Religion & the Sickness Experience in Early Modern Britain.

Over the years, a number of studies have been made of the sickness experiences of clergymen and religious figures as recorded in their diaries. One of the most well known is that of the diarist Ralph Josselin, vicar of Earl’s Colne in Essex. Another, lesser known, diarist I studied in the course of researching my book was Phillip Henry of Broad Oak in Flintshire, a puritan minister whose mid seventeenth-century diary covers a time of great religious upheaval, but also goes into great detail about his sicknesses. I also uncovered the records of an eighteenth-century Welsh Methodist preacher, who recorded the behaviours of his sick parishioners, naturally viewed through the lens of his own religious beliefs.

In every case, it is clear not only how central religious beliefs were in interpreting and understanding sickness, but how individual experiences could be affected by denomination.

For Puritans like Phillip Henry, for example, sickness was a test from God and it was up to the individual to interpret the message being given to them. In many ways sickness was to the body what sin was to the soul – both needed firm and definite action. As Henry wrote in 1657 “They that are whole need not a Physician…sin is the sickness of the soule, and sin-sick soules stand in great need of a Physician, and that Physician is none other than Jesus Xt”.

(c) Mansfield College, University of Oxford; Supplied by The Public Catalogue Foundation
(c) Mansfield College, University of Oxford; Supplied by The Public Catalogue Foundation

When ill, Henry constantly monitored his symptoms and looked for causes in his behaviour. If he had a cold, he might wonder whether this was a result of the sin of pride. In other cases he felt that illness had been brought on by his over-attachment to wordly goods, or laxity in prayer. In almost every case, he viewed his body as the instrument through which God was correcting him.

If anything impressed the Godly in the sickness behaviours of others it was fortitude and stoicism. If people were penitent, so much the better. The clergy were especially pleased when the sick attended church, despite their afflictions, even if they had to be carried in, and limped out!

In the 1730s, John Harries, Methodist rector of Mynydd Bach and Abergorlech in Carmarthenshire, kept a journal in which he recorded his visits to sick parishioners (National Library of Wales MS 371B, Register of Mynydd Bach Chapel). Harries paid careful attention to the behaviour and comportment of the sick. When Morgan Evan Morgan ‘departed this life 23rd December 1736/7’, Harries noted that he had ‘behaved himself very sivil and sober’ despite being in a ‘lingering distemper about eight years’. Catherine Richard likewise ‘behaved herself inoffensive’, while Joyce Evan ‘was very cheerful…expected but to live, but hoped to be saved’.

In other cases, however, it is clear that Harries was looking to the sick for signs he could interpret of his own destiny. When Mary John died in October 1737 he noted that she ‘relied wholly on Jesus X for her soul and behaved very patient’ but also noted that she was the first received to communion at the same time as him. As he noted, ‘I shuld take this into consideration’. Those who did not conform to expectation troubled him. When Mary Richard died in July 1742, Harries was keen to stress that ‘she was very wavering and inconstant in her profession [of faith], sometimes in and sometimes out’.

M0018191 Dying man in bed. Credit: Wellcome Library, London. Wellcome Images images@wellcome.ac.uk http://wellcomeimages.org Left: a dying man in bed. Original Negative is a Vinegar Negative CAN NOT BE RESCANNED Woodcut circa 1531 By: Hans BurgkmaierOfficia M.T.C. Cicero, Marcus T. Published: 1531 Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0 http://creativecommons.org/licenses/by/4.0/
M0018191 Dying man in bed.
Credit: Wellcome Library, London. Wellcome Images
images@wellcome.ac.uk
http://wellcomeimages.org
Left: a dying man in bed. Original Negative is a Vinegar Negative CAN NOT BE RESCANNED
Woodcut
circa 1531 By: Hans BurgkmaierOfficia M.T.C.
Cicero, Marcus T.
Published: 1531
Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0 http://creativecommons.org/licenses/by/4.0/

He took comfort in those whom he felt offered a glimpse into his own fate. The last moments of Ann Rees showed a woman who ‘behaved herself very lovely [and] told me a few hours before she dyed that shee hoped for salvation for God’s mercy’. Reflecting on this Harries wrote that ‘the Lord prepare me for death and judgement. I see both young and old are carried away to another world unobserved’.

Constantly keeping company with the dying and dead could actually have an effect on the health of ministers. Welsh Methodists were apparently prone to depressive illness, due to their intensive introspection and concentration upon their own failings and weakness. Phillip Henry reported his unease at having attended three dying parishioners within a few days in January 1651, and worried that this was leaving him was a diminished sense of his own spirituality. Other ministers like the Manchester Presbyterian Henry Newcome, found the continual round of deathbed sittings and funerals overwhelming.

