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.

Unpacking the ‘eccentric’ in popular memory: Local characters of old Cardiff.

Disclaimer!: This is not a fully-formed argument, just some thoughts about the ‘eccentric’ in reminiscences of childhood and popular memory. I’d be interested in hearing what others think.

I’ve been reading the ‘Cardiff Borough Records’ – a magisterial five-volume set of miscellany relating to Cardiff from Norman times through until the early twentieth century. It is fascinating. There is everything from court cases to inquests, slander suits to land rents and tithes. For a good Cardiff boy like myself, I find the references to land parcels very interesting in, say, the fourteenth century, which still have echoes in areas and street names to this day. There are, for example, several references to the ‘Weddle’ or “Weddal fields”. Wedal Road is now a busy conduit not far from the University of Wales hospital. But I digress…

One section that stands out for me is the ‘Reminiscences of Old Cardiff’, which contains a brief but fantastic list of ‘eccentric old characters of Cardiff’. These include ‘Pegg the Wash’, an apparently feisty and pugnacious old washerwoman, whose habit was to chase children away from her house with a stick, perhaps peppering her imprecations with a good Welsh oath or two.

“Dammy Sammy” was an apparently well-known schoolmaster, whose sobriquet relates to his colourful choice of language in front of his young charges. A dwarf sweet-seller, known as ‘cough candy’ took advantage of his appearance and, in fact, seems to have augmented it by using his top hat as an advertising hoarding, pasting shop adverts and flyers onto it. The list goes on, but also noteworthy is ‘Hairy Mick’, the lamplighter!

What, though, stands out about these reminiscences? For me, it is the fact that all of these figures involve, or have relevance, for children. They were clearly denizens of a childish world – larger-than-life characters who left an indelible mark on the memory.

Memory, and reminiscence, is an odd thing, especially in terms of using and interpreting these characters in context of, say, social conditions.  How can we separate the ‘truth’ (if such a thing exists) from misty-eyed, if not evocative, depictions of ‘characters’. It is an interesting question. History is full of ‘characters’. If we think of history taught in schools, it is most often done in terms of a cast of individuals (Henry VIII, Hitler et al) and set-piece historical events.

And yet there is a remarkable constant throughout history and human nature, in our ability to identify and remember people who, for one reason or another, were somehow different. I can illustrate this from my own memory. When I was little, there was an unfortunate character who frequented a main street nearby, and who would suddenly leap out and shout at the traffic, sometimes even accompanied by violent gestures and karate actions. A certain mythology built up around him; it was popularly supposed that his wife and children were killed in an accident, thus affecting his mind and causing his behaviour. Whilst it’s certainly possible, it is interesting that no hard evidence really exists; people simply ‘know’.

In his excellent study of the history of folklore in London, Steve Roud makes this important point relating to the endurance of certain types of popular myths – things that are still ongoing today. Aside from more obvious ones such as empty properties gaining a reputation for being haunted, or patches of waste land being attributed to plague pits, he also notes the spread of often baseless rumours, which are then taken as truth. One such is the belief that a certain portion of land or building can never be developed as it was, at some stage, ‘given to the people’. There is one of these on my doorstep; the Caerphilly Miner’s Hospital has long been said by locals to be the property of the people of Caerphilly. Unfortunately, this hasn’t stopped it from recent closure…and redevelopment! A mythology of the individual, perhaps especially when that individual is located within the context of childhood memory,  fits well into this type of folklore.

How could we interpret characters like ‘Dammy Sammy’? As a medical historian, I am loath to engage in ‘retro-diagnosis’ since it’s obviously possible that he just had a foul mouth! But it’s also plausible that a pathological condition, say Tourette’s syndrome, certainly unknown and undiagnosed at the time, might explain spontaneous expletives. If so, a historian of nineteenth-century attitudes towards such conditions might find a useful case study. In a sense, it is not the character himself, but the reason why (s)he stood out that renders them interesting.

Let’s speculate further. Was ‘Peg the Washerwoman’ simply a bad-tempered old woman? Highly likely. But dementia, or perhaps an underlying psychological or sociopathic condition might explain a fear of strangers and a desire to drive them away. Historians of witchcraft have long highlighted the fact that ‘difference’ was often a crucial deciding factor in suspicions of witchcraft. Old women, especially those at the margins of society, were vulnerable.

The point is that we sometimes need to look beyond the simple description or reminiscence and try and unpack the social context of the ‘other’ in society. That the names of these characters – and their apparent ‘eccentricities’ – have survived or achieved notoriety, whilst many others have not, tells us something of how difference was perceived in past societies.

Hay Festival 3rd June 2012 – Heroes and Villains of Welsh history

Come and see the Doctor!

https://www.hayfestival.com/p-4613-ben-curtis-alun-withey-and-tyrone-osullivan-join-huw-bowen.aspx

Writing Welsh History (3)

A couple of weeks ago I took part in the ‘Writing Welsh history’ event at Swansea University. One of the main topics of the evening was how we approach Welsh history; is it somehow different to other countries or regions? Are there any specific problems facing historians that are uniquely Welsh? That last question is one that vexes me. The recent television series was titled The Story of Wales. As a participant in the television debate following the series noted, it is not The story, but A story. I believe that we are lacking a grand narrative of Welsh history. It is natural to think in terms of chronologies, but it is difficult to think of the sweep of Welsh history without using the broader British history as a reference point. In other words, could we even tell a story of Welsh history?

This problem is particularly relevant for me as I contemplate my next academic project. I’m thinking about tackling a narrative of Welsh medicine from earliest times to the present day. This hasn’t been attempted before, and there is certainly a need for such a study. The problem, though, lies in structure. From available source material, for example, is there enough evidence to fill chapters before, say, the tenth century? The obvious solution is to adopt a thematic approach, rather than a narrative chronology. But in other ways it highlights the fact that Welsh history cannot always be neatly compartmentalised.

There have been many ‘history of Wales’ volumes (I’m thinking of works by John Davies, Geraint Jenkins and Prys Morgan) and these ably take on the difficult task of constructing a narrative. Geraint Jenkins’s Concise History of Wales is excellently written on what he describes as a ‘formidable task’ of writing the entire history of a country. In terms of periodization, the first chapter, ‘the earliest inhabitants’, covers everything from Celtic and Roman Wales up until around 380AD. Chapter two covers around seven hundred years, up to 1063. But after 1063 the pattern changes to around two hundred years per chapter. This isn’t a criticism; it just underlines the reality for any chronological history of Wales that, before the 11^th century, it is difficult to go into forensic detail.

But I also think that we do need more of these types of ‘stories’ to get a more fixed idea of what our history actually consists of. In my first book, I purposefully avoided a narrative, firstly because the evidence wasn’t suited to this type of approach, and secondly because I wanted to address a number of different themes in broader medical history. But this time I’m tempted to bite the bullet and try and answer my own question of whether we should think in terms of ‘Welsh medical history’ or ‘medicine in Wales’.