The ‘Celebrated Inventions’ of Alexander Ross.

One thing that has continually fascinated me throughout all of my research on medical practitioners, barbers and retailers in the long eighteenth century, is the extent of what historians call ‘occupational diversity’. Rather than having one occupation, people might have several…and often at the same time. This was particularly common amongst certain types of shop owner, who routinely diversified into other trades. Sometimes these could be related trades, but often they seemed to bear no relation to each other. So, you might find an apothecary doubling up as a mercer, or cloth trader, or a barber-surgeon also selling candles. It’s also possible to find wonderful hybrids: Mr Dade of Norwich who, in the late 18th century, was a perfumer, tobacconist, haberdasher and umbrella maker!

copyright Wellcome Images

Mr Dade’s example raises one group that I’ve become particularly interested in recently, which is perfumers. It’s easy to think about perfumers as people who ‘just’ sold perfumes, but actually they often diversified. Many perfumers were also hairdressers. Some were chemists or druggists. But many also specialised in what were then called ‘toys’. Rather than the modern sense of children’s playthings, the 18th-century meaning of ‘toy’ referred to small items, trinkets, and daily objects for the body and personal grooming.

In the 18th century some perfumers became particularly prominent, with connections to Royalty or the literati and glitterati of the day. As William Tullet’s recent book has shown, Charles Lillie of London was famed for his snuff, as well as his many perfumed products, but was also celebrated in publications such as the Spectator. Others, such as William Bayley, Richard Warren, Charles Emon and William Yardley established their own businesses, and frequently advertised their products.

Trade tokens for bear’s grease – copyright Wellcome Images

Another big name in perfumery in the 18th century was Alexander Ross. Ross was a specialist in ‘Bear’s Grease’ – a product for hair growth made from the fat of bears. Some London barbers and perfumers even apparently kept live bears in their own shops to promote their products…something that occasionally caused public order problems. But it was Ross’s son, also Alexander, who arguably rose to even greater prominence than his father, and grew the business to include a whole range of other products.

Alexander Ross the Younger, for example, established his ‘Ornamental Hair Warehouse’ in Bishopsgate in 1814, from where he sold products such as his Grecian Volute Head Dress. Ross was also a prolific writer, authoring tracts about hairdressing, looking after the skin and managing fingernails. He had his own magazine – the alluringly-titled ‘Ross’s Toilet Magazine’ which, according to its ad, was ‘full of toilet secrets’.

But it also seemed that he diversified into a range of machines for the body. The advertisements for these contrivances, and the testimonials from people who had used them, shed fascinating light onto both the side-interests of a perfumers, and the lengths that people would apparently go to in order to try and look good.

Image from Google Books

One of what Ross himself termed his ‘celebrated inventions’ was the ‘nose machine’ apparently a device for straightening the nose. This was available for ten shillings and sixpence, but promised to improve the features. The advertisement included supposed letters from satisfied customers. “I obtained the nose machine and am very much pleased with it” wrote one. “thanks to your machine” said another “my nose has achieved a tolerably symmetrical shape”.

It wasn’t just the nose that Ross’s products offered to reshape. His ‘ear machine’ was said to ‘have the characteristic that it gives the exact amount of pressure required to make the ears properly positioned’. Fingers could be beautified and pressed into good form by Ross’s ‘Finger shapers’. Feet could be ‘improved in form, the toes straightened and the ankles strengthened’ by ‘appliances worn during the night or any leisure time’. If all this wasn’t enough, he even sold ‘chin and cheek improvers’ to force jowly jaws back into a socially-pleasing form.

Bad posture and form were also bodily defects that various of Ross’s products tried to remedy. One was a ‘simple contrivance for improving the figure and drawing back the shoulders’, a snip at 7s and 6d. A slightly more mysterious process was offered for what Ross termed ‘over-stoutness’. Here he promised that excess weight would be dispersed by ‘carrying out regulations as given by Mr Ross’ and ‘weighing from certain time to time’. ‘Hip bands’ promised to transform hips that were ‘squatty and inelegant into good shape’.

The skin was certainly not forgotten, with various of Ross’s skin tonics, ‘bloom of roses’ and ‘pimple removers’ (using his ‘vegetable skin pill’ to give a ‘transcendent complexion’). Directions for getting rid of red noses, bruises and scars and even removing tattoos, were all available from Mr Ross’s emporium in Lamb’s Conduit Street in London.