But it was not only ministers who applied their religious tenets to sickness. A lucky find in Cardiff University library’s collection was a transcription of the diary of Sarah Savage, Phillip Henry’s daughter. (J.B. Williams, Memoirs of the Life and Character of Mrs Sarah Savage, London: Holdsworth and Hall, 1829). Like her father, Sarah was quick to seek the hidden meanings in her symptoms. In 1691 she was “all day at home having got an ill cold in my head”. Clearly feeling ill she fretted that “My heart was a little let out in love and praise to my Redeemer”, but reassured herself that this was “but a fit [and] soon off again”.

An attack of the smallpox the following year placed her and her family in mortal danger. Her daughter Ann, also a diarist, wrote that ‘when I had received the sentence of death within myself, surely the Lord as ready to save me”. Ann also felt that the experience had taught her a valuable lesson: “the mercies, the sweet mercies which I experienced in the affliction, I shall never forget”.

Lawrence Stone’s (now much criticised) book on early modern family life suggested that people were reluctant to invest much love in their offspring since they stood a good chance of losing them. A wealth of evidence has been put forward to refute this. Puritans, often portrayed as the most stony-faced of all Christian denominations were as troubled as anyone by illness in children. In July 1663 Henry visited a local household where a child was ‘ill of the convulsion fitts. I went to see him & O what evil there is in sin that produces such effects upon poor Innocent little ones’. With a troubled conscience he reflected ‘if this bee done to ye green tree what shall be done to the dry?’.

L0043760 Memento Mori Credit: Wellcome Library, London. Wellcome Images images@wellcome.ac.uk http://wellcomeimages.org The head and shoulders of a 'memento mori' corpse. These statues were used to remind people of the transience of life and material luxury. 16th century Published:  -  Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0 http://creativecommons.org/licenses/by/4.0/
L0043760 Memento Mori
Credit: Wellcome Library, London. Wellcome Images
images@wellcome.ac.uk
http://wellcomeimages.org
The head and shoulders of a ‘memento mori’ corpse. These statues were used to remind people of the transience of life and material luxury.
16th century Published: –
Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0 http://creativecommons.org/licenses/by/4.0/

When family members, especially children, were ill, even the strongest of faith could be tested. After witnessing the sickness of other people’s children, he was forced to confront the death of his own young son from measles. It is one of the starkest and most moving diary entries I have ever encountered, and conveys the conflict between religious conviction and a parent’s desperation. Perhaps most strikingly, Henry looks to God to show him where he (Phillip) had strayed to be punished thus.

“At Sun-Sett this day hee dy’d, our first born and the beginning of our strength, a forward child, manly, loving, patient under correction. O that I could now be so under the correcting hand of my heavenly Father. Lord, wherefore is it that thou contendest, show mee, show mee? Have I over boasted, over loved, over prized? My heart bleeds. Lord have Mercy”.

Religion was a central part of the sickness experience, and coloured not only hopes and expectations of recovery, but also the actual, physical experience of illness. Ministers and lay individuals alike, albeit perhaps to different extents, looked to God to explain how they were feeling and what this might suggest about their own conduct.

Polite Sickness: Illness narratives in 18th-century letters

I have always found letters a brilliant source of information about patients. If writing to friends, relatives and business contacts was commonplace, then one of the most common topics was the writer’s health. Illness was a natural topic to discuss. It was a worthy news item and served to keep the recipient updated with the latest symptom or condition. It could be pragmatic; some sufferers wrote directly to doctors and procured their medicines by post. But others used letters as a means to gather information about their illnesses, not from doctors but from others in their social networks. These would often elicit a stream of responses with favoured recipes, which had never yet failed or were ‘probatum’ (proved) to work.

But letters worked on another level. They gave sufferers the chance to assemble their illness into narrative, and sometimes even episodes. As I have argued in my book Physick and the Family, the eighteenth century  in particular witnessed the rise of what I term the ‘heroic sufferer’. Here, rather than simply listing symptoms, or providing a description, letter writers began to create sickness stories with themselves often as the hero. Sometimes the letters have a resigned air; the missives of the Morris brothers of Anglesey are a good case in point. Their letters commonly contain entries along the lines of ‘the end is near, remember your dear brother’, sometimes suggesting that this might be their last letter and, inevitably, carry on as normal thereafter. Also interesting in their case is the virtual competition that seemed to exist among them as to who could be the most ill! Another common trope was to represent oneself as the battered victim of sickness, nonetheless heroically battling on in the face of almost insurmountable misery.

