Robbing the Doctor: 17th-Century Medics as Victims of Crime

During the sixteenth and seventeenth centuries, a common complaint against medical practitioners was that they effectively picked the pockets of the sick, whilst doing little for them in return. As the Helmontian physician George Starkey remarked in the middle of the seventeenth century, the patient was “like to pay the price of the doctor fully with his life” – which Starkey regarded as a brave acte’!

But medics, just like anyone else, could sometimes be victims of crime. The records of the Old Bailey contain a fascinating list of these unfortunate practitioners, and the list of crimes and calumnies they suffered. More than this, however, they can offer an alternative glimpse into the world of early modern medical practice.

(Old Bailey in the 19th century – image from Wikimedia Commons)

Sometimes, for example, physicians and other practitioners found themselves the victims of petty crime. In 1686, Edward Newgent of St Clement Danes pinched the periwig of an unnamed ‘Doctor of Physick’. The good doctor testified that he had been walking along the street in the evening, when the assailant whipped off his hat and wig, and pelted away down the street with them. The doctor gave chase and had the thief arrested. For this seemingly innocuous crime, the unlucky Newgent was sentenced to death!

Another victim of circumstance was Richard Allen of Holborn. In 1675, hearing a disturbance in the street, Allen, ‘by profession a Sea-Chirurgeon’, opened his door and was attacked by a mob (including bayliffs on the hunt for a person to serve a writ). Allen, was set upon by the men, ‘they hacking and hewing him without any mercy, that they left him dead upon the place’. So ‘mortal and dangerous’ were his wounds, that a ‘good part of his skull was taken clean off’.

(Image from Wikimedia Commons)

At other times, the medicines or very tools of their trade might be targets for thieves. Surgeons, and their instruments, seem to have been a particular target. Instruments, especially high end examples, could be expensive and decorous, and were therefore worth taking. Consider the case of William Marriott, surgeon, whose house was broken into in October 1693 by the terrible trio of Batson, Dando and Bedford, ‘about 3 o’clock in the morning in a rude manner’. Swearing ‘great oaths’ and ‘offering to send his Soul to Hell’ they relieved him of £42 in cash, a gold locket and ‘a pair of forceps val. 4s, and other surgeons instruments besides’. All were acquitted.

March 1679 saw a “mischievous youth” slip into a barber-surgeon’s shop and observing that the barber was in another room, he made off with a “case of instruments, most of them tipt with Silver”. Crime didn’t pay for the errant youth; he was burnt in the hand for his trouble. A trio of thieves also relieved a London practitioner Peter Hillery of a “case of Chirurgeon’s Instruments” along with his sword. Hillery testified that he was “drinking in a Brandy shop” with one of the thieves, when he found the items missing. Quite why he felt the need to take his instruments to the pub with him is, unfortunately, not recorded.

(Image from Lewis Walpole Library)

Accosted by the highway robber, Daniel White, one John Delaphont was forced to stand and deliver ‘two boxes of surgical instruments, together with his hat, coat and shirt!

As well as the crimes themselves, some cases offer us a view into the world of what might be termed ‘irregular’ or ‘unorthodox’ practice. The descriptions of individuals are sometimes telling. In October 1679, for example, “several Bottels of a medicine called Elixar Vite” (otherwise known as ‘elixir vitae’ – a strong distilled water) were stolen from “a very ancient Itallian Gentel Man who has long professed Physick in this Kingdom”. The Italian was Salvator Winter, one of a string of European itinerant practitioners, who toured Britain in the mid seventeenth century, peddling their wares. In other sources, Winter was described as a ‘medical licentiate’, and signed letters testimonial to the skill of other practitioners. The servant of the unfortunate Winter was indicted, but later acquitted.

(Image from Wikimedia Commons)

Another ‘unorthodox’ practitioner named Blagrave – “a pretender to physick” was relieved of a “Gold chain, a Medal, divers pieces of plate, several rich Cloaths, some Money &c”. The richness of the pickings from Blagrave highlights what a lucrative profession the practice of medicine could potentially be. To possess this level of goods suggested a man of means.

It wasn’t all one-way traffic however. As the records sometimes tell, medical practitioners could sometimes be tempted away from the path of righteousness. The exotically-named Toussaint Felix Urvoy was indicted of the heinous crime of stealing three china dishes in 1760. The case was complicated since Urvoy was owed money by the complainant, and claimed the dishes had been lent to him. Another witness described him as ‘a quack doctor’ who had befriended him in a public house (a pattern seems to be emerging here!) and said he ‘had some particular nostrums by which he could cure several disorders’.

Consider, though, the cautionary tale of the surgeon Stephen Wright, born to a wealthy Irish family, given a good education, versed in arithmetic and classics and sent to Dublin to be apprenticed to a prominent Irish surgeon. All was going well until…

“Unhappily for Stephen he chose to go by the Way of London, and to acquaint himself a little with England, the Place of his Nativity, whence his Forefathers came; tho’, as he said, his Father had a pretty good Estate, besides a handsome Sum of Money in Ireland, to which he was Heir, but by his desperate Misbehaviour, he has effectually prevented his inheriting either one or the other. For some Time after his coming to England, he served a Surgeon in the Country in Surrey, and might have done well, had he kept to his Business and been industrious, as he had good Education, and seemed capable of his Profession. His Friends had advanced to him 180 l. to bear his Expences at the Colleges in Paris. But he not content with that, resolved to improve this Sum, tho’ the Project he fell upon was wrong and foolish, and had no Success answerable to his Desire. In Effect he went to a Gaming-House in Covent-Garden, where in two or three Days, or at most a few Days, he lost the 180 l. designed to bear the Expence of his Travels, and then having no Money left, and not knowing what to do, but being destitute of the Grace of God, he resolved upon desperate Courses of Robbing.”