Perfume bottle – copyright Wellcome Images

Various other products offered to colour or beautify the hair, remove it or make it grow on bald places. These included his ‘golden hair wash’, ‘Spanish fly ointment’ and ‘Cantharides oil’. For the truly brave, Ross offered his ‘Magneto Electric Machine’ for 21s, the regular use of which he claimed would stop hair falling out and promote its growth. How many hopeful customers ended up with hair standing to attention on their heads by over-winding the machine?!

There are many more product in his list, but I’ve left my favourite until last. Those feeling a bit down in the dumps were pointed towards Ross’s own ‘tonic medicine’. For a mere 5s and 6d…or 70 stamps, customers were promised ‘hilarity of spirits and a permanent animated tone for the features’. After a year of lockdown, couldn’t we all do with a bottle of this?

I think that perfumers are a fascinating occupational group, and there is much more to be said about them. I also think that the extent to which retailers diversified in the past is interesting, and reminds us that job titles by themselves can’t always tell us everything about what people actually did.

**And if you’d like to hear this as a podcast, click below**

The Celebrated Inventions of Alexander Ross, perfumer. – Dr Alun Withey

This podcast is all about a 19th-century perfumer, Alexander Ross, who not only sold loads of perfumes (as you might expect!) but also created his own range of strange machines, to push, pull and force the body into a socially acceptable shape!

1. The Celebrated Inventions of Alexander Ross, perfumer. 10:03
2. Finding Your Beard Style in the 19th Century 07:08

Barbers and Shaving in the Eighteenth Century

“It is the business of the barber to cut and dress hair, to make wigs and false curls, and to shave the beards of other men. In ancient times he used, also, to trim the nails; and even in the present day, in Turkey, this is a part of his employment”. So wrote the author of an 1841 survey of professions and trades.

One of the main subjects of my forthcoming book is the history of barbers, and their place as providers of shaving, and also as practitioners of the male face and head. I’ve been looking at some of the important questions that have sometimes been overlooked: how well equipped were barbers’ shops?; how did barbers learn to shave, and who taught them?; what happened to the barbers when men began to shave themselves around the mid eighteenth century, and also when beards came hugely back into fashion in the mid nineteenth century? But I’ve also been interested in a much more basic question: what was it like to be shaved in an early modern barbershop?

V0019646 A barber’s shop, Alresford. Coloured reproduction of an aqua Credit: Wellcome Library, London. Wellcome Images images@wellcome.ac.uk http://wellcomeimages.org A barber’s shop, Alresford. Coloured reproduction of an aquatint. Published: – Copyrighted work available under Creative Commons by-nc 2.0 UK, see http://wellcomeimages.org/indexplus/page/Prices.html

Barbers have (very unfairly, in my opinion!) long been the whipping boys of the haircutting trades. In the eighteenth century the chattering barber was a comic staple. Many satirical cartoons lampooned the clumsy barber, engrossed in his own conversation and paying no attention to the safety of the customer in the chair. Country barbers, affecting airs and graces, were another favourite target of cartoonists. Worse still, the rise of hairdressing as a distinct occupation in the eighteenth century caused further tensions, as hairdressers sought to establish themselves as polite practitioners to the elites, and experts in tonsorial practice! In the process, they took every opportunity to barbers were relegated to the status of ‘mere’ shavers.

For an occupation like barbering/barber-surgery, with its long and proud tradition, not to mention considerable status in early modern towns, this must have been hard to take. Complaints from barbers about their diminished status were still rumbling on in trade journals late into the nineteenth century.

The problem was that a shave in an early modern barbershop varied considerably in quality. First was the question of how well equipped the barbershop was. Some high-end establishments had cases of razors, strops and hones for sharpening, bowls, basins, towels and some sweet-smelling creams or pomatums to apply afterwards. Other shops were much more basic, though, with only the minimum of equipment, and no fripperies. Perhaps the most important factor was the quality of the razor. Before the mid 18th century, the type of steel used in razor manufacture made them sometimes brittle, and difficult to sharpen. Once cast steel was introduced around 1750, things did begin to improve, although cast steel razors were expensive and beyond the reach of poorer barbers.

Being shaved with a blunted or poorly maintained razor was an ordeal for the customer. Rather than slicing off the beard hairs cleanly, a blunt razor rasped and bit, taking off layers of skin as well as stubble. Some barbers were more diligent than others in ensuring that their razors were up to the task. One account, from J. Torbuck’s Collection of Welsh travels, and memoirs of Wales (1749) gives us an interesting (if slightly tongue-in-cheek), insight into what could happen when things went wrong!