Depending on the writer though, some sickness narratives take an almost humorous view of their symptoms, treating the reader to a light-hearted walk through what were almost certainly unpleasant episodes. To me these are the most engaging. One set of letters I came across in my research for my PhD fits into this category. They are letters from a Breconshire attorney, Roger Jones of Talgarth. I haven’t researched much about the man himself (maybe I will one day) but he was clearly a ‘man about town’ – in eighteenth-century parlance, a Beau Monde. One particular run of letters were fired off in rapid succession following an abortive trip to Hay on Wye. In February 1769 he wrote to his brother, clearly in some distress.

“Dear Brother…on the fifth day of last month I was visited with a palsy which advances upon me…I was going to the Hay market and before I went halfe a mile off I was taken with a numbness and a kind of stiffness(?) in my left hand. It surprized me much and I turned home. I was immediately bled and sent for my apothecary in ye town of Hay whose advised to contact a physician. I directly sent for Dr Applby(?) of Hereford who attended me on Saturday. I have been bled, cupped, blister’d [and purged] and yet without effect. My disorder has advanced that it now affects all of my left side, both arm and leg.”

Poor Roger. Advised by his physician to eat nothing but puddings(!) he was forced to cancel a trip to Bath, and asked his brother, a clergyman, to pray for him.  Judging from other letters, he was not a man who held physicians and their prescriptions in any great esteem.  In July 1770 he wrote to his brother that he was again “greatly afflicted in both mind and body”, and felt that his body was “gradually wearing out” and that he now had a most “melancholy life”. Despite this, some of his accounts are also comedic. Struck down with an attack of some mystery condition, he attempted to get his servant, Morgan, to help him take a vomit. Unfortunately, Morgan was ‘thick of hearing’ and clearly failed to grasp what his ailing master was trying to tell him. In the end Roger was forced to repair to the local inn, the Lyon, where a Mrs Morgan assisted in giving him “the puke”.!

A sample of Roger Jones's spidery writing. Copyright for this image belongs to the National Library of Wales. Please do not use without their permission.
A sample of Roger Jones’s spidery writing. Copyright for this image belongs to the National Library of Wales. Please do not use without their permission.

In August 1770 he was again sick and ailing at home, this time under the stewardship of a Dr Isaacs. He was first prescribed ‘opening pills’, presumably purgatives to try and drive the malady out of him. When these failed to take effect, Dr Isaacs subjected Roger to a veritable barrage of the 18th-century’s most potent medicines. He took a glister (an enema) which, as he ominously reported “worked”, which was repeated with a purge daily for a week! It is difficult to imagine today a treatment regime that subjected the already weak patient to seven days ‘worth of self-inflicted diahorrea and vomiting. Roger’s verdict? “I think I am rather better but am grown a great deal thinner”!

Through the words of Roger’s letters we get a very intimate and human image of him; something of the character of the man comes out and he speaks to us very directly through more than 200 years’ distance. As we read letters from patients like Roger it is striking how little human nature has changed. We are all still obsessed with our symptoms and will readily tell everybody about them. What has changed are the means of communications; the quick-fire nature of texts and emails are not suited to the construction of sickness narratives. But next time you are in a doctor’s waiting room, see how willing complete strangers are to tell others all about their symptoms and treatments, maybe share the name of a favourite tablet! Treatments might have changed; we haven’t

Eighteenth-Century fashionable diseases, and the dangers of crowded rooms.

“Fashion, like its companion luxury, may be considered as one of those excrescences which are attached to national improvement; Whilst one part of a polished nation is assiduously engaged in cultivating the arts and sciences, another part is not less busily employed in the invention and regulation of its fashions”.

So wrote James McKittrick Adair in 1790 at the beginning of his Essays on Fashionable Diseases. Adair was a medical luminary. According to the blurb at the start of his book he was variously a member of the Royal Medical Society, a Fellow of the Royal College of Physicians of Edinburgh, Physician to the Commander in Chief of the Leeward Islands and colonial troops, a judge on the Court of King’s Bench…the list went on.