Given that so much focus is often upon the occupational lives of medical practitioners, it is interesting to see glimpses of their world through another lens. Lists of stolen items, for example, can be extremely useful in gauging what sorts of equipment physicians and surgeons owned, and where they took them. The terms by which medics were referred to and known is also revealing, not least in the colourful characters who sometimes inhabited the margins of medicine. The reason that I particularly like these records, though, is that they offer an intimate insight into the daily lives, frailties and misfortunes of a group of individuals, showing us a side of their lives not often reflected in the usual records of their medical occupation.

The Agony and the Ecstasy: Hunting for 17th-century medics with few sources!

At the moment I’m once again on the hunt for elusive Welsh practitioners in the early modern period. The idea is to try and build up a map of practice, not only in Wales, but across the whole of the country. Once this is done we should have a clearer picture of where practitioners were, but also other key factors such as their networks, length of practice, range and so on.

Working on Welsh sources can at times be utterly frustrating. For some areas and time period in Wales sources are sparse to the point of non-existence. Time and again sources that yield lots of new names in England draw a complete blank in Wales. Ian Mortimer’s work on East Kent, for example, was based on a sample of around 15000 probate accounts. This enabled him to draw important new conclusions about people’s spending on medical practitioners in their final days. For Wales there are less than 20 probate accounts covering the early modern period!

Wales had no medical institutions or universities, so there are no records of practitioners’ education or training. Welsh towns were generally smaller than those in England – the largest, Wrexham, had around 3000 inhabitants by 1700 –and this had a limiting effect on trade corporations and guilds. As far as I can tell there were no medical guilds in Wales between 1500-1750. It is also interesting to note that relatively few Welsh medics went to the trouble of obtaining a medical licence. A long distance from the centres of licensing in London, it could be argued that a licence was simply not necessary. Coupled with this was the fact that there was virtually no policing of unlicensed practice in Wales…only a bare few prosecutions survive.

The common perception has long been that there were simply few practitioners in early modern Wales. In this view, the vacuum left by orthodox practice was filled by cunning folk, magical healers and charmers, of which there is a long Welsh tradition. When I wrote Physick and the Family I suggested that there was a hidden half to Welsh medicine, and that if we shift the focus away from charmers etc then a much more nuanced picture emerges. When I began my search in earnest on this project, I was (and still am) confident that Welsh practitioners would soon emerge in numbers.

At the moment, however, the number stands at around the 600 mark. This includes anyone identified as practising medicine in any capacity, and in any type of source, roughly between 1500 and 1750. So, 600 people engaged in medicine over a 250 year period, over the whole of Wales. Admittedly it doesn’t sound much! As a colleague gently suggested recently, this puts the ratio of practitioner to patient in Wales at any given time as roughly 1-50,000!

Here, though, the question is how far the deficiencies of the sources are masking what could well have been a vibrant medical culture. How do you locate people whose work was, by its nature, ephemeral? If we start with parish registers, for example, their survival is extremely patchy. For some, indeed many, areas of Wales, there are simply no surviving parish records much before 1700. Add to that the problem of identifying occupations in parish registers and the situation is amplified. How many practitioners must there be hidden in parish registers as just names, with no record of what they did? It is also frustrating, and probably no coincidence, that the areas we most want to learn about are often those with the least records!

Records of actual practice depend upon the recording of the medical encounter, or upon some record of the qualification (good or bad), training, education or social life of the practitioner. Diaries and letters can prove insightful, but so much depends on the quality and availability of these sources. There are many sources of this type in Wales but, compared to other areas of the country with broader gentry networks, they pale in comparison.

All of this sounds rather negative, and it is one of the signal problems in being a historian of medicine in Wales of this period. In a strange way, however, it can also be a liberating experience. I have long found that an open mind works best, followed by a willingness to take any information – however small – and see where it can lead. Once you get past the desperation to build complete biographies of every practitioner you find, it is surprising what can actually be recovered.

In some cases, all I have is a name. Oliver Humphrey, an apothecary of a small town in Radnorshire makes a useful case in point. He is referred to fleetingly in a property transaction of 1689. This is seemingly the only time he ever troubles the historical record. And yet this chance encounter actually does reveal something about his life and, potentially, his social status and networks. The deed identifies him as an apothecary of ‘Pontrobert’ – a small hamlet 7 miles from the market town of Llanfyllin, and 12 from Welshpool. Immediately this is unusual – apothecaries were normally located in towns, and seldom in small, rural hamlets.

The deed involved the transfer of lands from Oliver and two widows from the same hamlet, to a local gentleman, Robert ap Oliver. Was this Robert a relative of Oliver Humphrey? If so, was Oliver from a fairly well-to-do family, and therefore possibly of good status himself? Alternatively, was Robert ap Oliver part of Humphrey’s social network, in which case what does this suggest about the social circles in which apothecaries moved?

Where there is a good run of parish registers, it can be possible to read against the grain and find out something of the changing fortunes of medics. Marriages, baptisms and deaths all point to both the length of time that individuals can be located in a particular place, and how they were identified. In some cases, for example, the nomenclature used to identify them might change; hence an apothecary might elsewhere or later be referred to as a barber-surgeon, a doctor or, often, in a non-medical capacity. This brings me back to the point made earlier about the problems in identifying exactly who medical practitioners were.

An example I came across yesterday was a bond made by a Worcestershire practitioner, Humphrey Walden, “that in consideration of the sum of £3 he will by the help of God cure Sibill, wife of Mathew Madock of Evengob, and Elizabeth Havard, sister to the said John Havard, of the several diseases wherewith they are grieved, by the feast of the Nativity of St John the Baptist next ensuing, and that they shall continue whole and perfectly cured until the month of March next, failing which he shall repay the sum of £3”.

