to have an armoury of remedies at the ready, just in case. In literate households, manuscript collections of remedies were effectively the next best thing to a consultation with a physician. But how were these collections assembled? Where did the remedies come from? By looking at a typical eighteenth-century recipe book in more detail, we can start to see the ways that medical information travelled through social networks in early modern Britain.

Between roughly 1706 and 1717, Amy Rowlands of the wealthy Rowlands family of Plas Gwyn, Anglesey, compiled her own book of medical and culinary receipts (available to see at the University of Bangor library, as MS Henblas A5). Her book is typical of the form. It is carefully laid out, written in a fair hand and fully indexed, following the format of a ‘receptaria’ medical book.  The image below is from the first page of the book, where Amy seems to be trying out a few writing exercises, based on a moral pnemonic.

Amy’s book contains more than a hundred recipes for a variety of conditions and using a wide range of ingredients. This one, “for the stone”, is fairly typical.

“Dry the roots of Red nettles and make them into pouder and drink a spooonfull of the powder thereof in a draught of white wine something warme and it will break the stone though itt bee ever soe great. And that with speed use it every day until the stone and gravell be all broken and consumed, A thinge of smale prices and great virtue”.

Looking through the book, it is clear that the sources of Amy’s recipes were broad, and included local acquaintances as well as a variety of more intriguing sources. Some, for example, were clearly given directly to her by people from her network of family and friends. Examples of these include:

‘To make Ginger Bread with honey Madam Griffiths way’‘To make Ginger Bread the best way Cosen Sidney Rowland is way’.

“Madam Griffiths is more difficult to trace, but ‘Cosen Sidney Rowland’ lived in Dewis Bren near Llangollen, and therefore in reasonably close proximity to Amy.  “A Reciept for a Consumptick Cough” was provided by  “Mrs Jane Williams of Ty yn ystrithsons”, clearly another acquaintance, as was a recipe for “flower water” attributed to Mrs Griffiths of Carnarvon – again, in very close proximity to Amy’s Anglesey home.

Aside from family and friends, there were other potential sources of remedies. One recipe, for example, was kept from a consultation with a practitioner:

“A Diett drink Dr Humphreys Recett to me Amy Rowlands

Take of the bark of Ash of the tender twigs of tamarisk of each two ounces of the same of Brooklime: scurvy grass, Liverwort, Hartshorn, Agrimony: Sage of each one handful: of Sene three ounces. Bruse all these and infuse them in seven quarts of smale(?) ale: after 24 hours you may drink of itt about half a pint furst in the morning and last att night you may ad quince seeds Brused to correct the wind if you please”.

For me, these records are especially interesting. Firstly, and obviously, they confirm that Amy sought the help of a doctor – one ‘Dr Humphreys’. Receipts attributed to doctors often appear in remedy collections, without the author having necessarily ever consulted the physician in question. Hence can be found remedies such as “Dr Butler’s receipt for the plague water”, noted in several collections from Wales at this time.  The inclusion of the title leant provenance and value to the remedy, especially if it had a positive reputation. Amy’s note here, however, strongly suggests that she had met (or perhaps consulted by post) this “Dr Humphreys”, and she recorded his directions for future use. Locating Humphreys is difficult given the commonness of his surname, but he was likely a local practitioner or apothecary, and unlikely to have been licensed.

Indeed, Amy Rowlands was seemingly not overly concerned about the ‘professional’ credentials of a practitioner; it was the reputation of a remedy that mattered more. A remedy for a ‘Meigrim in the head’ is included, attributed to “Pembrockshir Bess” – perhaps a cunning woman or magical healer.

Sources could, though, also come from much further afield, and suggested spread by word of mouth, rather than personal acquaintance.  The remedy below is attributed to “Mrs Pitt who lived in Stippleton in Dorsettshire” and is a receipt to make “a very good seercloth”. Amy included a note that she had made this recipe herself, and found it good – perhaps the best indicator of its reliability.

The efficacy of a remedy, though, was not just based on whether it had cured the author of the collection; the opinions and testimonials of others were just as valuable.

