Medicine in a Vacuum – Practitioners in Early Modern Wales

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

Image from Wikipedia Commons
Image from Wikipedia Commons

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

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

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

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

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

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

Image from Wikipedia commons
Image from Wikipedia commons

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

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

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

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

Image from Wikipedia Commons
Image from Wikipedia Commons

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

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

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

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

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

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

17thc Wales

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

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

Cunning folk

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

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

Welsh registers

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

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

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

Pontrobert today

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

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

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

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

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

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

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

2013 EAHMH Book Award for Physick and the Family

Ok, ok, this is self-promotion of the worst kind but, if you can’t do a little self-publicity on your own blog then what is the world coming to? To be fair, this is a special post for me. I’m absolutely delighted to have been awarded, last month, the 2013 European Association for the History of Medicine and Health Book award for my book Physick and the Family: health, medicine and care in Wales, 1600-1750.

The prize is awarded biennially for the best medical history monograph relating to Europe in the preceding four years to the award. It’s only the second time that the award has been made and the first to a work of British history. I’m obviously very proud. Here is a link to the Association’s website with the details of the prize. http://www.eahmh.net/index.php?option=com_content&view=article&id=57&Itemid=62

Aside from the prize itself though, I’m very proud that my little book about Welsh medicine has punched above its weight and, I hope, it goes some way towards demonstrating the value of regional histories. The book grew out of my PhD research and is indeed based on my thesis. From the outset the whole point of the book was not simply to say ‘here are a load of Welsh sources, I hope you enjoy them’ but rather to use Wales to explore broader questions and issues within medical and social history of the early modern period. As such the books addresses an undeniable gap in Welsh history but has always been intended as a book about medicine, the family, care, the community and so on more broadly.  That it has been awarded such a prestigious prize hopefully means that objective has been realised.

Onwards and upwards and, heartened by this, I need to do better in updating the blog more often!
p.s. Oh what the Hell, let’s go the whole hog – ‘Physick’ is just out in paperback at £14.99

http://www.amazon.co.uk/Physick-Family-Health-Medicine-Wales/dp/0719085462

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.

Picture from hha.org - copyright belongs to them
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/

“The infamous Dr Foulkes”: The ‘black villain’ of 18th-century physick

National Library of Wales Ty Coch 22 Add. MS 836d (also known as ‘Piser Sioned’) is, like so many other early modern ‘miscellanies’ an absolute treasure trove of information. Attributed to various authors over a period of several decades, it contains everything from family records to poems, and quotes from Tyco Brahe.

In the first few pages are records of ‘unfortunate days of the year’, alongside remedies for sore tendons and records of books that the anonymous author had lent to Arthur Jones. One of my particular remedies in the book is this one:

An approved imparabl’d medicine to eat anie overgrown film over an eye

R;/ The green part of a goose dung fresh (or at least very juicy) it will not be fitt after 16 or 24 hours, drop the juice thereof into the Eye with the dew that falls on the first, second or third day of june, wch you must provide or procure in that season. The first does the effect, the second clears the Eye, it does nt smart at all, and nothing has been found better as yet”

Needless to say that putting fresh, “green” goose dung into your eyes is probably best consigned to the book of history. Let’s just take it as read that people at the time believed it would do them good, and leave it at that!

Elsewhere in the document, however, is a record that is starkly at odds with the more generic and haphazard notes that make up the majority. It is unsigned, making it difficult to verify the allegations being made, but appears to relate to someone who has first-hand knowledge of the events being described. First taking the form of a vernacular poem, the verse is dated 1716 and headed:

“To the infamous Dr Foulks, Dr of Physick and Rector of Llanbedr in Denbighshire”.

It is worth quoting the first two verses to get a flavour of the allegations.

Thou Holy letcher thou religious cheat

How shall I halfe thy horrid guilt repeat

Now but my colours strong enough to paint

The blackest villain in a seeming saint

Doe lay thee open to a publick vicar

For greater crimes than ever Judas knew

Thou art, what shall I say, thou art alone

Whose sins epitome, all sins in one

And yet

Thou art too vile to live too bad to die

Nor canst thou from deserved vengeance fly…

 

by philtrers force and sympathetick charms

Oh! Black physician to the fernal Tribe

Who canst for soul and body to prescribe

But such designs thy medicine impart

That both are ruined by the cursed art

 

“Quick, Strait, begone from Wallia, Fruitful Isle

To some far distant unpregnated soile”

 

Strong stuff. “The blackest villain in a seeming saint”, “Black physician to the [in]fernal tribe”. Clearly he was a notorious figure in Llanbedr. But who was this “Dr Foulks…and what had he done?

The Reverend Robert Foulkes of Llanfrothen, Merionethshire, was indeed an M.D. who had graduated from Oxford in 1725. This Dr Foulkes was a correspondent of some of the most eminent physicians of his day and, in 1718, had set up his own physic garden at Cambridge. He wrote to Welsh luminaries such as Edward Lhuyd (then at the Bodleian) on the subject of botany, and was considered to be an authority in his field. Reportedly of delicate health he died young. All in all, this does not sound like the sort of man to inspire the vitriol of the ‘Piser Sioned’ author.

By incredible coincidence, however, there was another Robert Foulkes, also a vicar and physician, at roughly the same time, and it is this man who is the more likely candidate. The Reverend Robert Foulkes of Llanbedr Dyffryn Clwyd, Gwynedd, indeed seems to be the subject of the poem but he is a shadowy figure. Little can be found about either him or his medical practice so we have only the poem to shed light. What had he done to elicit such contempt? Luckily for us the poet left a few lines of narrative to fill in the blanks. At the very end of the poem, written in the margin, is the following note:

“The subject is now too well known but futurity may drown it in oblivion, unless it be commemorated in writeing as thus,

The s(ai)d doctor was guardian to the young ladies of Llanerch in Flintshire with(?) the Davises. He debauched one at 13 years of age and gave her physick to prevent conception. He lay with her 15 or 20 years, at last she refuted physick and conceived, she was delivered privately, he disowned the childe, but s(ai)d he had to do with her mother and did not know(?) but the child might be his grandchild – a black villain”

 

So Dr Foulkes’ sins were laid bare. It is unclear whether this poem was ever published but it would fit the sort of libel that could be distributed around a local area or pinned up in prominent places. Since the “subject [was] now too well known” it seems that Foulkes already had a soured reputation. That he was a vicar, entrusted with the moral and spiritual health of his parishioners, would have been difficult for them to accept. That the sins occurred with young women with whom he had been entrusted with their care would surely have been worse. Even when faced with the allegations and the presence of an illegitimate child Foulkes seemingly refused to take responsibility.

I’m still on the hunt for information about this ‘black villain’ and it would be interesting to find out more about him. Vicars who practised medicine were not uncommon, but those who inspired such venom as did Dr Foulkes certainly are. Sadly, it seems that figures of authority or fame who used their positions to exploit or abuse others are not just a modern phenomenon.

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

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

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

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

File:Hans Sloane.jpg

Sir Hans Sloane

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

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

A selection of bladder stones and calculus
A selection of bladder stones and calculus

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

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

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

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

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

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.