“I next sent out for a barber (resolving to see the best face upon matters I could) and, in about half an hour’s time, in comes a greasy fellow, swift to shed innocent blood, who, in a trice, from a protable cup-board call’d his cod-piece, pulls out a woollen night-cap that smelt very much of human sweat and candle-grease, and about two ells of towelling, of so coarse a thread, that they might well have serv’d a zealous catholick instead of a penitential hair-cloth.

After some fumbling, he pulls out a thing he call’d a razor, but both by the looks of effects, on would easily have mistaken it for a chopping-knife; and with pure strength of hand, in a short time, he shav’d me so clean, that not only the hairs of my face, but my very skin become invisible; and he left me not sufficient to make a patch for an Aethiopian lady of pleasure:

I gave him a small piece, bearing Caesar’s image and superscription; at which, he doffed me so low a bow, that the very clay floor was indented with his knuckles, and so he reverendly took his leave.”

(Image Copyright Wellcome Trust)

Images such as ‘Damn the Barber’ drew on what must have been a fairly common trope, of the painful shave, highlighting the lack of care and attention by some ‘Professors of the Tonsorial Arts’, or the damage done to customers. ‘Zounds! How you scrape’ cries the unfortunate victim of one blunt razor!

(Image copyright Wellcome Trust)

But for all this, barbers remained hugely important in the lives of men throughout the seventeenth, eighteenth and nineteenth centuries. The barbershop, as Margaret Pelling, Sandra Cavallo, Jess Clark and others have shown, was an important social space for men, as well as being a site for shaving, and also the purchase of cosmetic goods. Even when men did begin to shave themselves in greater numbers, they often did this in conjunction with visiting the barber. For many (perhaps even most) men too, it was simply cheaper and easier to go to the barber’s shop than to purchase and maintain shaving goods.

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.

BBC Free Thinking Feature: Bamburgh Castle Surgery, c. 1770-1800

Over the past few years I’ve been working on the records of a unique eighteenth-century medical institution. The eighteenth century saw the rise of institutional medicine, first in the form of hospitals and infirmaries, and later dispensaries. The former were large, imposing buildings in a town landscape, housing inpatients and treating surgical cases, as well as other conditions. Dispensaries were smaller, sometimes occupying existing buildings, but generally acted as outpatient services where the poor could be given medicines, patched up if necessary, and sent on their way.

Both hospitals and dispensaries were funded by subscription. Subscribers were invited to pledge an annual sum of money, put towards the building, running and upkeep of the institution. In return, subscribers had the right to recommend patients for treatment, according to the size of their donation. Unlike today, patients could not simply turn up at the doors, unless in absolute emergency. Instead, they required a certificate of permission, signed by a subscriber and, as such, could be difficult to access at times.

Image from Wikimedia Commons

Also, institutions were firmly urban in nature. They were closely bound up with the civic ambitions of Georgian towns. A hospital could be a strong statement about a town’s importance and beneficence to the poor. ‘See how kindly we look upon our poor objects’.

Unsurprisingly demand for these facilities was high. Even outside London, annual admissions could number in the thousands. Especially in the crowded and often unsanitary conditions of towns, conditions like epidemic fevers were rife.

But one medical institution stood apart – both literally and notionally – from the rest. In the 1770s, Dr John Sharp, Archdeacon of Northumberland, philanthropist, and member of a family which included a prominent surgeon and famous anti-slavery campaigner (Granville Sharp) was a trustee of a large charitable fund established by the late Nathaniel Lord Crewe. Crewe had set aside large amounts of money from land revenues, stipulating in his will that these were to be put to charitable use.

Image from Wikimedia Commons

One of the properties was the dilapidated medieval Leviathan of Bamburgh Castle. Undertaking a massive programme of restoration, Dr John Sharp adapted the castle to a variety of charitable uses, including a school, corn charity, home for shipwrecked sailors and the surgery/infirmary.

With his brother’s advice (a surgeon at St Bartholomew’s hospital in London), Sharp equipped Bamburgh with the very latest in medical technologies, including an ‘electrical machine’ for literally electrocuting patients back to health, a full stock of medicines and equipment, and other modern apparatus such as the ‘machine for the recovery of the apparently dead’ – used to try and revive the recently-drowned.

Last year I visited Bamburgh and made a short radio programme for BBC Radio 3, which is now available online.

Click on the link and then the ‘play’ icon in the new page to access the programme

For more about Bamburgh and its facilities, you can also click here for my ‘History Today’ article about Dr Sharp and his medical charity.