Apart from the wonderful early money-back guarantee, this source actually contains a potentially very important piece of information. It confirms that a Worcester practitioner was treating patients in Wales – Evenjobb is in Radnorshire. Walden may have been an associate of John Havard and been selected for that reason. Alternatively, he may have had a reputation along the Welsh marches as a healer for certain conditions, and been sought out for that reason. It strongly suggests the mutability of borders though, and the willingness of both patients and practitioners to travel.

In other cases practitioners pop up in things completely unrelated to their practice. The only record I have of one Dr Watkin Jones of Laleston in Glamorgan occurs because he was effectively a spy for the earl of Leicester, being called upon to watch for the allegedly adulterous activities of Lady Leicester – Elizabeth Sidney. At the very least, however, it confirms his presence in the area, his rough age, and the fact that he was connected to a gentry family.

And so the search continues. My list of potential source targets is growing and I’m confident that a great many more Welsh medics are still there to be found. If, as I suspect, the final number is still relatively small, I still don’t accept that as conclusive evidence of a lack of medical practice in Wales. As the old maxim goes absence of evidence is not evidence of absence. What it might call for is a revaluation of Welsh cultural factors affecting medical practice and, perhaps, a greater and more inclusive exploration of medical practice, in all its forms in Wales.

Physick and the Family: health, medicine and care in Wales, 1600-1750 (Manchester: Manchester University Press, 2011)

“Master Docturdo and Fartado”: Libellous Doctors in Early Modern Britain

I’ve just returned from a great conference at the University of Exeter – the Landscape of Occupations – organised by the project on early-modern medical practice of which I’m a part. There were a great variety of papers and many different aspects of occupation, occupational titles and identities and a range of other factors relating to ‘work’ in early-modern Europe.

One of the papers I was struck by was given by Professor Laurinda Abreu of the Unviersity of Evora, Portugal. Her paper explored something of the power struggles between the Portuguese crown and medical faculty for the assumption of medical authority and control over medical licensing. While the topic of conflict will be a familiar one to anyone studying early modern medical practice in Britain, it was really interesting to explore the same themes in a different context.

The relationship between different types of medical practitioner in the past has often been fraught. I’m oversimplifying here but, in general, physicians did not like surgeons as they saw them as low-status butchers who got their hands dirty. For their part, surgeons did not like physicians, whom they viewed as arrogantly adopting a position of superiority, often without basis. Apothecaries were not popular with either group since they often dabbled in physic and surgery – something they were not supposed to do. Quacks, cunning folk, ‘old women’ who healed and other types of ‘irregular’ practitioner, were pretty much attacked by all other practitioners!

This apparent antipathy worked on a macro level, with entire groups entering paper wars and public slanging matches. But it is also clear that individual practitioners were prepared to take each other on if they thought that their territories were being invaded. I was reminded of a particular dispute between Exeter practitioners that was so vociferous that it ended up becoming a libel case in the Star Chamber court.

On May 10th 1604, the Exeter physician Thomas Edwards accused one of his colleagues – and possibly former friend – John Woolton of libel. The two men came from different backgrounds. Woolton was an Oxford graduate, son of a former Bishop of Exeter, holder of a medical licence and, later, an MD. In this respect he was about as ‘orthodox’ a physician as it was possible to be and was a leading physician in the town. Edwards, by contrast, had come to practice through the more usual route of apprenticeship and learnt his trade by observing his master, Francis Pampergo. Although he briefly went to Oxford, Edwards returned and established an apothecary business in Exeter.

Problems began to arise when Edwards, the apothecary, began to practice medicine, as well as selling drugs in his shop. Apothecaries were nominally banned from practising medicine, so Edwards was effectively breaking the law. In so doing, though, he also brought himself into direct competition with the prominent Woolton – a competition that Woolton was not prepared to tolerate.

Some time late in 1603, Woolton wrote a letter to Edwards which, even by the libel standards of the day was couched in the bitterest terms. Woolton began by addressing Edwards as ‘Master Docturdo and Fartado’ – hardly endearing terms to begin with. He went on, though, to launch a series of attacks on Edwards’ credibility, character and reputation. Edwards was accused of everything from dishonest dealings with his suppliers to the excessive bleeding and purging of one of his patients – Sir William Courtenay. Interestingly, Courtenay had originally been one of Woolton’s patients, so was he bitter at losing this prominent member of the Devonshire gentry to a mere ‘empirical’?

The crux of the complaint, however, lay in Woolton’s objections to Edwards’ practice. “Your master taught you not to go beyond your mortar and pestle [and so] you aught not to minister so much as a clyster or open a vein’. Woolton backed up his objections by stating that Edwards was using dangerous substances in his ‘desperate practice’, including mercury, ratsbane, brimstone and aqua fortis, all of which were part of the chemical arsenal of Paracelsian physicians and which, argued Woolton, Edwards had insufficient knowledge of’.

Woolton made several copies of his letter, keeping one for himself, sending one to Edwards and passing on some to ‘divers others’ who published them, making the allegations widespread. The result of this was inevitable; Edwards was enraged. Reports suggest that tensions elevated and Edwards went looking for the doctor, with his rapier drawn. Woolton spotted him and shouted that he should ‘go back to his pestle and mortar’.

The battle lines were drawn and Edwards sued for libel. These were serious allegations the ‘publishing [of which] doth provoke malice and breach of the peace’. Edwards’ reputation was in the balance and everything hinged on whether the judges and court were sympathetic to the word of an apothecary against a prominent, university-educated physician.

The judgement was conclusive, and Woolton was censured…in fact severely! The Lord Coke ‘began a very sharp sentence, and the greatest number agreed. He would spare Woolton corporal punishment because of his degree (!), but he fined him £500’. This, at the time, was an immense sum. The other libellers and publishers were also fined £40 a piece and Edwards was awarded £200 damages.

But still Lord Coke had not finished. Speaking ‘very sharply of the sin of libel’ he decreed that Woolton should ‘at a public market at the next general assizes’ be made to stand and publicly confess his faults. For a man of such eminent background as Woolton, the shame of this punishment, not to mention the financial penalty, must have been enormous.

