The Great Georgian Snuff Debate

We’re used to debates about tobacco. In any given week it’s a fair bet that smoking/cigarettes/e-cigarettes will be food for editorial thought. What the UK’s Guardian recently called a ‘global epidemic of tobacco’ is, according to their statistics, a bigger killer than Malaria, TB and AIDS…combined. Recent scare stories have surrounded e-cigarettes, prompting tabloids to ruminate over the question of whether they might even act as baby steps to full-strength cigs. The central problem with tobacco is its undoubted potential to kill. We think of this as a modern debate about a modern affectation. But, in fact, debates about the healthiness of tobacco have raged for centuries. Three hundred years ago, snuff was at the centre of the storm.

One of the most quintessential emblems of the eighteenth century dandy or fop is the snuffbox. By the mid eighteenth century the practice was ubiquitous…and not to everyone’s taste. In 1754 a disgruntled reader known only as ‘T’ wrote to the editors of the Connoisseur magazine, complaining about the practice.

“Dear Sir, I know not if you yourself are addicted to a filthy practice frequent amongst all ranks of people. The practice I mean is that of snuff-taking…[everyone] appears obliged to cram his nostrils with a quantity of scented dirt to fence them from the disagreeable effluvias of the rest of the company…

It is indeed impossible to go into any large company without being disturbed by this abominable practice. The church and the whole playhouse continually echo with this musick of the nose, and in every corner you may hear them in concert, snuffling, sneezing, hawking and grunting like a drove of hogs’.

To illustrate his point further, ‘T’ claimed to have witnessed ‘a whole congregation suddenly raised from their knees in the middle of a prayer by the violent coughing of an old lady, who has been almost choaked by a pinch of snuff in giving vent to an ejaculation’! Any lady who succumbed to this vile practice was, in their view, no better than a serving wench. Why, then, was snuff so apparently popular?

Snuff first came to Europe in the 16th century and was first advocated as a medicinal product, being used to treat headaches and other conditions. Snuff was manufactured from cured and Tobacco leaves were slowly cured and fermented, and certain ‘flavours’ could be added. Snuff quickly found favour amongst wealthy elites, with prominent advocates including Queens, Popes, nobility and prominent society figures. By the eighteenth century everyone from George IV to Samuel Johnson were hawking vast quantities of powdered tobacco up their nostrils.

Advertisments promoted special types of snuff. The ‘Golden Snuff’ advertised in the Daily Courant in 1704 counted headache, drowsiness, dullness of hearing and humours in the eye amongst the list of afflictions readily cured. Also of use in ‘Gouty and Rhewmatick paines and for asswaging swellings’, its manufacturers also claimed that ‘it never decays’.Medical authors were divided on the subject. Thomas Apperley’s Observations in Physick considered the potential benefits of a small pinch of snuff against certain conditions, but was cautious of the effects in ‘one not accustomed to it’. In a 1790 Account of Several Excellent and Genuine Patent and Public Medicines a writer known as ‘Castor’ extolled the virtues of the ‘Cephalic Snuff’ in treating ‘hysteric and paralytic complaints’ as well as the ‘Complaints of the Head that Painters &c are subject to’!

Others were far less than convinced. In his 1799 Essay on Regimen James McKittrick Adair railed against the practice of snuff taking, since ‘encrusted snuff impedes the breathing’ while ‘acrid, poisonous oil’ produced by nasal mucous could be highly injurious to the stomach. Adair suggested that the ‘use of tobacco in any form is a vile practice’ and that sniffers of snuff should cleanse their nostrils and wash their mouths with warm water. Dr Allen’s Synopsis of Medicine from 1730 condemned the ‘inordinate use of snuff’ for apoplexy and others cautioned people to beware of the damage that ingesting snuff could cause.

In 1720 an anonymous Dissertation on the Use and Abuse of Tobacco in relation to the Smoaking, Chewing and Taking of Snuff, and was ‘humbly subscrib’d to the Ladies and Gentlemen who use it in the Above ways’. In 1760 Edward Baynard wrote a whole book of poetry about snuff, titled Health: to which are added cautions agains the immoderate use of snuff, devoting 36 densely written pages to his task. Snuff was under attack.

Part of the problem for naysayers of snuff was its popularity. Snuff had become a social ritual, and one popular at all levels of society. Taking a pinch had become embedded in popular culture, and with it came a secondary market in snuff paraphernalia. Snuff boxes, for example, became increasingly elaborate and ornate. As such they were high up the list of desirable items for pickpockets. In 1688 one Claudius Bertin was relieved of a gilt ‘Princes Mettle snuff box’ valued at thirty shillings. Two snuff boxes stolen from the house of the wealthy Don Diego Capyllar in September 1692 were valued at over £5 alone – then a princely sum.

