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.

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.

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.

The ‘heroic sufferer’; sickness narratives in early modern letters

I mentioned in my last post about the concept of the ‘heroic sufferer’. Patient narratives are very much the coming thing in medical history. ‘Off Sick’, for example, a recent collaboration between Cardiff University and the University of Glamorgan has looked at the voices of the patient over time. The historiography of disability is re-engaging with the often indistinct voices of disabled people in the past. Even in popular history, it’s often these ‘voices’ that people want to hear about – ‘Voices of the Great War’ and so on. Overall, there has been an impetus to learn about the sickness experience through those who had that experience; not those who treated them.

In my own work, I’ve looked at sickness narratives in the seventeenth and eighteenth centuries through the letters that sufferers wrote to friends and relatives. Other than actual conversation (or even perhaps more than conversation), letters allowed people to construct their own narrative; their own sickness persona. Writing it down gave sufferers power over their own image; freed from the immediacy of speech, letter-writers could fashion themselves as literary sufferers. The results were often fascinating.

What strikes me most about these letters is the construction of a distinct persona, almost the creation of a different ‘sick self’. As I said in the previous post, it’s something that we do to a certain extent when we call in sick to work. There is perhaps an innate need to engender empathy, if not sympathy, and people are often very keen to detail even the most intimate symptoms to complete strangers. This seems to have been a constant for hundreds of years.

One of the most fruitful batches of letters for my purposes were those of the eighteenth-century Morris Brothers of Anglesey – Lewis, William and John. Lewis and William, especially, were prolific letter writers and, as was common for the time, health was a regular topic of conversation. Lewis Morris was a constant sufferer of sudden fits, coughing and giddyness, sometimes so bad that he could hardly get up. What struck me, though, was how far he was prepared to defend his right to be the unchallenged winner in any competition for worst symptoms. When William suggested that he was labouring under his own cough and ‘an asthma’, Lewis wrote back swiftly: “I own your asthma is heavy, but if you had such an asthma as I have, you would be unable to go to the office or even sit there”. In other words, my cough is worse than your cough!

Lewis was also the art exponent of the good old-fashioned wallow. In one letter complaining of various maladies, aches and pains, he was “scarce alive” but, stoically, would “trudge on while I live”.  Recovering from a “pleuritic fever” he told his brother he was “just returned from the shades of death”. When his brother asked him to check some papers, Lewis responded that he would do so if he recovered, having been suffering from an ague fit. Many times he began letters wearily, doubting that his life had long to run, but by the end of the letter was talking in fairly cheery terms about items of news and events.

Perhaps my favourite of all, though, were the letters of Roger Jones, an attorney from Talgarth in 1770s-Breconshire. Jones seems to have been something of a savant – a man of letters, constantly travelling around and involved in polite society (such as there was in eighteenth-century Breconshire!). His letters to his brothers reveal another side to sickness – that of the comedic narrative. Sickness was, at the time, far from funny, but Jones’s letters show a very modern sense of laughing at the profoundly un-funny, perhaps in a way to reduce its impact.

In 1771, for example, he set out on a journey to Hay on Wye, where he suddenly felt “weak and faynty and was obliged to give over”. A fever ensued, and he took pills and a glister to flush out his system. In the night he took a whey drink, which made him sweat profusely which “with the weakness occasioned by the fever, reduced me to a mere skeleton”.

Jones was certainly no fan of doctors. Whilst ill at Bath the previous year he had consulted a physician, who had prescribed glisters, opening pills, cordial drinks and purges which made him no better but a lot thinner. We can only guess at the frustration he encountered once when he lost his voice and tried to get help from his servant…who was deaf. Poor Roger was forced to repair to the local alehouse, where the landlady administered an emetic or, as he called it, “the puke”.

These are the voices of the sick in the past, speaking to us in their own terms but, importantly, terms they have selected very carefully. They tell us plenty about the experience of being ill – but they tell us more about how sufferers wanted to represent themselves to others. They are brilliant (and often under-used) sources in medical history and, one day, I can feel an article coming on!

Constructing the Sufferer (part 1)

I’ve always been interested in the ways that people construct narratives of sickness, and the sickness persona. I was watching a comedian recently who brought up the subject of the ‘phoning in sick’ voice; the slightly husky, weak and tired tone people adopt when they have to convince the boss that they really are ill, and not having a ‘duvet day’. One day there’s going to have to be a study of the language and art of phoning in sick – stuff like having been ‘up all night’ being ill, ‘really don’t think I can make it in today’, ‘see how I feel tomorrow’ are all stalwarts. But sufferers have always constructed and deployed sickness in some measure. When I was researching for my book I looked at petitions by the sick poor in the seventeenth century, written to try and convince the parish authorities to give them money.