‘An infallible cure for sore Eies effected on Captain Fitspatrick in London when Given Over by all doctors, Given me by Mr Moris Owens of Holy Head

Taking some Garlick and pound them and bay salt together into a sort of a pultiss and apling them to the soles of the feet spread on leather for nine nights sucksesifly the which has done a wonderful cure upon the above Gentilman

In this example, the benefactor of the remedy was “Mr Moris Owens’ who perhaps (although by no means certainly) knew the ‘Captain Fitspatrick’ upon whom the initial remedy was so successful. Here, the remedy had travelled a physical distance (from London to North Wales), but had also moved through a social network by several removes, connecting people who otherwise had nothing to link them.

It is this last point that really highlights the value of these fantastic sources. They certainly reveal much about medicines, ingredients and the physical processes of manufacturing remedies in the early modern period. But, in cases where authorship and attributions are known, they also reveal much about the diversity of sources of medical information and the sheer wealth of medical knowledge that was available. Far from being helpless in the face of sickness, people in fact were surrounded by potential sources of relief. Recipe collections offer us a unique insight into this process.

(Images are copyrighted to me, and used with permission of the archive at Bangor University: Please do not reproduce them without the express permission of Bangor archives. Thanks)

The mystery of ‘Sansom Jones’ – the phantom Welsh doctor

“This book I had from — a resident of this parish (Bettws in Monmouthshire), who swears it was the book of Sansom Jones a physician of this county, some two hundred years ago”.

This note, dated around the early twentieth century, appears in the front cover of an intriguing manuscript – Cardiff public library MS 2.126. Since I first came across the document in 2005, it has fascinated me as it represents something of a mystery. It is, or at least appears to be, a remedy collection dating to around the early seventeenth century. It looks and feels ‘right’. The palaeography is consistent with a document of that age. The layout is what you’d expect from an early modern receipt book and the remedies are neatly written and ordered. And yet it is one of the most frustrating sources I have ever looked at.

It should be a fascinating view into the medical world of that most rare of creatures – the early modern Welsh doctor. We even have his name – relatively unusual for sources of this type. Except, so far, “Sansom Jones” has eluded every attempt I have made to find out more about him…or even to establish whether he even existed. He highlights one of the big problems for historians in trying to piece together individual lives through scattered documents. We have a few pieces of the jigsaw, but not the final picture. It also raises the danger in assuming that documents in local or county archives are necessarily from their own area.

Let’s start at the beginning of the ‘Jones’ document. The first couple of pages are interesting. The book begins with a list of standard apothecary measures – a common enough inclusion, especially if this were the book of a practitioner. Lists of scruples, drachms and other measures were necessary and useful in compounding the correct measures and dosages of remedies. But then the plot thickens, and the name ‘Bethia Marsh’ is written in bold script, suggesting authorship or ownership; more about that later. But also prominently written is the following heading:

“Noblest teaching of urine to know the proffices thereof for the nature of man and woman which is known through urines. Through which urines the sicknesses of men are knowne, translated out of lattine (sic) into English. By mee Alexander Spraggot. 1569. May ixiiii”.

So the plot thickens. Here we appear to have the title page of a published book by the eponymous Mr Spraggot. We have an exact date and so, at least, a starting point. Looking at the book as a whole, it does ‘feel’ very much like a published work. It is very neatly set out and has, quite unusually, a complete alphabetical index at its end.

There is a section on uroscopy (the diagnosis of medical conditions by the appearance, smell and taste of human urine), followed by some general notes on life and health. These include “To knowe life or death/tokens of death”, “A treatise of Hypocras”, with astrological notes on sickness and other general observations including notes on why students are unhealthy – essentially because they spent so much time in motionless reading! The rest of the volume is given over to medical remedies, generally set out in order of different parts of the body.