Jewellers and makers made a wide variety of boxes in precious metals and bedight with jewels and ornamentation. In 1765 a Mr Burnsall of London begged leave to keen to acquaint the public of the wide range of goods, including ‘Agate snuff boxes richly set in gold’ that he had for sale in his London shop.

Fans of the product even took to the newspapers to defend their favourite ‘tipple’. A poem found inside an 18th-century recipe collection provided, taken from the Chester newspaper of 1761, proselytized about the power of snuff to lighten the day and preserve the health. The first three verses should be enough to give a flavour:

‘Six reasons for taking a pinch of snuff
When strong perfumes and noisome scents
The suffering nose invade
Snuff, best of Indian weeds presents
Its salutary aid

When vapours swim before ye eyes
And cloud the Dizzy breath
Snuff, to dispel the might applies
Its quick enlivening grain

When pensively we sit or walk
Each social friend away
Snuff best supplies the want of talk
And cheers the lonely day’.

Snuff-taking continued unabated into the nineteenth century; ‘celebrity’ snuffers included Benjamin Disraeli, but the practice gradually declined as it became increasingly viewed as an antiquated relic of the past. Whilst it is still possible to buy snuff today, it is unlikely, given its many nasty side effects including mouth and throat cancer. Unless someone bothers to invent ‘e-snuff’, which seems equally unlikely, then it seems best to consign it to history. Nonetheless, it does provide us with a useful means to look at how people dealt with addictions, and in particular tobacco use, in the past.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

17th-century remedies and the body as an experiment

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

Image from http//:www.theboredninja.com

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

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

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

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

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

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

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

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

Reading between the lines: reconstructing lives from parish registers

I’ve recently returned from a research visit to Ruthin archives to look at the Denbighshire parish registers. The purpose of the visit was to trawl through every one of the hundreds of parish register transcriptions, looking for medical practitioners. With two bookcases full of volumes, each containing many individual registers, this was always going to be a long task. The registers for the town of Wrexham alone took two days, and monotony soon sets in when faced with page after page after page of names and bare information.

Parish registers are commonly the domain of genealogists and family historians, perhaps researching their own family history. Through the popularity of television shows like Who Do You Think You Are researching your own family tree has never been so popular, aided by the growing availability of source material online. Historians too are making use of parish registers. In aggregate they can reveal a whole range of demographic information, allowing assessment of long and short term population changes, marriage, birth and death patterns and so on.

But parish registers are generally deficient in detail, and even more so the further back in time you go. In the register of marriages in the seventeenth century you may get no more than the names and locations of both parties. The same for births. The burials registers give you name and parish, and sometimes the name of the father if the deceased was a child. In some cases occupations are given, but unevenly and sometimes selectively. So much depends on the diligence of the parish notary. As such, individual registers are generally unsatisfactory as qualitative evidence for the lives of individual people. If, however, as I was able to do, you search through a large number of records, then it is often surprising what extra information is able to be gleaned. In fact, the marginal comments made by the register creators often contain nuggets of extra information that can reveal much not only about their own prejudices, but of wider attitudes in society.

Parish registers were legal documents. As such they were deliberately formulaic and only required the bare minimum of information. With no legal reason or administrative need to add in anything else, many notaries didn’t bother. But it is the very fact that extra comments were not necessary that renders them more interesting.

One thing that becomes clear is the disapproval levied against anyone who was perceived to have transgressed in some way. Some women in the Denbighshire burials registers, for example, were obviously held in low regard by the local clergyman. Several entries appear with the appellation ‘harlot’ written in the margin, ‘whore’ and even one recorded as being a ‘wich’.  Here was an indictment of loose morals writ large and preserved forever in legal documents. Whoever wrote these remarks was making a definite statement and was fully aware of the stain that they were forever putting against these parishioners names. Being ahistorical for a moment, it is sad to reflect that perhaps these women’s only appearance in the record is coloured in this way. Perhaps the worst (or best) example I have come across is poor Barbara Roberts, buried in Denbigh in 1832 and, according to the vicar, “The dirtiest woman in the neighbourhood”!

There is an obverse to such pejorative comments though, and this is the sometimes laudatory comments that could be made. Those who left money to the parish poor or were well known for their good deeds might forever be bestowed with comments such as ‘a well liked body’ or ‘a person of good repute’. Here again we can encounter glimpses of personal affiliations. It is no coincidence that gentry and other clergy were often well reported in parish registers!