Conflict in medicine has been a constant factor across time, but it is interesting to see the level of acrimony that individual disputes about medical authority could engender. The ruinous outcome for one of the parties here demonstrates the intolerance of the courts for those who resorted to publicly defaming rivals, but this did not stop practitioner squabbles from continuing well into the eighteenth century.
(For more on this case see R.S. Roberts, ‘The Personnel and Practice of Medicine in Tudor and Stuart England: Part 1, the provinces’, Journal of Medical History, 6:4 (1962)

“By the King’s Special Grant”: A Venetian Quack in Early Modern Britain

Among the most colourful characters in early modern medicine were the ranks of medical mountebanks and quacks that traversed the country selling all manner of dubious pills, potions and preparations. A vast range of medical substances were available with everything from the ‘Catholick Pill’ to the ‘Hercolean Antidote’ offering frightened (and gullible) patients a chance to escape the heavy burden of their conditions. The subject of quacks has been well covered over the years – perhaps most famously by the late Roy Porter – and quack remedies are always appealing to a popular audience. There is perhaps something within us that sympathises with the sheer cheek of these characters, even though we might question their motives as well as their remedies.

It was common for quacks to move around; in fact it was common sense. Once people realised that they had been duped it was probably not a good idea to hang around. Robert Bulkeley of Dronwy in Anglesey encountered one such figure on the road in the early seventeenth century. Bulkeley was suffering from toothache and a ‘mountebank’ offered to cure it for a penny. Unsurprisingly, two days later Bulkeley was a penny down but still had the toothache. But some ‘medical entrepreneurs’ travelled further than most. On occasion, foreign characters visited British shores, carrying with them a whiff of exoticism and something different to the travelling tinker’s pack. Some even achieved some measure of fame and renown as they moved around. One such was Vincent Lancelles, reputed to be Venetian, who appeared in Britain in the mid seventeenth century.

We know something about Lancelles from the flyer that he sent around to advertise his current or future presence. It was nothing if not confident:

“By the King’s Grant and Speciall Approbation, be it knowne that there is arrived in this towne M. Vincent Lancelles, Physician and Chyrurgeon, Spagyrique and a very expert operator, and one of the King’s most excellent Majesties Servants, and approved by the Colledge of Physicians of London, and by His Majesties Physitians in ordinary…”

Perhaps he had seen the King. Perhaps all the doctors of England did indeed laud him for his skill. Perhaps the august College of Physicians were falling over themselves trying to add him to their members. Perhaps.

The flyer then went on to list over 100 maladies that Lancelles unselfconsciously claimed to have mastered. These included epilepsy, melancholy, ‘hydropsie’, ulcers of the lungs, heate of the liver, flux, paine of the kidneys, cholick, worms…the list went on. And on. In addition to ailments he could also ‘helpe the blinde’, perfectly draw teeth and make hair grow again. Faced with such expertise, who would not want to flock to see Signor Lancelles?

In the mid seventeenth century Lancelles begins to be mentioned in various sources around the country. In 1652 he was in Chester. We know this because the so-called ‘Water Poet’, John Taylor was also there whilst on one of his many perambulations around the country. Whilst lodging at the Feathers in Watergate Street, Taylor “met with two brothers of mine acquaintance thirty years, they brought me to the chamber of a reverend Italian physician, named Vincent Lancelles, he was more than 80 years of age, yet of a very able body,and vigorous constitution”. Taylor was clearly impressed by the old man:

He helped such as were grieved for three several considerations —

First, He cured the rich, for as much as he
could get.

Secondly, He healed the meaner sort for what
they could spare, or were willing to part withal.

Thirdly, He cured the poor for God’s sake, and gave them money and other relief, as I myself (with thankful experience) must ever acknowledge : For he looked upon my lame leg, and applied such medicine, as did not only ease me, but I am in hope will cure me, the grief being nothing but a blast of lightning and thunder, or planet stroke, which I received nine years past at Oxford.”

It is clear that Lancelles was either in Britain for some considerable length of time, or alternatively left and came back. In either case he can be placed at Oxford in 1652 before seemingly moving north later on, making his way to Ashbourne in Derbyshire and Wrexham. It was there that an unfortunate incident probably brought him to the attention of the diarist Philip Henry.

In June 1663 Henry wrote an entry in his diary: “This week dyed in Chester a servant to an Italian Mountebank known by the name of his Apothecary, who received some blows about 3 weekes since upon ye stage in Wrexham, in a scuffle with Mr Puleston of Emeral”. In the entry the mysterious Italian is referred to as Giovanni, but the balance of probability points to Lancelles. And what of his servant, killed in a scuffle with the over-excited crowd?
Perhaps the incident was too much for Vincent who, if it is the same man, would be in his 90s by then! Whatever the reason, this is possibly the last reference to the enigmatic Italian mountebank.

Early modern Britain was replete with medical practitioners of many different qualifications, motivations and skills. All appealed to a common human trait, that of trying to rid the body of ailments and restore balance and health. They are some of the most fascinating body of historical actors that you could hope to find.

Do you need a doctor? Applying for medical jobs in the eighteenth century

Filling in job application forms must rank as one of the world’s least rewarding pastimes…unless, of course, you get the job! There is the matter of displaying your own competence for the role, addressing your experience, evidence of your skills, ability to fit in with the recruiting organisation and, importantly, providing people who will attest to your obvious brilliance. It feels like a very modern thing to do. Whilst we increasingly acknowledge that people in the past could be ambitious, we don’t often get chance to actually glimpse the process in action – especially the further back you go. Some fantastic sources in Northumberland Archives, though, give us the chance to do just that. Better still, the aspiring job applicants were medical practitioners!