For headaches, for example, there are remedies for “headach proceeding of a cold cause”, “headache proceeding of heate”, “for the mygrim or rigrim” and so on. Several pages deal with purges for various conditions, including “melancholie”, “palsey” and also specific diets, e.g. for the “rhewme”. There are sections on obstetrics and childbirth as well as conditions relating to both men and women. Given the standard practice of using animal, plant, and any number of other materials (!) in remedies of this time, there is ample evidence of a full range, and nothing out of the ordinary.

In many ways, there is much to support a theory of this as being the book of a practitioner; it contains just the sort of useful information that a practitioner might rely upon in his daily work. There is little evidence to suggest attributions in the book. In ‘domestic’ remedy collections (i.e. those used in families) it is common to find recipes gifted from others – e.g. my aunt’s remedy for a cold, Mrs x’s receipt for the gout, and so on. But this book has none, suggesting a more formal purpose. The fact that it is written in fair hand also supports a deliberate and disciplined document.

But if we look deeper at the document, what else might it reveal? Firstly, who was Alexander Spraggot? Did he indeed write a book called ‘noblest teachings of urine’, or might this be an unpublished manuscript from 1569? The answer to the latter is no. In terms of the date, I was partly lucky, since the paper was watermarked…but even this is slightly mysterious. Having sent a copy of the watermark to a colleague who specialises in this area, the watermark turned out to be from an unusual source for an early modern Welsh document…it was from Russia. Not only this, it dated no earlier than the mid seventeenth century, meaning that, at the very least, any copy from Spraggot’s original must have been done nearly a century later.

Searching under the name Alexander Spraggot reveals few likely candidates. Perhaps the most likely seems to be ‘Alexandrus Spraggot’, appointed the vicar of Martocke church in Somerset in 1564 – not a great distance from South Wales. But did Spraggot ever author a work of this name? Not as far as I can tell. There are no records in the British Library of a book by this title or author, so here the trail runs cold.

So what of the second name mentioned in the book – Bethia Marsh? Here again, I’ve drawn something of a blank. A lady of this name was born near Salem, Massachusetts in 1650 – roughly around the date of the creation of the book (or at least its paper), making her an unlikely candidate. The name isn’t especially Welsh either. One possibility is that Bethia was, at some point, the owner of this book which, after all, contained a large number of useful remedies. It was common for people to write their names in such books to assert ownership, and also for remedy collections to move across families as they were gifted, especially to newlyweds.

What, finally, of Sansom Jones, the mysterious Welsh practitioner of Bettws, south Wales? Is there anything to suggest that he was the true owner of the book? Sadly not. Having looked for the relatively unusual name of Sansom in likely parish records, I can find no trace…so far. He was not, at least as far as the records suggest, a licensed physician. His name doesn’t appear on any list of known doctors, nor does he appear to have been apprenticed or trained. None of this, of course, means that he never existed. He could, as many Welsh practitioners did, have simply carried on his medical practice to the local population unhindered by the need to obtain a licence, being so far from the centre in London. With such an indistinct date, he might have been of a later time period, with a misjudged attribution by the note writer. Another possibility is that he was actually from a different ‘Bettws’ than the one in Glamorganshire; there are several across Wales.

And so the search continues. As I turn my attentions back to Welsh medical practice (after a hiatus studying shaving and rupture trusses in the eighteenth century) the need to find out more about the daily life and work of Welsh doctors will again become paramount. If Sansom Jones was there, and if this was indeed his book, I want to find him, as ownership of these types of documents does much to provide an alternative to depictions of Welsh doctors as obsessed with folklore and magic.

p.s. If anyone can shed any light on any of this, I’d be very grateful.

Medical practice in early modern Wales – revision time!

I started researching Welsh medical history properly in 2004. At that point, there wasn’t really a big historiography on the early modern period for Wales…in fact there was essentially only one book. Over the years, I’ve been busy putting that to rights, and have so far published my own book, three academic articles, four book chapters and a range of other stuff. The obvious problem is that if anyone else chooses to start looking at this topic, my research is first in the firing line. But, that’s another day’s worry.