Edging the Competition: Surgical Instruments in the 18th-Century

As I’ve written about in other posts about razors and posture devices, in the second half of the eighteenth century, the introduction of cast steel transformed products for the body. Steel had many physical properties that rendered it very useful across a range of instruments. Unlike its predecessor, blister or shear steel, which was of uneven quality and could be brittle, cast steel was durable and capable of carrying a very sharp edge. It could also be polished to a mirror-like shine, making it very attractive to wear as ‘brilliant’s – imitation diamonds.

Many of the instruments I’ve written about, from razors to spectacles, were things that people bought to use upon their own bodies. But there was another group of instruments that was transformed, but one which people generally did their best to avoid – surgical instruments.

The surgeon’s knife held something of an ambiguous position within medicine. For patients the briefest glimpse of a scalpel or, worse, an amputation knife, was enough to send them into a swoon. Some surgeons argued that people would much rather subject themselves to the dubious ministrations of the quack than to the slice of the blade. Surgeon’s instruments also suffered from the taint of the manual craft. It was argued that almost anyone could wield a knife or a saw, without any need for theoretical knowledge of the body. As such, surgical instruments were little more than tradesmen’s tools.

Nevertheless there was an increasing demand for instruments in Britain in the later eighteenth century. Across Europe numbers of medical students were swelling. In France the numbers of surgeons nearly tripled between 1700 and 1789. By the early years of the nineteenth century, around 300 students per year were enrolling in London hospitals, as well as Edinburgh and Glasgow. As well as the increasing numbers, medical education was changing, especially in the matter of dissection. Before the 1750s, anatomisation was generally a theatrical event where the dissection was carried out by a surgeon, watched over by a crowd of enthralled and doubtless, sometimes, nauseated crowd.

But changes in medical education meant that trainee surgeons were increasingly given access and encouraged to get their hands dirty. Reading books about anatomy was fine as far as it went, but could never replace empirical observation and experience. This was also an age where views of the body were changing, and the human form was likened to a machine. As Thomson’s The Art of Dissecting the Human Body, in a plain, easy and compendious method dissection manual put it, there were only two possible ways to discover the workings of a machine. One was to be taught by its creator…difficult in this case! The other was simply to take it to bits and put it back together again.

Surgical manuals began to set out the requisite kit for the gentleman surgeon. One was to purchase a set of pocket instruments containing the most commonly-used items. The German anatomist Lorenz Heister advocated a pocket set including lancets for opening veins and abcesses, straight and crooked scissors, forceps, probes, a razor and needles. A similar kit was popular in London, containing knives ‘made of best steel’, lancets and scissors, as well as a salvatory and plaster box. Clearly some surgeons were apt to keep buying until they had amassed a huge number of instruments. The surgeon and author Benjamin Bell cautioned against such acquisitiveness, arguing that too many instruments confounded the surgeon under the pressure of the operation.

Image from http://collectmedicalantiques.com/gallery/cased-surgical-sets

The increasing demand for instruments opened up a range of new opportunities for the makers of instruments. Traditionally cutlers had been the mainstay of surgical instrument manufacture. With their experience in making edged tools and of tempering metals to exact requirements, they were the best qualified. But by 1763 the Universal Director, a directory of London trades, was describing surgical instrument manufacture as ‘a distinct branch from the common cutler’. By 1800 the first dedicated surgeon’s instrument catalogues were being produced by prominent makers such as J.H. Savigny of the Strand in London. Savigny’s catalogue contained a wide variety of different instruments from knives and saws to catheters, tourniquets and even apparatus for the recovery of the apparently dead!

Image from Savigny’s instrument catalogue, 1800

Surgical instrument makers were also keen to puff their products in newspapers. The market for these products was fairly narrow and specialised; these were not items marketed for the public. Nevertheless it is noticeable that makers did their best to clothe their advertisements in the language of polite commerce, and include popular and elegant designs in their trade cards. The language of advertisements was all polite puffery. The tone of advertisements for ‘Thurgood’s Surgeon’s-Instrument Manufactory’ in Fenchurch Street was deferential, seeking to reassure ‘any professional gentlemen’ that ‘nothing shall be wanting on his (Thurgood’s) part to render full satisfaction’. Many other adverts were targeting ‘gentlemen of the faculty’ and seeking to encourage their business.