As a physician to the wealthy Adair was in prime position to observe the types of conditions that afflicted his clients, but also the types of conditions that were becoming fashionable. The eighteenth century was perhaps the golden age of the ‘trendy’ disease. Where once sickness had been something feared and malign, some conditions were now becoming if not desirable then not unwelcome either. This was the age of the ‘heroic sufferer’; letters became filled with narratives of illness, commonly with the writer fashioning themselves into the role of embattled victim, wrestling with almost overwhelming symptoms and constantly surprised that they even had strength to hold a pen. These were the types of people who seemingly darkened the door of McKittrick Adair’s consulting rooms.

Of the evil influence of ‘fashion’, Adair was in no doubt. No longer was it just contained to dress, but influenced manners, politics, morals, religion and, worst of all in his view, even medicine was becoming enthralled to the “empire of fashion”. Whereas fashion had long influenced people in their choice of doctors, it was now influencing their choice of diseases too. This is how Adair explained the rise of fashionable diseases.

When doctor and patient were both persons of fashion, the patient would enquire of the doctor what condition their symptoms displayed. The doctor, not wishing to offend the polite patient’s ear with a lengthy medical discourse (or perhaps even not knowing!) gives the symptoms a general name – e.g. nervousness. As sickness and symptoms are a popular topic for discussion, the patient speaks to others and ascribes similarities where, Adair argued, none exist, but soon the condition becomes widespread…and fashionable!

In the early part of the eighteenth century “spleen, vapours or hyp was the fashionable disease”. Thirty years previously, a treatise on nervous diseases had been published by a professor of physic at Edinburgh. “Before this”, Adair argued, “people of fashion had not the least idea they had nerves”. At some stage an exasperated apothecary of his acquaintance, bowed under the weight of symptoms from a wealthy patron exclaimed “Madam, you are nervous!”. As Adair put it “the solution was quite satisfactory, the term became fashionable and spleen, vapours and hyp were forgotten”.  But the process didn’t end there…

The 'faces' of nervousness and biliousness.
The ‘faces’ of nervousness and biliousness. (Courtesy of Wellcome Images

“Some years after this, Dr Coe wrote a treatise on biliary concretions, which turned the tide of fashion: nerves and nervous diseases were kicked out of doors, and bilious became the fashionable term. How long it will stand its ground cannot be determined”.

In many ways Adair was forward looking, and questioned the role of his fellow practitioners and their ministrations. He was particularly frustrated by the old Galenic practices of bleeding and purging, which still clung on in the late eighteenth century. “The idea of bleeding and purging each spring and fall, to prevent fevers and other diseases, was formerly very general in this country”. This was due to the “ignorance and knavery” of rural medicators who, he argued, feathered their nests by “disciplining whole parishes” in this way.

Worse still, many patients who only suffered slight complaints were now given to violently purging themselves using an array of potent substances from magnesia, salts and rhubarb to James’s purging pills, which destroyed the very health that they were trying to preserve! Adair’s point was that people were simply overdoing it with medicines. Instead of the odd purge, potion or pill, people were taking them every day, ill or not, to the extent almost that the cure became the kill!

Adair had other words of warning for the fashionable, in terms of their continued attendance at packed society balls. In places like Bath, where Adair had his practice, fashionable functions were everywhere and life for the well-heeled was a constant round of parties, balls and visits. Danger, however, lurked in this lifestyle.

Just as blacksmiths, bakers and glassmakers were weakened by the excessive heat of their trades, he argued, so the cramped, airless fug of the ballroom was deeply injurious to the human body. Heat and fire could only hurt the delicate constitution so, once again, in their quest to be fashionable, the dandies and fops of Bath society were putting their health in danger.

Part of the problem was the noxious air that became trapped in crowded rooms. The smell of sweaty, unwashed bodies mixed with stale perfume, alcohol and coal smoke to produce a toxic miasma that threatened to overwhelm those delicate constitutions. The very atmosphere of Bath made the whole situation worse, surrounded by hills and therefore trapping the residual warmth and creating a cauldron-like atmosphere. The steam from the hot baths added to this, as did the fires caused by so many visitors in their lodging houses. Bath was the modern Babylon as far as McKittrick Adair was concerned.

His book is interesting as it sits right on the cusp of change. He was ‘modern’ enough to see the changes in medicine and disease, but still essentially rooted in ideas of the past, e.g. the concept of bad airs and heat. He wrote as a professional who criticised other professionals but still took the same position as did elite physicians of the 16th and 17th centuries, who complained constantly about quacks and empiricks.  Most of all Adair’s book fizzes with Enlightenment style and language, but also seems oddly familiar in tone. Even at 200 years distance, it feels like we could hold an interesting conversation with this man.  What stories would he be able to tell us about his clients?!

