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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

‘For Mrs Bridges

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

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

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

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

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

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

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

There are a number of interesting elements to this letter. Firstly, it is clear that Mrs Bridges visited this practitioner. The letter itself is virtually a follow-up to the appointment, containing some record of the encounter but, more importantly, a full set of instructions and directions for her recuperation. This suggests that the face-to-face encounter was one stage in a process. Where, today, one generally leaves the doctor’s surgery armed with a prescription, this encounter was holistic, and involved a further stage. Put more simply, the ‘appointment’ didn’t end when Mrs Bridges left the physician’s 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.