In 1774 a vacancy arose for the position of Surgeon-Apothecary at an infirmary in North East Britain. The infirmary was a charitable institution set up for the ‘relief of the sick and lame poor’, and was located in the magnificently austere Bamburgh Castle on the Northumbrian coast. The post had become available on the departure of the previous incumbent and, on the face of it, might not have seemed an ideal move. But something about this job appears to have resonated with the practitioner population of late eighteenth-century northern Britain. Perhaps it was the chance to work with the Reverend Dr John Sharp – administrator of the Lord Crewe Trust and the man who established the infirmary. Perhaps it was a genuine desire to do good for the poor people of rural Northumberland, who were far the nearest hospital in Newcastle. Or perhaps it was the lure of a decent salary and some authority within in institution, with their own staff to command! Whichever it was, news of the job appears to have spread fast, and letters poured in to Dr Sharp. Typical of the speculative applicants was Arthur Gair from Alnwick. Keeping his letter short and to the point, Gair nonetheless threw his hat firmly into the ring:

“25th June 1774. Reverend Sir, As I am informed the place of Surgeon-Apothecary for the Charity of Bambro’ Castle is now vacant, I beg leave to offer myself as a Candidate for the same & till I have the pleasure of paying my respects to you at the Castle which I intend to do on Monday next, I take this method to declare myself , reverend Sir, your most obedient and humble servant”.

(Image from the excellent Bamburgh Castle Research Project blog = http://bamburghresearchproject.wordpress.com/2012/12/07/an-18-century-bamburgh-castle-scandal/)

Others were less circumspect. Only three days later than Gair, the good Dr Sharp received the following letter from a Dr William Rennick. Unlike Gair, Rennick was not one to hide his light under a bushel.

“I beg leave to signify, that as there are rather too many physical practitioners in this place, I should be inclined to settle in Belford provided I could be favoured with the benefit, lately possessed by Mr Edmonton, at Bamborough – If you are willing to permit me to succeed him on satisfactory recommendation I should ever make it my study to merit your approbation of my conduct, and to display a grateful sense of the solicited obligation. I have been settled here as a Surgeon-Apothecary & man midwife near two years; my qualification in which professions, as well as the tenor of my moral conduct will, I flatter myself, bear the strictest enquiry. I am a native of Berwick & married. My attendance on some particular patients prevents my being able to wait on you in person.
I am with respectful esteem, Sir, your most humble servant”

Rennick’s was a slightly unusual pitch; pointing out that there was too much competition in his area was perhaps a risky pitch. But the rest of his letter is a work of polite (if slightly oily!) genius. Stressing that he would ‘ever make it my study’ to make his boss happy, it is possible to overdo it…and Rennick overdid it!

Some applicants were keen to provide character references. William Stoddart of Alnwick endorsed John Wilson’s application, stating Wilson was a “young man of sobriety and diligence in his profession. I would by no means have given you the trouble of this, but I could not tell how to deny him what I thought I might say with so much truth”. One William Green also tried his hand with a ‘celebrity’ referee – persuading a powerful local gentleman, Sir John Eden of County Durham, to write him a reference. “As there is a vacancy in the Castle of Bambrough” Eden wrote “I am desir’d to recommend to your notice Mr William Green”. That Eden was ‘desir’d’ to recommend Green suggests that his reference was not given entirely without coercion.

It is also interesting, however, just how far news spread. John Sharp’s brother Dr William Sharp was a prominent surgeon in St Bartholomew’s Hospital in London, and often advised his brother on medical matters relating to the infirmary. In September 1774, William was visited by a naval surgeon, originally from the Bambrough area, who had learned of the position and asked William to petition his brother on his behalf. Although William did not know the man personally, “appearances were in his favour”.
Ultimately all of these approaches, entreaties and salutations were in vain; the job was filled and the successful candidate was a Dr Trumbull, for a time, before the role was taken by the aptly-named ‘Mr Cockayne’!

The letters are fascinating though, as they add a further dimension to the process whereby practitioners actively sought new positions in the eighteenth century, and shed some light on the methods they used to bolster their chances. We don’t know how the post was advertised, if at all – there is some evidence that the infirmary used the Newcastle Courant from time to time to share news and progress – but it is clear that some sort of grapevine existed. Many of the applicants stress how they have ‘heard’ about the vacant position – another reminder of the power of early-modern social networks.

The next time you’re applying for a job, perhaps take a line from some of these medics. Will you try the ‘short and sweet’ approach of William Gair, or the florid prose of Mr Rennick?! In either case, may your applications be more successful than theirs!

17th-century remedies and the body as an experiment

I have long argued that, for people in the past, the body was a site of experiment. Today, we are constantly told that medicines should be handled with caution. In the accompanying (usually terrifying) leaflets included with most medicines, we are told in great detail how to use them, how not to use them and, most worryingly, the list of possible side-effects, which often seem to outweigh the benefits. One of the potential side-effects in my box of mild painkillers, for example, is a headache…the reason I usually head for the painkillers! But medicines, say the manufacturers, should only be used as directed by a medical professional. Care should be taken with the dosage, and they should not be used for more than a few days. If symptoms persist, head for the nearest A&E and don’t book any holidays!

Image from http//:www.theboredninja.com

We are a society who is certainly prepared to self-dose – something attested to by the shelves full of proprietary medicines in modern pharmacies. Indeed there is a broader issue of distrust with modern biomedicine, leading people to try out alternative and healers. The resurgence of medical herbalism in recent years, the popularity of herbal ‘magic bullets’ from Royal Jelly to Glucosamine and treatments from acupuncture to Yoga all attest to our willingness to consider alternatives.