Lady Elinor Stepney and the Georgian ‘Heroine Pill’

In many ways, Lady Elinor Stepney of Llanelly, Glamorganshire, (born 1702) had everything going for her. She was the only daughter, and therefore sole heiress, to the fortune and lands of her father John Lloyd of Llangennech, including the picturesque house of Buwchllaethwen near Llanelly. She married John Stepney, heir of the wealthy patriarch Sir Thomas Stepney of Llanelly, and together they had five children; Margaretta (b. 1718), Justina (b. 1719), Maria (b. 1721), Thomas (b. 1724) and John (b. 1726).

Buwchllaethwen House – ancestral home of Elinor Stepney

By the late 1720s, perhaps unsurprisingly, given that she bore so many children in such a relatively short space time, Elinor was somewhat delicate and prone to bouts of illness. But these were no attacks of fashionable nervousness or fainting; she was chronically ill. Information about her ailments is sketchy, but a series of letters from Elinor, her husband John, and some prominent medical practitioners, can help us to recreate what was an increasingly desperate situation.

It is difficult to say, from nearly 300 years’ distance what was wrong with Elinor, although a common theme seems to have been chronic stomach pains and fits. In January 1729, for example, she was suffering from “Colical pains”, and had regular fits which left her debilitated and weak. According to her husband, after having “escap’d her fits from Tuesday to Sunday” but then was stricken with terrible pains that “seized her in her stomack, side, back, gut…with a palpitation of the heart & thence it dispers’d itself in to her stomack as before, then to the back and both the sides, the violence of which would throw her into small fits, & her stomach very much swelled”. Even down the centuries, this account of the “violence” of her pain is striking.

It is clear from other clues that Elinor’s sickness had an impact on the family’s life. It was said that the Stepneys rarely left Llannelly House, preferring the peace and solitude of a country life. But, clearly worried about his wife’s deteriorating condition, John Stepney was determined to seek out the best medical advice that money could buy, and this often took he and his wife outside their native countryside and to one of the most busy and cosmopolitan cities in Georgian Britain.

One of his Stepney’s correspondents was Dr John Powell of Carmarthen, in many ways an unusual Welsh practitioner. Powell was distinguished from his many unlicensed and unorthodox colleagues by having gone to Lincoln College in Oxford, achieving a BA, MA and MD. He was licensed by the Bishop of Llandaff to practise medicine in the diocese of Llandaff, Hereford and St Davids and letters testimonial to his skills were signed by several medical luminaries, including the president of the Royal College of Physicians in London, Thomas Witherley.  Unusually, given that many Welsh doctors who left the Principality to train subsequently set up practice outside Wales, Powell returned to Carmarthen and counted a number of wealthy Welsh gentry amongst his clients.

But Powell also seems to have taken advantage of the popularity of the newly fashionable city of Bath, and especially its growing reputation as a place of healing, as it appears that he sometimes held a practice there.  Even more interestingly, his consultations were not always held alone; letters suggest that he occasionally held court with another rising medical star – Richard Mead. Mead was a celebrated Whig physician and medical author who had attended Padua and Leiden, and studied under the famous Herman Boerhaave. He was a fellow of the Royal Society, fellow of the Royal College of Physicians and was physician to George II. Amongst the exclusive clients who made their way to Bath to consult these two luminaries were Sir John, and Lady Stepney.

Richard Mead (1673-1754)

Powell first corresponded with John Stepney, their letters discussing Elinor’s health, and mentioning the consultations in Bath, the prescriptions given and offering further advice. At this point it seems that Elinor was the third party. John Stepney seemingly took responsibility for ordering the many medicaments that Powell prescribed, generally including purges, vomits and various electuaries, pastes and juleps. In January 1729, for example, Powell recommended “a paper of cordial powders” to help with her stomach pains, as well as a “stomack plaster to spread and apply to her stomack”. If she found herself “bound”, she could take “2 ownces of purging tincture” to relieve her symptoms. From Dr Mead came the advice to take chalybeate tincture, and drink “bitter decoction” and peppermint waters. These were well-known digestifs and were clearly targeted specifically at her symptoms.

A common theme in the letters is that of the sheer amounts of medicines that Lady Stepney must have been taking. So much so, in fact, that she frequently ran out and even, on occasions, depleted local supplies so much that emergency doses had to be obtained from Powell in Carmarthen, but even from London. In September 1725, there was even a note of irritation in Powell’s letter to John Stepney regarding the increasing demand. “Had your lady spoken to me that she would have her things made by our apothecary here” he wrote “I would have sent them to her by the first carrier when I came home”.  As a result, he chastised Stepney, “she has lost a pretty deal of time both in takeing the medicines & drinking ye waters”. Powell immediately sent for another batch of medicaments, including a “fresh cargo from London”, including “a Vomit, 2 Doses of Purging Pils, a Paper of Ingredients for a bitter wine, anchovies, Garlic Electurary” and a “Antiscorbutic Electuary”.