Advertising also offered opportunities for illustration. The trade card of John Chasson of London depicts a variety of amputation knives, saws and other instruments set against an elegant rococo surround. The razor and surgical instrument maker Henry Patten’s card shows a range of instruments, including lancets, hanging from branches of its elaborate frame. Given their associations with manual trades, it is noticeable that advertisements began to pay attention to the form as well as the function of instruments. John Chasson’s instrument cases, for example, could be bought in elegant boxes covered in fashionable shagreen (sharkskin). The handles of knives and saws began to change from traditional wood and bone to more exotic and expensive products like ebony, ivory and tortoiseshell.

Image courtesy of Wellcome Images

Perhaps the most surprising claim made by some makers, however, was that their products lessened pain and improved the experience of patients. In 1778, J. Savigny advertised his newly-invented lancets to the faculty. Stressing his metallurgical skills, Savigny argued that they were ‘wrought to such a degree of accuracy, as will greatly lessen the pain of the patient, and totally remove all apprehension of disappointment in the operator’. In another, he argued that the ‘extraordinary degree of accuracy’ in their edge would lead to the ‘approbation of the patient and reputation of the phlebotomist’. It’s interesting to note that the patient comes first. Many surgeons agreed that speed was of the essence in any surgical technique, and that this could only be achieved by keeping instruments maintained since, as Benjamin Bell noted, they were ‘injured with every use.

The late eighteenth century, then, was something of a golden age in the manufacture of surgical instruments. As the medical faculty sought desperately to separate itself from accusations of quackery and establish itself as an learned profession, the need for new instruments, based on the latest scientific and philosophical principles, was key. Likewise, with an expanding market and greater opportunities to promote their products, surgical instrument makers were continually engaged in developing and refining their products. Whether it would be of any comfort to a poor patient to know that the knife about to saw their leg off was made of the latest cast steel, however, is a moot point!

‘He is gone from his service before his time’: Medical Apprenticeships in Early Modern Britain

One of the biggest frustrations in studying Welsh medical history is the lack of institutions. In the early modern period Wales was unique amongst the individual nations of the British Isles in having no universities and no medical training facilities. Unlike England, Scotland and Ireland there were no colleges of physicians or surgeons. Why was this? One of the main reasons was the lack of large towns. Wrexham, in north Wales, was by far the largest town in early modern Wales, with a population of around 3500 in 1700. There were many other smaller Welsh towns but, without large populations to cater for, there was no need for practitioners to form trade gilds or corporations.

Over the past few weeks, however, I’ve been turning my attention to the Welsh Marches – the border between England and Wales – and doing some research on large towns such as Shrewsbury and Chester, which were important centres for Welsh people and, it seems, for Welsh practitioners too. One area that I’ve been particularly interested in is that of medical companies and trade guilds. As part of our project in Exeter, we’ve been looking in more detail at the role of barbers and barber surgeons in medicine, both in terms of what they did and how they were described, but also exploring the important question of medical apprenticeships. One company in particular, the Chester Company of Barber Surgeons and Wax and Tallow Chandlers is a particularly rich source of evidence.

The Company were responsible for the regulation of barbers, barber surgeons as well as chandlers who made candles and soap. The relationship between the trades may not immediately be apparent but, in fact, was often interchangeable. People described as barbers were commonly medical practitioners as well as hair cutters and beard trimmers. Barber surgeons often ran barbering shops. The gap between them was extremely fuzzy.

But also, for reasons that are less clear, barbers might also make and sell candles. In the records, barbers can be found referred to as wax chandlers (ie those making wax candles), or as both. Wax candles were relatively expensive since they burned for a long time. Interestingly, however, there appears to be no overlap between barbers and tallow chandlers. Tallow was animal fat, used in candle production. Although tallow candles were cheap, and as bright as wax candles, (around half the price of wax, or less) they burned for only around half the time, so were less effective.

In conjunction with the borough the Company regulated trade and practice, laid out rules for members and also oversaw apprenticeship. Membership bestowed certain rights but also carried responsibilities. Brethren who did not abide by the rules risked censure and fines…and the list of rules was long!

Some orders were routine and concerned attendance and appearance. Every member was expected to attend all meetings unless they had a valid reason, and to wear their gown. They should ‘behave themselves orderly’, not disturb or interrupt meetings and should always call their fellow members by their proper names…on pain of a fine. Other rules related to respect and civility. One brother of the company should not ‘dispraise anothers work’ nor lodge any lawsuit against a fellow member. Neither should they disclose any secrets of their work to lay people, nor give out details of the meetings.