But all of these ‘alternatives’ are controlled. When we buy over-the-counter remedies they are generally mild and, unless deliberately consumed in large quantities, not dangerous. They are also strongly regulated, and have to pass years of testing before they make it onto the shelves. Alternatives are now generally regulated, with professional practitioners, while herbal medicines from health food shops are also subject to increasing regulation and scrutiny. Alternative practitioners now have available qualifications and endorsements. All in all, while we certainly consider alternatives, we are doing so within a defined, controlled and measured environment.
Early-modern people, however, held a different view of both their bodies and the concept of how medicine worked. In their view, medicine was a process and one that required continual experimentation to find what worked and what didn’t. Even a cursory glance over an early-modern remedy collection confirms this. Some remedies are highlighted – sometimes by a pointing hand or a face, to signify their value. Sometimes words like ‘probatum’ (it is proved) attest to their efficacy, or even notes like ‘this cured me’ or, my favourite, the simple ‘this I like’. Others, however, were clearly unsuitable and might be crossed out many times with thick strokes, highlighting the dissatisfaction of the patient.

A page from Wellcome Library MS 71113, p.10. See article by Elaine Leong at http://recipes.hypotheses.org/tag/lady-anne-fanshawe

It is worth mentioning that the whole concept of ‘working’ has shifted over time. Today, a remedy ‘works’ if it makes us feel better. In the seventeenth century, however, a medicine ‘worked’ if it had an effect. Therefore if a purgative was taken as a measure against, say, a cold, then provided it made the subject purge it was regarded as having ‘worked’, regardless of whether the cold got better. In this sense medicine was experimental. People consistently adapted, modified and changed recipes, adding or replacing substances, until they found something they were happy with.

This process of experimentation was, though, potentially deadly. Use too much of the wrong type of herb, plant or substance, and the results could truly be dangerous. It is often forgotten that plants are full of chemicals. It is entirely easy to suffer an overdose using plant material as it is with modern tablets. The contents of early-modern remedies are often the butt of jokes. Using everything from animal matter, live or dead, to breast milk, spiders’ webs and so on is difficult to fathom from several centuries distance, even though it was perfectly logical to people at the time. In fact, little actual work has yet been done to assess exactly how much damage could potentially be done by people using things like animal or human dung in their efforts to make themselves better. It would be interesting to actually work out the levels of various compositions in some medical remedies, to gauge their potential for harm. This is not helped by the often vague doses provided in recipes. Whilst some directions might be fairly specific in terms of weight measurements, others might rely on including ‘as much as will lye on a sixpence’ or, worse, a handful. Depending on the size of the recipe-preparer’s hand, this could vary considerably!

But this experimentation also meant that virtually everyone was a scientist, involved in testing and measuring remedies against their own bodies. In some cases, though, the element of experiment was literal. Many elite gentlemen followed an interest in science, and especially chemistry, as part of their wider intellectual pursuits. In the early 1700s, the wealthy London lawyer John Meller, latterly of Erddig in Flintshire, kept a notebook entitled ‘My Own Physical Observations’ in which he recorded details of his chemical experiments, and sometimes upon himself! Some of his experiments, for example, appear to be related to finding substances to purge himself. On more than one occasion he seems to have gone too far and suffered the consequences. We can only imagine the circumstances which led him to record that one purge had “proved too hot” for him!
(image from education.gtj.org.uk

Our early-modern ancestors were arguably more in tune with their bodies than we are today. They continually sought new ways to relieve themselves of illnesses and symptoms, accumulating those that seemed to make things better and discarding the rest. Whilst we also do this to some degree, the stakes were much higher for them. We are protected to some degree by the various safeguards in place, and also perhaps by a reluctance to put our own health at risk.
Many early-modern remedies must, though, have been harmful and some might have resulted in permanent damage to internal organs, or even death.

Sickness and medicine are often referred to in military terms, with ‘magic bullet’ cures helping people to ‘battle’ their illnesses. In a sense though our forebears were engaged in single combat, each remedy, each experiment, carrying both high risk and high reward. Remember this the next time you reach for your packet of painkillers!

Bloodletting in Medicine: The return of the Leech

According to a report on BBC news last week, a Welsh company is now the leading producer of medicinal leeches. The company, based near Swansea, produces over 60,000 leeches for use in hospitals around Britain which, although it pales into insignificance next to the 40 million or so farmed in the 19^th century, still represents something of a comeback. So why haleeches endured in the practice of medicine for over four millennia?

We perhaps most associate leeches with the Tudor and Stuart period and they have, rather unfairly, become associated with quack medicine and ‘olde worlde’ quaintness. Think of the scene in Blackadder where a physician apologies for one of his leeches who is “an absolute hog”. In fact, though, leeches were an important part of the early modern health ‘regimen’, as well as being a key tool in the treatment of illness. Far from being magical or ‘folkloric’ they were actually cutting edge!

Bloodletting was a central part of early modern medicine. To get rid of excess blood (as well as other bodily products!) was to rid the body of potentially harmful substances. One means of doing this was by visiting a barber-surgeon who would open a vein and take a few ounces. The ideal amount would see the patient light-headed and nearly fainting, but not actually unconscious – a state known as syncope! But lancets were potentially dangerous; be careless with the instrument, hit the wrong vein or artery, use a dirty or infected instrument and your patient was in trouble.

Leeches, by contrast, with their 300 tiny teeth, were incredibly effective without much discomfort or danger to the subject. Leeches had the added advantage of simply dropping off when they had gorged themselves, but also left a ‘thank you’ gift in the form of a coagulant that helped to close the wound. Staunching the cut made from a lancet could be difficult, as well as introducing undesirable matter into the open wound.

Neither were leeches a poor man’s treatment – in fact quite the opposite, as they were relatively expensive. Unlike other sorts of medicines, people did not routinely keep their own leeches, and it is rare to see them in remedy collections. Instead they were the domain of the doctor and would be applied under his supervision. In fact, so inextricably linked to medical practice were they, that physicians were sometimes even referred to as ‘leeches’.