Accidents and other notable or lamentable deaths were often remarked upon and these are often touching in their brevity. ‘An infant died on the road in the arms of its mother’ is a typical example which says so much but also so little. Registers are full of drownings, deaths in fires and other accidents that reflect the dangers of hard rural lives, belying any depictions of a romantic rural idyll. People who were extremely old (‘110 by common repute’) were likely to be remarked upon, as were women like Jane Reece of Holt in Denbighshire who died aged 58 in 1696 “pregnant for the 100^th time”.

Even occupations were not free of the individual foibles of recorders. In some parishes certain occupations might be recorded where others were ignored. This might mean that weavers or glaziers might be recorded while apothecaries or barbers could go unremarked. This is only one of the frustrating problems facing anyone looking for occupational data. ON the other hand they can throw up surprising little quirks. In Denbighshire alone I found evidence of three ‘Aquavitae’ men,  in different parishes, all of whom were known only by their first names and who had died on the road. These were travelling salesmen selling what was a semi-medicinal strong brew. Of no fixed abode they probably succumbed to the harsh life of travelling. Given what they were peddling this seems a fitting case of ‘Physician heal thyself’.

Registers can be frustrating documents but they are often well worth spending time with. By reading against the grain it is possible to learn much about early modern life, as well as the characters of individual clergy as they wrote their sometimes barbed observations. I think that more qualitative work on early-modern registers is badly needed.

Bloodletting in Medicine: The return of the Leech

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

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

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

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

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

 

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

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

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

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

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

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

Polite Sickness: Illness narratives in 18th-century letters

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

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

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

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

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

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

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

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

Finding medical practitioners in early-modern Britain.

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

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

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

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

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

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

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

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

The English Priest’s Powder: A 17th-century quack doctor’s advertisement

The marketing strategies of 17^th and 18^th-century quack doctors are now familiar territory. As Roy Porter’s outstanding book Quacks did so well to bring alive, early modern Britain was a vibrant medical market, a panoply of colourful characters and dubious remedies. They were, to use Porter’s phrase, “a ragtag and bobtail army of quacks”.

Taking advantage of the newly-available cheap print, quack doctors produced reams of advertisements to peddle their wares. Ranging from brief, straight to the point details to more sophisticated means of selling, quack doctors were often skilled wordsmiths; in many ways they needed to do something to stand out from the crowd. With so many different medicines and vendors jockeying for position, they needed to be innovative. This might include elaborate descriptions of the virtues of their medicine. They often included testimonials from those who, they claimed, recovered through the use of their pill or potion. They might use imagery to embellish their advertisements. Occasionally, though, some particularly innovative strategies can be found. One of my favourite is the clever tool of selling without appearing to sell. One of the ways this was done was by disguising the advertisement in the form of a book. A case in point is the engagingly titled Riddles mervels and rarities: or, A new way of health, from an old man’s experience, published in 1698 by Thomas Mace.

Title page from ‘Riddles and Mervels’ – availble on EEBO (copyright)

At first glance this appears to be a typical ‘self-help’ book, a genre popular in the period. In his opening preamble, Mace sets out his philosophy that age and experience are better than any university-trained, licensed physician. Anticipating howls of derision from the faculty, Mace acknowledged that “I am no physician either by education, graduation, licence or practice’. And yet, he argued, a man like himself of 80 years knew his own body better than any young man of 20 or 30 who had merely spent 5 years reading books in a university. Compelling stuff!

The first hint that all might not be as it first seems occurs early on with the inclusion of the following:

“TO Prevent all Frauds, know, That This Rare Power, known by the Name of the English PRIEST’S-POWDER, is to be had No where but at These few Places Following, viz. By the Author (Tho|mas Mace) at his House in St. Peter’s Parish in Cam|bridge, near the Castle; And at Mr. Daniel Peachcy’s in St. Buttolphs Parish there: And in London, by Mr. Adam Mason at his House in Old Bedlam near Bishops|gate; And by Mr. William Pearson, Printer, at the third Door in Hare Court in Aldersgate-street near the Meet|ing House; And by Mr. John Vaughan, Milliner, at his House in Grivil-street near Hatton Garden; and by Mr. Will. Benson in the Old Baily”

Indeed, advertisements in ‘proper’ books were not unusual, but the alert reader will no doubt note the name of the creator and seller of the powder…one Thomas Mace – the man who claims to be no physician. Disguised within an ‘explication of the title page’, the sell goes on…