By 1730, Powell was corresponding directly with Elinor herself, and it seems that her treatment had now included visiting Bath again to take the waters, although the sulphourous liquids did little to ease her discomfort. In June 1730 Powell noted that her stomach “acted indifferent” to most types of food and that she should stick to drinking asses or goats milk until such time that she could bear to take the waters again.

It also seems that Powell was becoming increasingly concerned about Lady Stepney’s apparent habit of staying indoors.  It was imperative, he argued, that she “use exercise to get out into the air more or less everie other day, if not everie day”, and for three to four miles every morning, whether walking or on horseback, or even in a coach “if it be inclement weather”.  This, he argued, would “restore your lost Stomack and Appetite and cause all ye animal functions to perform their proper office”. Such themes of natural, animal constitutions, vigorous exercise and fresh air, were common in eighteenth-century medical thought.

But one of Powell’s prescriptions to Elinor stands out particularly from the page. On returning from a consultation in Bath in May 1731, Powell made reference to some prescriptions from Richard Mead, and to one pill in particular. These pills were made from “Russia Castor, Goa stone & wild valerian, with the syrup of compound peony”.  These pills were designed to ‘loosen’ the constitution, and be taken in conjunction with a cordial julep. The pills, Powell stated, “I call ye heroine pills”. Not to be confused with the Class A drug, it is interesting that the use of the name predates the latter use by 250 years. Perhaps Lady Stepney was one of the first in history to partake of a dose of ‘Heroine’.

Unfortunately there is no happy end to this tale. Elinor died in 1734, at the young age of 32. Her memorial reads:

“Near this place rested the body of Mrs Eleanor Stepney wife of John Stepney Esquire, and daughter of John Lloyd of Llangennech, Esquire. She was a most obliging, endearing wife, a most tender but prudent Mother; happy in all valuable endowments, religious and moral; constant in her devotions to God, ever sincere to her friends, charitable to the poor, just and benevolent to all, a pattern truly worthy the imitation of her sex. In her husband’s affectionate esteem she still lives and as an instance of that esteem this monument is erected to her memory. She died the 3rd of January 1733/4. Aged 32 years”

Despite the best efforts of her husband, family and some of the most prominent medical practitioners and treatments of her day, Lady Elinor was ultimately helpless in her ongoing battle against her unknown malady. The striking accounts of her treatments and suffering provide us with a useful, if ultimately tragic, account of the experience of sickness in eighteenth-century Britain.

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

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

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

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

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

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

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

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

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

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

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

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

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

Concocting Recipes: The early modern medical home.

It has long been argued that the early modern home was a medical hub. And, in many ways, so it was. Sickness was first and last a domestic experience. It was almost always treated in the home and, given the range of potential conditions, the presence of one or more sick members of the family was doubtless a fairly regular occurrence.

In the main, it was women who were expected to take responsibility for medicating the household.  Women were assumed to be natural carers, and also to have acquired some skill in the preparation of medical recipes, and their application, by the time they reached the age of consent to marry. There were books dedicated to schooling literate women in the art of physick, many including what was effectively a ‘starter’s collection’ of remedies to enable them to treat a large number of common conditions. Indeed, medicine was part of the wider role of ‘housewife’, and ‘huswifery’ meant looking after the inhabitants, as well as maintaining the living space.

The role of men in household medicine is far less defined. There were, for example, no books specifically written to help men cope in the case of domestic illness. And yet they clearly did cope. Diaries, such as those by Phillip Henry of Broad Oak in Flintshire, and Robert Bulkeley of Dronwy, Anglesey, both note sickness episodes of their wives, and suggest that they played a part in caring for them. It is also clear that men played a part in the acquisition of ingredients, often keeping records of where they found herbs for sale cheaply, or which apothecary they regularly purchased from. In this sense, medicine still fitted in to the patriarchal male family role, since it involved a broader input into the physical care and support of the family.

One question that remains largely unresolved, however, is that of how well equipped the early modern home was to cope with sickness. The contents of domestic recipe books suggest not only that a very broad range of skills were needed to be able to concoct remedies, but also that a range of equipment would also be necessary. How well equipped were ‘ordinary’ homes to meet these needs?