 

What sorts of treatments were they used for? Apart from taking blood, leeches might also be deployed to suck the pus out of boils! Depending on the condition being treated they might be applied to various parts of the body – even to eyes. What it felt like to sit in a chair while a leech sucked blood through your pupils is perhaps best not dwelt upon but, in general, people seem to have borne their treatments with stoicism. One patient from the late 18^th century reported that “this day I have felt such relief from being bled, having amused half a dozen leeches on my forehead yesterday without much effect”.

Because of their strong associations with the 17^th century, it might be easy to assume that leeches simply disappeared with the advent of new scientific approaches through the eighteenth century. But they didn’t. In fact, if anything, their popularity increased. Indeed, how long they were a part of ‘official’ medicine is often most surprising.

In the 19^th century leeches were ordered in vast numbers by hospitals, including the major London institutions as well as local infirmaries. The account books of hospitals sometimes include specific entries for leeches, as did the Aberystwyth infirmary in 1836, who ordered 50 shillings’ worth of leeches – a not insubstantial stock! Even as late as 1896 some hospitals were still ordering in stocks of leeches, and they continued to be used in some parts up until the Second World War.

And now leeches are back…if they ever really went away. Today the value of these amazing little creatures has been recognised across a range of surgical uses. They are, for example, used in microsurgery, especially in preventing necrosis (tissue death) after limb transplant. The substances they inject into the body have also been found to aid blood circulation, helping to increase blood flow to the newly transplanted parts.

After centuries of emphasis upon medical progress, and the ignorance of patients and practitioners in the past, it is interesting to see the ways in which past practices and beliefs are again beginning to find their way into orthodox medicine. Over the coming years it will be fascinating to see what other remnants of pre-modern medicine make a return to prominence. Let’s hope that purging isn’t among them!

(This post has recently appeared on the University of Exeter’s blog http://blogs.exeter.ac.uk/exeterblog/ – apologies for cross-posting)

Name and Shame: performance and reputation in early modern medicine

Last week the issue of the performance of surgeons came under scrutiny. The health secretary, Jeremy Hunt, threatened to ‘name and shame’ any surgeons who refused to publish their performance data, including mortality rates, in league tables. http://www.bbc.co.uk/news/health-22899448 Surgeons have raised many objections to the plans including potential stigmatisation of those seen as under-performing (an issue that is itself problematic say some authorities), the potential for misleading figures and, no doubt, a dent to professional pride.

The measurement of performance  – at least in terms of quantitative measurement and aggregation – together with the publication of results are a modern phenomenon in the medical profession. It is interesting to consider the issue of performance, and of public perceptions of medical practitioners in the past.

In the early modern period, for example, reputation was most certainly a central factor in people’s choice of medical practitioner. They wanted at least some reassurance that the man about to lance their boil or cut for the stone was not some cack-handed amateur who would leave them bleeding to death on the kitchen table. But reputation worked at a deeper level than this. In rural communities, for example, people effectively became healers by reputation; once a cure had been attributed to them, word of the power of the healer would spread and a position cemented. This was generally the way that so-called ‘cunning folk’ and ‘irregular’ healers gained prominence.

It is interesting to consider early-modern perceptions of ‘performance’ though. If we were to apply a modern measure to seventeenth-century practitioners, what sorts of figures would emerge? For many reasons we have no means of accurately measuring the ‘figures’ for early modern doctors. Beyond parish registers there were no official figures for causes of death outside London (if we include the Bills of Mortality) and nothing like today’s patient records from which to infer case histories. Some physicians did keep case books, and these can often reveal interesting stories, but not enough to aggregate.

What does seem likely though is that, at least by modern measures, 17^th-century doctors were probably highly inefficient. Mortality rates, at least for surgeons, were undoubtedly far greater than today. Major surgery (such as opening the chest cavity) was seldom done due to the overwhelming risk of losing the patient. Before anaesthetic, any surgical intervention was risky whether due to hypovolemic shock caused when the body loses too much blood, the physical trauma caused by the pain and wound infliction or, perhaps even more so, the risk of secondary infection after surgery due to unwashed hands and instruments, and dirty conditions. Even relatively minor procedures such as bloodletting carried the risk of introducing infection, and a certain amount of deaths must surely have been attributable to blood poisoning or infection caused in this way.

All of this begs the question of why, if it was so risky, did people elect to visit surgeons at all? Why did some surgeons, especially into the eighteenth century, gain prominence and even fame if they stood a fair chance of killing their patients? Surely people would not have given such people the time of day if it were proved that they responsible for the deaths of far more people than they saved?

The answer is that people simply had a different expectation of what medicine and surgery could do for them. This was a world of sickness in which the patient, while by no means powerless, relied on an array of defences to support them in their fight to return to health. These included domestic medicine, family and friends, books – if they were literate, and also medical practitioners. Rather than one consultation with one general practitioner, as today, people commonly consulted many healers until they found one they were happy with. They might combine treatments and seek the opinions of several, whilst still falling back on their own tried and trusted remedies.

But did they expect practitioners to heal them? They certainly hoped that they would, but also understood that they might not. Let’s imagine for a moment that an early-modern person learned that the mortality rate amongst the patients of their prospective surgeon were in excess of 70% A surgeon with those sorts of rates in today’s league tables might well not last long on the register. But a seventeenth-century person might well view things a bit differently. Whilst acknowledging the potential danger, they could well view this as a risk worth taking – as a last-ditch effort to make them well again.

This explains why people went to doctors at all, and brings us back to reputation. If a practitioner had healed at least some people then they were potentially worth visiting. The fact that many people died under their ‘care’ was not necessarily viewed as their fault; it was an artefact of living in what everyone acknowledged were dangerous times for the sick. Therefore, doctors who had had at even some success were a potential lifeline. More than this, they could be held up as figures of approbation, despite what might be seen as a good record of not curing! What they did, however, was offered some degree of hope where otherwise there might be none. In that case, half a loaf was better than none.