“Universall-Physical-Me|dicine, for all sorts of Constitutions, and all sorts of Maladies, Sicknesses, and Diseases, is a Chymical Prepar’d Powder which for some late years past I have Publish’d in the Name of the English PRIE                         T’S POWDER, and which it self is never to be Taken, either Inwardly (as Physick) nor Ap|plyed Outwardly to any Wound, Sore Scab, Bruise, Swelling, Pains, Aches, Head-Ach Rheumetick-Sore-Eyes, &c. All which, and many more, tis most Ad|mirably good for.) I say, it is never (it self) to be us’d or Apply’d (as Me|dicine) But (only) a lycture, which It sends forth, into some Certain Li|quors; into which it is to be Infus’d, for some certain Hours: And Those Li|quors, (Retaining its Virtue) are only to be us’d; And (as Physick) are to be taken, into the Body, in the way of Potion; […]ther for Vomit, Purge, Glister, or Sweat; But in the way of Chirurgery, are only Outwardly Applyed, by Washings or Bathings &c.

As the book progresses, it seems to revert to the ‘every man his own physician’ style. Mace assured the reader that his intentions were honourable and that he only wished to “Accommodate the Meaner sort of Men; but more especially the Poorest of all, who stand most in Need of Help and Comfort in their Sicknesses, seeing no Great and Skillfull-Physicians, will so much as look after Them, or scarce think of their Miseries; so that many Thousands live in Misery; Languish and Dye, for want of That which every ordinary House keeper might Easily Purchase, and not only have the Benefit of it for himself and his whole Family, during his Life, in all common Sicknesses, and Disea|ses, but might also be assisting to all his Poor Sick Neighbours round Him”

There follows a discourse on the Philosopher’s stone, including several pages of what can only be described as vernacular poetry. A short stanza should suffice:

MUch Talk has been of The Philosophers-Stone,
From Ages past; That by its livge alone,
‘Twould turn Inferiour Metals into Gold.
A Glorious Worder sure, if True; but Hold!
Where is’t? Who has’t? we no such Thing can see;
‘Tis surely Folded up in Mystery

There is even a page of music to allow the reader to literally sing the praises of the remedy!

EEBO (Copyright)

But the next sections of the book, although clothed in a discussion of the miraculous effects of the philosopher’s stone, are in fact a shining example of pure quack rhetoric. On first glance it seems that Mace is merely reporting the effects of the ‘philosopher’s stone’ on a range of conditions. But, looking more closely, his ‘priest’s powder’ has been cunningly woven into the narrative. A clue comes in the title to his first section – “The admired use of this powder (or stone)”…which one is more prominent?!

The real clincher comes in the “Eight eminent stories” of the power of the “powder (and stone)”.  Ranging from the dying man who could not sit upright but recovered almost as soon as he had taken the powder, to the cured leper, to the woman suffering from yellow jaundice, whose “foul, corrupt stomach” was poisoning her food, all were miraculously brought to recovery not only by the mysterious priest’s powder but by the personal intervention of the ubiquitous Thomas Mace…who, as he was no physician but knew his own body, clearly just happened to be passing!

This was selling by not selling. The reader, perhaps expecting a list of cures and remedies for all ailments, and lulled by the promise of being able to cure themselves of all maladies without the need for physicians, surgeons or apothecaries, was instead subject to stealth marketing. Mace provided everything about his powder, including where to buy it and how to use it, but disguised it in a discussion of the ‘Philosopher’s stone’ to try and locate his ‘Riddles and Mervels’ as a scientific discourse. Clearly this was an advertisement, but it shows the innovation of medical retailers, and the lengths to which they went to sell their goods. Little is known about Mace. By his own admission he was an old man, but was he someone with a genuine concern for his fellow man, or just another medical entrepreneur, out to make a fast buck. You decide.

Medicine by Post: A 17th-century doctor’s directions

Medicine in pre-industrial society was loosely structured. Finding a possible practitioner to minister to your ailments wasn’t difficult; they were virtually ubiquitous. From village tooth-drawers, bonesetters, diviners and wise women across to trained, apprenticed or licensed physicians, the range of potential choices for the early modern patient were legion. And yet, this very ubiquity often serves to mask the most basic element in these encounters; what actually happened. What did the doctor say or do? What was the relationship like between treater and treated?

Early modern doctors could not necessarily command authority. Unlike today, where we go to the doctors to find out what it wrong with us, the seventeenth-century patient effectively self-diagnosed. They told the practitioner what the complaint was, and expected them to prescribe accordingly. In Galenic medicine, people knew their own humoural constitutions and largely determined – through their own knowledge and by reference to others – what this problem was.