One body of sources that lets us peer back inside the early modern home are probate records. When a person died, the probate process often required a list of their household contents to be made to allow their estate to be valued. For the study of the material culture of this period, these sources are incredibly valuable. They are, however, often frustratingly vague, and all depends on the diligence of the individual surveyor. For example, a detailed record might list every individual possession, room by room, including furniture, ornaments, valuables, but also sometimes even book titles and foodstuffs held in storage. Much depended on the intrinsic value of the goods; if they had a resale value, they might be worth including. In less detailed inventories, however, a whole room might be listed under a single entry, with a generic term like ‘household stuff’.

In terms of medical items, this causes a problem. Things like herbs and, perhaps, individual jars of ointments or medicines were too impermanent to list, so don’t appear in the inventories of ‘ordinary’ households and very seldom even in elite household inventories. Equally, finding any equipment that can be definitely be classified as ‘medical’ is problematic, since many had dual usage. Nevertheless, it is still worth speculating based on available evidence, to see if any hints about the material culture of domestic medicine can be gleaned from these sources.

Whilst writing my PhD thesis, to try and address this question, I looked at over 1300 inventories from 82 parishes in the county of Glamorgan in South Wales. I decided to look for two items of equipment in particular – the pestle and mortar, and the brewing still. Many seventeenth- and eighteenth-century self-help books extolled the virtues of a well equipped kitchen. For the seventeenth-century medical writer Thomas Brugis, top of the list of items desirous for those people wishing ‘to compound medicine themselves’ were ‘a great mortar of marble and another of brasse’. A long list of other items were included, from ‘copper pannes to make decoctions’, ‘glasses for cordiall powders’ and a range of medical implements. The popular medical author Gervase Markham, also entreated his idealised English housewife to ‘furnish herself of very good stills, for the distillation of all kinds of waters…for the health of her household’, and the emphasis all round lay firmly with a well-equipped kitchen, able to minister autonomously to sick family members within a household.#

As a baseline test, over 91% of the inventories contained at least one item of kitchen equipment, including pots, pans, crocks and so on. Overall, the suggestion was that the vast majority of homes had at least the ability to concoct basic remedies. As Elaine Leong has recently noted, for example, boiling was needed in around 20-30% of early modern remedies.

But what of more specialised equipment? The results were interesting. Out of 1248 inventories, only 148 (11%) had listed a pestle and mortar. Before 1635, there were no occurrences whatsoever, and a peak of ownership didn’t seem to occur until the early eighteenth century. Whilst this figure of 11% should definitely be taken as a bare minimum to allow for inevitable under-recording, this still seems surprisingly low. What was also clear, though, was that the item was more common in better-off households, and also in urban areas. The pestle and mortar would have been a basic utensil for grinding herbs and spices into powder. Whilst not owning one certainly can’t be used as evidence to say that a home wasn’t ‘medical’, its lack of appearance is still noteworthy.

Turning to the ‘still’ or ‘limbeck’ the results were even more striking. A still was a multi-purpose item, which could be used for home brewing, as well as the distillation and fermentation of substances for medical recipes. It has recently been calculated that around 10% of remedies required a still in this period. Despite this, the Glamorgan inventories yielded a total of only 41 references in 1248 inventories, giving an average of less than 3%. Here again, ownership was general limited to wealthier households.

[A full statistical analysis, including comparisons with other Welsh counties was included but, for the sake of brevity, it’s not detailed here. See Alun Withey, Health, Medicine and the Family in Wales, 1600-1750 (Swansea University, Phd Thesis, 2009)]

It is also worth noting (albeit perhaps unsurprisingly as noted earlier) that no inventories contained any reference to medical remedies, ingredients or substances, and only a bare few contained items which could be construed as ‘medical’, such as a blood dish in one home, and a ‘nurseing chayre’ in another.

What do these results tell us? They certainly don’t tell us that early modern homes did not manufacture their own medicines, nor that they were incapable of doing so. Even the most basic of utensils could be used in this process, and the majority of homes possessed these.

They also don’t reveal much physical evidence of medicine, such as a ‘storehouse’ of remedies or ingredients, but this is, in many ways, entirely logical. Medicine was transitory and pragmatic. Recipes were often concocted as and when needed. Some, like ointments, could last for years and be kept, but many were too impermanent to keep. Also, just because they weren’t listed, doesn’t mean they weren’t there. Whilst some historians are beginning to question the extent to which each household physically grew its own herbs, it’s plausible that many did.