All fees (fines) were to be promptly paid and recorded in the register. These paid for the costs of meetings and food, but also for the burial of departed bretherin. Rule number 14 provided for ‘the decente and comely burial of any of the saide companye departed’ and it was expected that every member should ‘attend the corpse and burial’ unless they had good reason. The fine for non-attendance was a hefty 12 shillings!

Popular culture and religious belief also features strongly. An ‘order against trimming on Sundays’ forbade the cutting of hair on the Sabbath day, again for a fine of 20 shillings. Every year the company also participated in a popular midsummer parade and festival in the city. This involved a procession of decorated carnival floats, and was a throwback to an ancient pagan ceremony. Unusually, it continued long after the Reformation and also survived the Puritan assault on popular revelries. In 1664, an order stated that money should be set out for the stewards to arrange for a small boy (a ‘stripelinge’) to be dressed and ride Abraham, the Company’s horse, in the procession, and to ‘doe their verie best in the setting forth of the saide showe for the better credit of the said societie and company’.

(Left image: public domain; right licensed under Creative Commons-Attribution-Noncommercial-Share Alike 2.0 Generic)

Perhaps one of the most important aspects of the Company’s function was apprenticeship. The rules of apprenticeship were clearly set out, and this sheds light on a very important and under-researched area of medicine. Only freemen of city, and Company bretherin, were allowed to take on apprentices. Apprenticeships were usually for seven years, but this could vary according to individuals. According to the company rules, no brother should take on another apprentice until his current one was within the last year of his service. The fine for disregarding this rule was a ruinous £10! All apprentices were to be entered into the register or risk a 30 shilling fine.

Why people sent their children to be apprentices in medical professions is not always clear. Medicine was not regarded as a prestigious occupation and, indeed, surgery was sometimes analogous with butchery. Nonetheless an established business in a town could be lucrative, especially given the range of services that barbers provided. As such, the decision to enrol children with urban medics could be pragmatic.

A brief glance at the apprentice registers reveals a number of interesting points. Firstly, it is clear that apprentices were often drawn from a town and its hinterlands. Although some came from further afield, the majority were local or lived within roughly a twenty-mile radius. On 18th Feb 1615 Richard Howe was apprenticed to Edward Wright, barber and wax chandler of Chester, for 8 years. Nicholas Halwood of Chester joined Robert Roberts, Chester tallow chandler for 7 years, while Robert Shone of Broughton’s apprenticeship to a Chester chandler was for 12 years.

In some cases family connections were clearly important, and parents might apprentice their child to a brother, cousin or more distant kin. This was a useful means of drawing on connections to further a career. James Handcocke was apprenticed to his uncle William Handcocke, a barber and wax chandler in September 1613, while Robert Glynne was apprenticed to Richard Glynne to learn the art of barber surgery. Fathers might also take on their own sons as apprentices, a situation that must sometimes have led to fraught relations. Nicholas Cornley was apprenticed to his father Richard for 7 years in 1626, while others such as Robert Thornley, a barber surgeon and painter (!) took their sons to follow in their footsteps.

The conditions in which an apprentice lived and worked depended so much on their masters. While many were well-treated and provided for, which was in fact a central condition of apprenticeship, some masters could be cruel and neglectful of their young charges. Robert Pemberton’s service to Randle Whitbie ended 3 years into his 10-year indenture when he was found to be ‘gone from his service’. John Owen of Cartyd, Denbighshire, ‘ran away before his time ended’ as did Philip Williams, apprentice to Raphe Edge, who took to his heels after a year. Nothing is given as to the circumstances of their treatment; it was not unknown for apprentices to complain of ill treatment, however, and authorities took this seriously. In other cases the stark phrase ‘Mortuus est’ (he is dead) indicates another reason for the termination of an apprenticeship.

The number of entries and records for the company is huge, and will take a concerted programme of research to thoroughly investigate. It will also be interesting to compare these sources with other similar companies across Britain to build up a bigger picture of the activities of medical trades in early modern towns. Once this is done we should have a much broader picture of the role, function and daily activities of medical practitioners in the past.

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!

Pig boys and boar bites: a seventeenth-century medical consultation

What did medical practitioners actually do in the past? Or, put another way, what sorts of things were they consulted for? Given the vast numbers of pages devoted to medical practice over the past few years this might seem to be a slightly redundant question. But, in fact, individual consultations are remarkably obscure. Physicians’ casebooks can be revealing, but the nature of these often means elite doctors and wealthy physicians. Also, whilst letters from patients can often give amazing insights into the sorts of diseases and maladies that afflicted them, it is less common to find evidence of the sorts of routine things to which practitioners could be called to attend for.