When I started working on the book, I decided to leave the issue of medical practice to one side. Physick and the Family is broadly about the experience of sickness in the early modern period. It looks at things like how people viewed sickness and how they conceptualised and described it. It looks at how well prepared people were to cope with a patient in their own homes, and also the ways in which friends, neighbours and the wider community coped with having a sick person in their midst. Except for when they became part of this sickness experience, doctors were not part of the remit. But they are now.

There has been a long-held view that Welsh doctors of the sixteenth and seventeenth centuries were part of a practice that was stagnating, backward-looking and pretty much tied to its ancient past. There are certainly reasons to support this view. Unlike England, Ireland and Scotland, Wales had no institutions in which practitioners could focus or gather. It had no universities or colleges of medicine and, as such, there was no formal medical training available. There were no hospitals aside, perhaps, from the odd lying-in room or lazar house.

Until the late seventeenth century, Welsh doctors were relatively reluctant to purse a licence, which they were at least nominally supposed to have, although the lack of policing and distance from London meant that this wasn’t so important in the Principality. Those wishing for a career as a professional physician, though, generally left Wales to train in Oxford or London, and then generally didn’t bother to return. The net result of this has been a view of Welsh practice as a vacuum of orthodox medicine, which was filled by cunning folk (in Welsh the ‘dyn hysbys’ – cunning man), and various other ‘irregular’ practitioners.

The problem with this view is that it simply isn’t accurate. It suggests firstly that there was a lack of practitioners in Wales, which isn’t the case. Secondly, the terminology itself carries baggage. When we talk in terms of ‘irregular’ and ‘unorthodox’ it automatically suggests unskilled. This too is inaccurate since much of the evidence I have looked at over the years suggests that Welsh doctors often went to extraordinary lengths to keep up with wider developments in medicine.

Books, for example, were one way that doctors could keep themselves informed, and there is evidence that Welsh practitioners sometimes purchased even esoteric Latin texts in order to access the latest thinking. The first Welsh-language medical book wasn’t even published until 1736, so they were in effect forced to engage with medical literature in English or Latin.

Secondly, it is interesting to note that Welsh practitioners, alongside their English counterparts, often adopted the title ‘Doctor’ even though they had no degree or licence. In Wales this is interesting because it is an English term; there were Welsh equivalents like “Meddyg” and “Physigwr”, but “Dr” was the preferred term. Although we can’t read too much into this, it might suggest that such practitioners wanted to feel part of a wider medical fraternity or profession.

Thirdly, all evidence points to the practice of medicine being identical in form and function to that in England and across Europe. As has long been demonstrated elsewhere, orthodox practitioners did little different in material terms to the cunning man. Whilst ‘magical’ practitioners might dress up their remedies with symbolism and esoteric language, the basic form and function was the same.

This is not to say that folklore itself was unimportant – far from it. There was an extremely lively oral tradition of medical knowledge in the Welsh language, and strong beliefs in the power of cunning folk. Wales, it must be remembered, was a largely rural country, and one of marked geographical contrasts. There were areas of agricultural lowlands, but also upland, mountainous regions, where travel was difficult. In many ways it was the perfect breeding ground for legends and magic to prosper.

But Wales shouldn’t be viewed as being cut off. It was connected in so many ways to the broader world. Shops, even in tiny villages, for example, sold a range of medical goods, imported often through large English towns such as Bristol, Chester and London, but sometimes directly through the coastal trade. People crossed the borders to visit English towns, again especially Bristol and along the marches, and Welsh accents would have been familiar in these towns. Welsh apothecaries had accounts with London suppliers, and imported proprietary medicines, meaning that Welsh people would have been familiar with popular potions like Daffy’s Elixir. They also bought newspapers and almanacks, so would have known about the lively medical marketplace developing in the seventeenth century.

Overall, Welsh medical practice is due an upgrade – if not a complete revision, and I’m ready to take on the task. I’m going to start on a new project shortly, assessing both the numbers and quality of Welsh medical practice. I have a theory that, like so many other parts of Welsh medical history, there is a lot more to discover, and some deeply-held myths to challenge.