Consider this example written to a wealthy lady in Cardiganshire in the eighteenth century – the spelling is original. (National Library of Wales, MS 182D)

“Madam Lloyd, by submission to your Honour, my little grand Child whome I nurs’d since he was a year old, happen to fell sick, this day fortneight (sic), and had been very low, I hope that he begin to recover. He is longing for rosted meat that ever he had in my cottage, and I sure that he cannot distinguies between any sort of rosted meat. If your honour please to send a bit, or order me to wait for it, I will be very glad and in so doing you will add to the obligation of your honest old shoemaker, and your most humble servant, John Jenkin, alias, little shoemaker”

Here, we have the heart-wrenching tale of a sick [and presumably orphaned] child, desperately ill and longing for something substantial to eat. The writer of the letter appeals to the charitable nature of ‘Madam Lloyd’, but it is interesting to note the language used, of the humble, honest old shoemaker, trying to use whatever personal connections he has to secure something for his grandchild.

Others appealed to the charitable nature of people in their surrounding areas to provide support or relief (National Library of Wales, MS 434B):

“To all faithfull people to whome it doth appeare or may concerne, 3^rd October 1656

Whereas John Owen, being a poore ould man borne and breed in the parish of Llanfydd being grievously troubled with a disease…that he is not able to travel and seeke or get his bodily foode & sustenance by reason it is broken out in several places of his body, the quantity of seven or eight places…so beseeching all good and charitable people out of charitie to commiserate his distressed state to bestow their benevolence towards payment to the churgeon…”

Another, Mary Jones of Llandenny, petitioned the parish to offer her support as her husband had fallen sick for ‘five quarters of a year’ and was ‘sick now’. Unable to raise the money herself to feed her family, and facing eviction from her cottage on the waste by the Duchess of Beaufort “to punish the poor man in spite and malice’, Mary was forced into desperate measures.

It is interesting to note, though, that although occasionally such letters were written by the parties involved themselves, they were more often written by an amanuensis – someone who knew the people involved but had more skill in writing. These notes are usually deliberately constructed to emphasise the individual’s suffering. They often highlight the symptoms and use emotive language to highlight the particular suffering.

The reasons for this are clear; the petitioner wanted and needed money, and thus needed to convince the authorities that their need was special. They make interesting reading not just for the language of sickness, but for the ways that it could be deliberately deployed.

I think there could be another post to follow on the ‘heroic sufferer’, but enough for today!

There’s a bug ‘going round’.

Again last week I had to nurse a poorly toddler as he was sent home from nursery with yet another variety of stomach upset. There is, I’m told, something going around. I need to confess here to being a terrible hypochondriac. When I worked in an office I hated it when people used to come in, green-faced, and that say that they’d been ‘up all night’ being sick. In my mind, it is only a matter of time before this thing finds its way to me! If I read on the internet (as has recently occurred) that the norovirus has closed hospital wards anywhere near where I live, the sense of a creeping tide of contagion gets worse. In fact, there always seems to be something ‘going around’.

Talking to a colleague last week, we were speculating about whether the same conception was true in the early modern period – whether people believed that the same nasty bit of pathogenics was doing the rounds. It would be interesting to know whether early modern people had any sense of one particular ‘bug’.

In some ways this seems unlikely. Humoural beliefs held that illness was a personal thing; it was one’s own humoural balance that generally dictated sensitivity and vulnerability to sickness. If, for example, someone was naturally sanguine (i.e. had a predominance of blood in their humoural makeup) that made them naturally more susceptible to apoplexy, plethora and venery!

But there certainly was some conception of a sickness that moved around populations; what, after all, were epidemics of plague and smallpox if not mobile and progressive conditions? But it also seems clear that people were aware of flare-ups of particular diseases or conditions in their vicinity. The letters of Owen Davies, an Anglesey parson in the early eighteenth century, certainly reveal evidence of this, noting episodes of epidemic fevers in his area. The diarist Phillip Henry of Broad Oak in Flintshire referred to an outbreak of fever in seventeenth-century Glamorganshire, which was particularly affecting children. In fact, when we look closely, there was a constant dialogue about illness, and people were ever vigilant for what sorts of things might affect them.

If we think about domestic recipe/remedy collections (books of favoured remedies sometimes accumulated in literate households), it is possible to see them as part of a domestic arsenal against sickness. They were in some ways a pragmatic response to disease; it made sense to have some sort of weaponry in your arsenal to attack whatever symptoms you might have. In other ways though, they were also an insurance policy. They provided at least some means of recourse in an environment where sickness was almost always lurking. And it wasn’t just remedies that were written down; people simply knew remedies, and were able to memorise and internalise information in a way that in today’s internet-dominated world we would find impressive.

The terminology of sickness has certainly shifted. When people in the past referred to the local presence of conditions, it is more likely that they were referring to something deadly, rather than a minor stomach upset. Nevertheless, something of the fear of contagion must be innate. While we might not all regard ‘bugs’ to the same degree of pathological hatred as I do, we feel uncomfortable when sickness gets too close.

Now where’s my antibacterial spray? This keyboard looks filthy…