One little source in Glamorgan Archives (MS D/DF/215) gives us a fascinating insight into the day to day work of an early-modern doctor. It is a receipt for medical services to the Jones family of Fonmon Castle in Glamorganshire from Dr John Nicholl. The Joneses were a wealthy family who had supported Cromwell in the civil wars. Colonel Phillip Jones bought the castle in the mid seventeenth century, adding and rebuilding parts of it. By the early eighteenth-century it was a magnificent country house. Of the doctor, John NIcholl, we know very little. It is likely that he was the same man whose will was proved in 1726, listed as a surgeon of Llanbydderi in Llancarfan – a few miles from Fonmon Castle. Nicholl was clearly fairly affluent, owning lands and property in Glamorgan which he bequeathed to his family.

Fonmon Castle today. Picture from hha.org – copyright belongs to them

The source itself is a bill giving a brief description of the conditions treated between May and July 1715, together with the prices charged. The bill was sent to the house steward, and a note on the back states that it was paid in full at the end of the year. In a largely cashless society, it was common for people (and especially large households) to have services on account which could then be settled at intervals. It is also common in large houses for the same practitioners to be continually employed over periods of time. What sorts of things did Nicholl treat though?

The first ‘cure’ referred to is a visit to ‘Madam Jones’ for an unspecified condition, for which Jones charged several shillings. Which ‘Madam Jones’ is referred to here is unclear, but likely to be the house matriarch. The next recipient of medical attention was in fact a kitchen maid, Anne Cornish. Again, Anne’s condition is unspecified but required a second visit and “blooding hur”.

Another is to the unfortunately-titled ‘pig boy’, who occurs twice in the receipt. It is clear that the boy had fallen foul of his porcine charges since the receipt reveals that he was bitten by a boar! This necessitated two visits by the doctor, one of which was to dress his leg. Pig bites are in fact incredibly painful and, while the incident might appear faintly comical, could potentially be dangerous due to the risk of secondary infections entering through the open wound, or from the animal itself.

The medical treatment of servants is interesting. Domestic servants were part of the early-modern household family. Whilst their working lives were doubtless hard, it should not be forgotten that many employers were in fact fairly benevolent to their young employees. In these cases, for example, the servants were clearly given more than a cursory look over; both were given treatment by an apparently ‘orthodox’ medical practitioner (as opposed to a cunning man or empirick). We cannot know their social status, but it is no stretch of the imagination to suggest that they might usually not be able to afford such treatment. Servants were valuable commodities though and, as such, needed looking after. I have found other examples of servants being paid even when sick, and allowed other ‘perks’ like being given money to go to a fair, or to purchase new clothes or shoes. We should not necessarily view early modern servanthood as a life of drudgery.

(image from costumehistorian.blogspot.com…a great site and well worth a visit)

The last example contained in the receipt again concerns ‘Mrs Jones’ but this time gives us a little insight into an accident that could only really befall someone of higher status. At some stage in midsummer 1715 Mistress Jones was clearly abroad in her coach, no doubt enjoying views of the beautiful Vale of Glamorgan. Whilst comfortable standing still, the suspension systems of early-modern coaches were rudimentary at best and did not cope well with rough tracks. Perhaps it was an encounter with a wheel rut or some other type of obstruction that caused poor Madam Jones to hit her face and bruise her nose. No doubt nursing wounded pride as well as a bloody nose she clearly called for Doctor Nicholl!

Even in small, apparently limited, sources like these it is often possible to recover tantalising glimpses not only of healing practices, common (and in this case elite!) maladies and individual patients, but even something of the social attitudes towards sickness in a society and at a time where records of medical encounters are frustratingly rare.

For an interesting blog post on the Joneses of Fonmon see – http://huwdavidjones.wordpress.com/2012/10/07/keeping-up-with-the-joneses-paintings-at-fonmon-castle/

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.

A Welsh doctor, Sir Hans Sloane, and the disappearing catheter!