Performance, even today, relies on much more than bare statistics. The reputation of practitioners is still important; we would all ideally want to see the ‘best’ specialist or the most eminent surgeon. It is worth considering how statistics can only tell part of the story though, and the ways in which our perceptions of reputation have shifted over time.

Finding medical practitioners in early-modern Britain.

History has been likened to dropping a bucket over the side of a ship, attached to a long chain. What comes up is a microcosm of life deep below the waves. So it is with an historical source. It offers a tiny little glimpse – a snapshot in time – of one particular event, or one person. On its own, though, it doesn’t give us a full picture. It is a frustrating fact but many people, in fact the majority of people, left little or no trace in the historical record. Even when one or two documents survive, it is often difficult to get much more than bare facts. Does this mean, though, that we shouldn’t bother even trying to piece together the lives of people in the past?

The project I’m now working on at the University of Exeter is a study of medical practitioners in the early modern period. In fact, it is the largest concentrated study of practitioners probably yet undertaken in Britain. The aim is to try and identify all those engaged in the practice of medicine in England, Wales, Ireland and (later) Scotland between roughly 1550 and 1715. It is a massive undertaking. Who, for example, will be included? The list is enormous. Physicians, apothecaries, surgeons, barbers, barber-surgeons, chirurgeons, chymists, druggists, surgeon-apothecaries, cunning folk, medical entrepreneurs and quacks…and all points in between. Dr Peter Elmer, formerly of the Open University and now a senior research fellow at Exeter has already collected over 12,000 names, many with individual biographies. I’ve been charged with finding Welsh practitioners and, after eight months, the list already stands at more than 600 – and this for a country that reputedly had very few doctors. You can keep up with progress on the project at our website here: http://practitioners.exeter.ac.uk/

How are these people being located? The majority of my work is done in archives and on online catalogues. At the moment it is the sheer number of practitioners coming to light that is most surprising. They were, quite literally, everywhere. The problem lies in the deficiency of records and their limitations in offering much more than a glimpse of an individual’s life. Parish registers, for example, are often the only record that someone ever existed. In some cases, they might contain occupational data, and this begins to give some context. The Montgomeryshire parish registers are a useful case in point, with around 60 references to medical practitioners between the dates noted above.

Amongst the Montgomeryshire names are men like Arthur Jones of Berriew, a barber who died in 1697, Richard Evans of Brithdir “Physition” who died in 1701 and John Humphreys of Llanfechain, “chirurgeon” who died in 1660. Given that occupational data in parish registers is relatively rare, it seems fair to assume that recorded occupations suggest that these were the primary occupations of the people concerned. In each case, however, these are the only references to each man that I can find. No further evidence of their practice, their social status or indeed their lives, can be firmly established. At the very least though, and when aggregated, even this bare data does begin to allow us to see something of the landscape of medical practice in a given area. In Montgomeryshire, for example, is a rare reference to the occupation of midwife – one Catherine Edward of Glynceiriog, who died and was buried in April 1688. Midwives seldom appear in the historical record in Wales, so even brief references are interesting.

In other cases, though, it is possible to build up a broader picture of an individual practitioner’s life. The baptisms of children give both an indication of family formation as well as placing a person within a given area for a fixed number of years. Richard Ellis, for example, was a barber in Newtown, now in Powys. No record can be found for his birth or death, but the baptisms of his children William, Sarah and George between 1732 and 1737, in each of which he was referred to as a barber, tell us that he was at least practising between those dates. Also, it might be inferred (although by no means certain) that this was at the earlier end of his career given that children tended to be associated with marriage and the establishment of a household. The Newtown apothecary Thomas Kitchen provides a similar example, with the baptisms of his children Edward, Eusebius and Margaret between 1733 and 1737. Whilst we can’t tell anything about his business from this, we can at least fix him both geographically and temporally.

Other types of sources can unwittingly provide testimony to the businesses and social networks of medical practitioners. Wills and probate inventories can certainly be revealing about shop contents but, by looking further at things like the names of benefactors and even the signatories to wills it is possible to discern networks. In early-modern Wrexham, for example, a cluster of seventeenth-century wills reveal close links between practitioners in the same town, suggested by debts but also by their acting as executors or appraisers for colleagues. In some cases, for example that of Godfrey Green of Llanbeblig, died 1699, his entire shop and business found its way into the possession of another apothecary, John Reynolds, where it was still described as being the shop goods formerly of Godfrey Green when Reynolds himself died in 1716.

The best evidence can often be found where a picture can be built up using a variety of different documents. I’m currently working on an article about medical practitioners in early-modern Cardiff and especially their role within the early modern urban environment. Town records are generally better than for rural areas, but it is interesting to note the depth to which medical practitioners were often involved in town business. One Edward Want of Cardiff, an “barber-chirurgeon”, appears variously in documents in the second half of the seventeenth century. From parish registers we have his dates of birth and death, as well as the fact that he took over his business from his father of the same name. From hearth tax records we can tell that he was based in the affluent West Street area of the town, while a 1666 town survey further reveals that he was charged 6d  half a burgage in that area – the small plot probably indicating a shop. At some point he had occupied a mansion house near the corn market, a fact attested to by a land lease document, further suggesting wealth and status. References in the wills of two other Cardiff traders indeed refer to him as an Alderman, and Cardiff borough records also list him as a juror. We can also tell that his son Sierra Want was apprenticed to a Bristol barber surgeon, a common practice for the sons of middling-sort South Walians. Whilst his will contains nothing  of his medical practice, the use of a variety of documents can help us build up a real picture of the commercial and personal life of Edward Want.

In pulling the bucket up from the depths it is often difficult to glean much more than the barest facts; we often need more to really start to close in on the lives of our early-modern forebears. With practice, a little ingenuity and a great deal of luck though, even the smallest of extra facts help us to piece together a picture not just of how many people were practising medicine in Britain, and perhaps especially in rural Britain where records are fewer, but also something of their lives, occupations and statuses within their communities.

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.