Nevertheless, the doctor could claim to have esoteric knowledge about how the body functioned. As far as learned physicians were concerned, while the sufferer might well know what was wrong with them, they did not have the necessary understanding of the body to be able to treat it safely. It was therefore only the trained and licensed physician who was qualified to treat the sick properly…at least that was the claim of the trained and licensed physician!

One means through which we can get an idea of the early modern equivalent of the ‘doctor’s appointment’ is through the occasional letters written to patients by practitioners after such encounters. One such letter I encountered during my PhD research, and is located at Glamorgan Record Office, MS D/DF V/202. It is a letter from 1628 addressed to a ‘Mrs Bridges’ but is (extremely frustratingly) anonymous, since the last portion of the letter is missing. Below is my transcription:

‘For Mrs Bridges

When yow come home yow may begin with the Physick wch yow have from hence so soon as yow will: taking it in a manner following, Provide the like Possetale as you did here. To a reasonable draught of that Posetale yow may put two spoonefull and an half of the opening wine. Mix them and put a little sugar to them to relish them: and so drinke it in the morning fasting. Walke, or use some good exercise after it for the space of an hour and halfe, and fast after it for the space of three howers: then make a light meale of boyled meate. The like yoe may do a little before foure of the clock in the afternoons and observe the like course.

But because your body will be apt to be bounde upon the use (of) this physick, therefore I have set you down some syrupes in a glasse, wherof I would have you to take three spoonefull mixed in the former draught any morning when you please.

And, the day after that the full course of the opening wine is finished I would have you take five spoonefulls of the syrupes to a draught of the former posetale and so drinke them warme. And two houers after take a draught of warm thin broth. And at any time when you are costive you may use a suppositorys made with honey and salt boyled to a height and put a little fine powder of Aniseeds and fenell seeds to it when you make it up.

Be carefull in your diet. Eat noe meatte but flesh as is of an easy digestion: as mutton, veale, lambe, capon, chicken or the like: Avoide all raw salletts, or fruites: But for sallets use capers washed in warme water. And sallett of broome budds, or Asparagus or the topps of young hopps are good. Or Cowslipp flowers candiyed and mixed wth a little vinegar. Or rosemary flowers wth a little vinegar and sugar.

I am afrayd your body will not endure the use of wine: but if you use any Let it be onely a draught of mulled claret wine with a sprigg of rosemary, and sweetened wth sugar, and take it in the middle of your meale.

All salt meates and baked, or spiced meates are nought for you: and milk or milky meates are worse.

Yow must endeavour to be cheerefull and avoyde all passions of fear, anger or melancholye.’

There are a number of interesting elements to this letter. Firstly, it is clear that Mrs Bridges visited this practitioner. The letter itself is virtually a follow-up to the appointment, containing some record of the encounter but, more importantly, a full set of instructions and directions for her recuperation. This suggests that the face-to-face encounter was one stage in a process. Where, today, one generally leaves the doctor’s surgery armed with a prescription, this encounter was holistic, and involved a further stage. Put more simply, the ‘appointment’ didn’t end when Mrs Bridges left the physician’s premises. This, too, is an important point. In this case – somewhat unusually – she has visited the doctor, rather than the other way around. He mentions her returning home, and also the physic he sent ‘from hence’.

Also noteworthy is the emphasis upon lifestyle, much of which would seem familiar in today’s health-conscious society. Here, the advice is to eat certain foods at certain times, and then in moderation, to ‘be carefull in your diet’ and, crucially, to stay cheerful, stoic and calm. It is worth noting too that the practitioner is ‘afrayd’ that Mrs Bridges’ body would not tolerate wine, although he did leave the door slightly open for the odd tipple.

In early-modern parlance, this was known as ‘regimen’. As surprising as it might seem, given their seeming predilection for dangerous or disgusting remedies, this was a very health-conscious society. Good health was something to be cherished and maintained. It was far better to prevent illness than to treat it. Mrs Bridges’ practitioner took pains to understand her humoural makeup, and based his comments directly upon this. Medicine, in this sense, was individualistic. It is one of the many contradictions of humoural medicine that a remedy meant for one individual should not theoretically have treated another. In practice, people shared and accrued recipes vigorously.

But what this letter gives us most is a little window into the consultation process itself. It gives us some insight into the processes of consulting a practitioner, albeit at probably the upper reaches of society. Bearing in mind that the vast majority of people couldn’t write, the very fact that this letter survives marks it out as exceptional. As more of these fascinating documents are uncovered, we may start to learn more about the early modern doctor’s ‘appointment’, at other levels of society, and with other types of practitioner.