But what is also interesting is the availability of ingredients for remedies in even the smallest rural shops. People could purchase exotic herbs and spices from their village shop, as well as compound remedies such as plague water and Venice Treacle. It is entirely possible that the extent to which domestic production was intertwined with the medical marketplace has yet to be appreciated.

In any case, there is a need for more studies into the material culture of early modern domestic medicine. If the early modern home was indeed a medical hub, a wider study should give us a broader understanding not only of what medicines people used in their homes, but how they made them.

The ‘heroic sufferer’; sickness narratives in early modern letters

I mentioned in my last post about the concept of the ‘heroic sufferer’. Patient narratives are very much the coming thing in medical history. ‘Off Sick’, for example, a recent collaboration between Cardiff University and the University of Glamorgan has looked at the voices of the patient over time. The historiography of disability is re-engaging with the often indistinct voices of disabled people in the past. Even in popular history, it’s often these ‘voices’ that people want to hear about – ‘Voices of the Great War’ and so on. Overall, there has been an impetus to learn about the sickness experience through those who had that experience; not those who treated them.

In my own work, I’ve looked at sickness narratives in the seventeenth and eighteenth centuries through the letters that sufferers wrote to friends and relatives. Other than actual conversation (or even perhaps more than conversation), letters allowed people to construct their own narrative; their own sickness persona. Writing it down gave sufferers power over their own image; freed from the immediacy of speech, letter-writers could fashion themselves as literary sufferers. The results were often fascinating.

What strikes me most about these letters is the construction of a distinct persona, almost the creation of a different ‘sick self’. As I said in the previous post, it’s something that we do to a certain extent when we call in sick to work. There is perhaps an innate need to engender empathy, if not sympathy, and people are often very keen to detail even the most intimate symptoms to complete strangers. This seems to have been a constant for hundreds of years.

One of the most fruitful batches of letters for my purposes were those of the eighteenth-century Morris Brothers of Anglesey – Lewis, William and John. Lewis and William, especially, were prolific letter writers and, as was common for the time, health was a regular topic of conversation. Lewis Morris was a constant sufferer of sudden fits, coughing and giddyness, sometimes so bad that he could hardly get up. What struck me, though, was how far he was prepared to defend his right to be the unchallenged winner in any competition for worst symptoms. When William suggested that he was labouring under his own cough and ‘an asthma’, Lewis wrote back swiftly: “I own your asthma is heavy, but if you had such an asthma as I have, you would be unable to go to the office or even sit there”. In other words, my cough is worse than your cough!

Lewis was also the art exponent of the good old-fashioned wallow. In one letter complaining of various maladies, aches and pains, he was “scarce alive” but, stoically, would “trudge on while I live”.  Recovering from a “pleuritic fever” he told his brother he was “just returned from the shades of death”. When his brother asked him to check some papers, Lewis responded that he would do so if he recovered, having been suffering from an ague fit. Many times he began letters wearily, doubting that his life had long to run, but by the end of the letter was talking in fairly cheery terms about items of news and events.

Perhaps my favourite of all, though, were the letters of Roger Jones, an attorney from Talgarth in 1770s-Breconshire. Jones seems to have been something of a savant – a man of letters, constantly travelling around and involved in polite society (such as there was in eighteenth-century Breconshire!). His letters to his brothers reveal another side to sickness – that of the comedic narrative. Sickness was, at the time, far from funny, but Jones’s letters show a very modern sense of laughing at the profoundly un-funny, perhaps in a way to reduce its impact.

In 1771, for example, he set out on a journey to Hay on Wye, where he suddenly felt “weak and faynty and was obliged to give over”. A fever ensued, and he took pills and a glister to flush out his system. In the night he took a whey drink, which made him sweat profusely which “with the weakness occasioned by the fever, reduced me to a mere skeleton”.

Jones was certainly no fan of doctors. Whilst ill at Bath the previous year he had consulted a physician, who had prescribed glisters, opening pills, cordial drinks and purges which made him no better but a lot thinner. We can only guess at the frustration he encountered once when he lost his voice and tried to get help from his servant…who was deaf. Poor Roger was forced to repair to the local alehouse, where the landlady administered an emetic or, as he called it, “the puke”.

These are the voices of the sick in the past, speaking to us in their own terms but, importantly, terms they have selected very carefully. They tell us plenty about the experience of being ill – but they tell us more about how sufferers wanted to represent themselves to others. They are brilliant (and often under-used) sources in medical history and, one day, I can feel an article coming on!