Medicine in a Vacuum – Practitioners in Early Modern Wales

In 1975, John Cule argued that the problems facing the historian of medicine in Wales are ‘quantitatively and qualitatively different’ to those of England. Even given the ever-expanding range of sources for medical history over the past twenty years of so, and the massive impact of digitization upon the availability of source material, this remains a truism.

Image from Wikipedia Commons
Image from Wikipedia Commons

It has long been held that Wales was a land largely devoid of formal medical practice. Instead, there remains a belief that medical folklore dominated, with cunning folk and magical healers providing the mainstay of medical provision. There are certainly strong reasons to support this view. Favourable religious conditions, laxity in prosecution, a largely rural landscape and the cushioning factor of the Welsh language, all served to provide favourable conditions for unorthodox practice to flourish.

My book on Welsh medicine argued that folklore was only half the picture. The other half was of a country far less medically remote than previously acknowledged. Far from being insular, Wales was remarkably open to medical developments, both in terms of ideas, retail and consumption. The Welsh language, I argued, served to disseminate, rather than limit the spread of ideas, and a wealth of evidence suggests a thriving economy of medical knowledge, manifest in a strong culture of remedy sharing. When I began my trawl of the archives for this project, I was confident that the numbers of practitioners would quickly stack up, since no quantification had ever been attempted.

After three years, however, I have managed to locate only 1300 individuals. Whilst this might sound fairly healthy, it represents the whole of Wales (with a population then of nearly half a million) between 1550 and 1740. To put it another way, there were more medical practitioners in 17th-century Bristol than in the whole of Wales. Understandably this has got me thinking. Have I simply been wrong all along? Have I overestimated the breadth and scope of medical practitioners? Was Wales, after all, really a land of cunning folk? All possible. But, I also believe that the numbers alone don’t give us the whole picture. As I want to argue today, there are reasons why we should not become over-reliant on raw statistics.

To understand the nature of the Welsh medical landscape in the early modern period, it is necessary to understand the landscape itself. One of the most important factors affecting formal medicine was the nature of urbanization. In the early modern period Wales was a rural nation, with a sparse and thinly spread population. Compared to much of England, Welsh towns were extremely small. The largest town was Wrexham, with a population of around 3,500 by 1700. Most of the larger Welsh towns were between 1000 and 2000 inhabitants. This had crucial implications for the structure of medical practice. Since there were no towns large enough to sustain large groups of practitioners, there is no evidence of any medical guilds or companies. Wrexham was the only possible exception, but its practitioners apparently never attempted to formalise the practice of their trade in the town.

Secondly, Wales lacked any medical infrastructure until well into the nineteenth century. There were no hospitals or medical training facilities on Welsh soil. Neither, until the 1730s, were any medical texts being printed in the Welsh language, although there was a lively trade in English medical books. Without local facilities, prospective Welsh medics needed to look elsewhere for formal education. Even here we are frustrated though since it seems that a mere handful (perhaps 10) ever darkened the doors of European medical universities, and perhaps a few score to Oxford and Cambridge. Compared to Irish medical students, who travelled in numbers, the Welsh, for reasons that are unclear, remained steadfastly put. We could simply stop here and therefore assume that we are chasing shadows. But, even a brief look at the nature of Welsh source material reveals the extent of the problem.

In general terms, for example, Wales lacks many key source types – a problem familiar to Irish medical historians. Parish registers before 1700 are excellent for some areas, but virtually non-existent elsewhere. A lack of probate accounts inhibits large-scale analyses like Mortimer’s work on southern England. Wills and inventories for Welsh medical practitioners are few, rendering quantitative studies difficult. Other types of sources such as property deeds and parish registers offer statistical insights but offer little in qualitative terms.

Image from Wikipedia commons
Image from Wikipedia commons

As I have mentioned, there were no medical guilds or companies. Practitioners are fleeting figures in borough records; with small towns there is less evidence for things like apprentice registers which might otherwise be revealing. What remains is an unrepresentative patchwork map of practitioners. There are simply more sources in some areas too than others. Monmouthshire, Denbighshire and Glamorganshire are all relatively well served. But for Cardiganshire, for example, I can find only three individuals in total. By any measure, this is simply not correct.

If, however, the limitations are recognised, and the sources allowed to shape the research questions, it’s possible to recover a surprising amount of detail about the types of individuals engaged in medical practice in Wales, their status within local society, training, social networks etc.

To get the full picture we need to look again at the question of hinterlands. In fact, I would suggest it makes little sense to regard Welsh practitioners as a homogenous group at all. Large English towns influenced each area of Wales. For south Wales it was the massive port of Bristol. For mid Wales and the Marches, towns like Shrewsbury, and for North Wales it was Chester, each of which contained large groups of medics and, evidence suggests, strong connections with Wales.

Case studies of individual towns can be instructive, rather than county studies where population density and local conditions, can vary so much. In North Wales the mighty Wrexham gives a much deeper picture of medical practice in a Welsh town than anywhere else in the Principality due to excellent records. In fact, rough patient-practitioner ratios in Wrexham are comparable to those in many large English towns. But what stands for Wrexham does not necessarily follow for Carmarthen, Monmouth or Brecon, so regional comparisons are important as far as records allow.

Image from Wikipedia Commons
Image from Wikipedia Commons

A second thorny issue, however, is that of the nature of medical practice itself. Our evidence highlights the dangers of drawing artificial distinctions between practitioner types. Much depends on occupational titles in sources. Medicine could be a part time occupation – perhaps especially important in the case of cunning folk. It must be assumed that such people did not earn a living wage through the occasional use of charming etc. The single practitioner in the tiny Welsh hamlet of Festiniog in the 1650s can hardly have been overworked! But more broadly, tradesmen like blacksmiths often found second occupations as tooth drawers, but this duality is not reflected in the sources. Shop inventories suggest medical goods available in a range of non-medical shops.

In the last analysis it may well prove true that the numbers of Welsh practitioners were lower than elsewhere. Indeed it seems logical that this was the case. But it also depends where the comparison is placed. Comparing, say, Cardiganshire with Cumberland, or parts of rural Ireland, is more realistic than comparing it to London! Many previous studies simply don’t differentiate. Equally, after effectively ignoring them in my book, it is likely that we need to put folkloric healers back in. Whatever the truth may be it is clear that numbers just simply don’t reveal the whole story. The unique characteristics of a country, nation, region, county or even town need to be fully understood before conclusions can be made.

(This is a version of a paper I gave at the ‘Medical World of Early Modern Ireland, 1500-1750, in Dublin in early September 2015).

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