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.

File:Hans Sloane.jpg

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
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.

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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?

L0022226 'The poor doctor and the rich patient. 'You are very ill!'(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.

V0010971 A couple of country folk consulting a decrepit doctor, a ser

(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.