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.