**WARNING: CONTAINS SOME GRAPHIC DESCRIPTION OF A PARTICULARLY UNCOMFORTABLE SURGICAL TECHNIQUE**

In 1720, Dr Alban Thomas was something of a high-flyer. The son of a Pembrokeshire cleric and poet, Alban first matriculated from Oxford in 1708, became librarian of the Ashmolean museum, assistant secretary of the Royal Society and, if that wasn’t enough, obtained his doctorate in medicine from Aberdeen in 1719. At a time when Wales was still a largely rural country, with no medical institutions of its own and fairly poortransport and road infrastructures, these were exceptional achievements for a boy from Newcastle Emlyn.Also unusual was that Alban appears to have returned to Wales to set up his medical practice; many Welsh practitioners who had trained in Oxford or London chose not to return, choosing the potentially more lucrative market of the larger English towns. Nonetheless, especially in and around the growing Welsh towns, there was still a relatively wealthy Welsh elite to cater for and some, like Alban, positioned themselves to serve the denizens of large estates and houses.

It is clear, though, that Alban still had connections. One of his correspondents was no less a luminary than Sir Hans Sloane, the Irish physician to the fashionable and, indeed, the royal and, later, president of the Royal Society. Surviving letters from Alban Thomas to Sloane suggest that theirs was a fairly regular correspondence, with Sloane acting in an advisory role for particular cases. It is one particular case that interests us here.

Sir Hans Sloane

In November 1738, Alban Thomas wrote to Sloane regarding a patient, Sir Thomas Knolles of Wenallt, Pembrokeshire, who was causing him concern. Knolles, although “a person of great worth, candour and humanity” was also “a person of very gross habit, of body an unusual size and make and about 20 stone weight with an appetite to his meat but very moderate in his drinking”. Knolles enjoyed exercise but, due to his size, this was often done on horseback.

At some stage, Knolles had become ‘dropsicall’ and suffered from swollen legs. The doctor used a combination of diuretics and tight, laced stockings to countermand this with, he reported, some success as Knolles returned to health, requiring only the odd purge as a ‘spring clean’. About four years previously however Knolles had begun to complain of a swelling in his scrotum, which Alban Thomas assumed to be hydrocele – a condition causing grossly swollen testicles (sometimes treated by injecting port wine into the testicles). After drawing off “about a quart of limpid serum” from the stoic Knolles testicles, followed by a dressing and strict recovery routines, the doctor hoped that he had cured the condition for good. This proved to be premature.

A selection of bladder stones and calculus

When Knolles began to complain sometimes of not being able to pass urine at all, at others a few drops and occasionally losing his bladder control entirely, he took it upon himself to get a second opinion from an unnamed doctor in nearby Haverfordwest. This physician prescribed a ‘Turbith vomit’ which wrought well and even caused Knolles to void a stone about the size of a kidney bean. Rather than being put off by this occurrence, Knolles was encouraged and began to pester Dr Thomas to give him more of these treatments. Unimpressed and undeterred,Thomas decided on a more proactive course. After putting Knolles on a course of diuretic medicines, liquors and balsams for a week he brought in to his consulting room. What happened next highlights the particular horrors of early modern surgery.

When Knolles arrived, Dr Thomas first applied a Turbith vomit, hoping that “so rugged a medicine” would clear the blockage without the need for more invasive procedures. It didn’t. In fact, the symptoms grew worse. It was at this point that Dr Thomas reached for his catheter and introduced it into the unfortunate Sir Thomas’s member. Expecting some resistance, he was surprised to find that the catheter went in without resistance. “On the contrary it seemed to force itself out of my fingers after passing the neck of the bladder as if it was sucked in, which I thought was owing to the pressure of his belly, the crooked end was now upward”. Yes, you read it right. The catheter was ‘sucked’ out of the doctors fingers and upwards further into the bladder! Now, any male readers may want to cross their legs!

In an attempt to probe for the stone that he feared was lurking in the bladder, and to release some water, Dr Thomas decided to turn the catheter around. At this point, the poor patient “cryed out with some violence…TAKE IT OUT I CAN BEAR IT NO LONGER”. Happily for Knolles the catheter came out “with as much ease as it went in without one drop through it or immediately after it”.

Three months later, the patient was still suffering, with the addition of great pain, defying all attempts for his relief. Despite being a “hail, hearty man having good lungs but lyable to hoarseness” and the occasional cold, Alban Thomas perceived him to be a healthy man. His efforts to treat Knolles had so far failed and he appealed to the eminent Sloane to help him “form a right judgement in this case”.

And so we leave the story there. What happened to Knolles is unclear, but the pain of his condition can only have been matched by the pain of his treatment. Suffering a succession of violent vomits, pills, electuaries and, finally, a wandering catheter, it is almost amazing to think that he ever went near Dr Alban Thomas again. Such (uncomfortable) cases remind us of the situation facing patients in the early modern period. For some the decision to see a doctor must have been a balancing act between bearing their illness or facing treatment.