Fowl Medicine: The early modern ‘pigeon cure’

In October 1663 news spread around London that Queen Catherine was gravely ill. Fussed over by a gaggle of physicians and priests, things got so bad that Her Majesty was even given extreme unction in the expectation that she might not pull through. In an effort to turn things around, as Samuel Pepys noted in his diary on the 19th October, “pigeons were put to her feet”. In another diary entry in 1667, Pepys recorded visiting the dying husband of Kate Joyce who was in his sick bed, his breath rattling in his throat. Despairing (for good reason) for his life his family “did lay pigeons to his feet while I was in the house”.

Samuel_Pepys

(Image from Wikipedia)

Pigeons? Laid to the feet? Was Pepys mistaken, or was there a misunderstanding of his complicated shorthand? Actually, pigeons were a surprisingly common ‘ingredient’ in medicine and were even recommended for various conditions in the official pharmacopoeia (catalogue) of sanctioned remedies. But what were they used for, and how?

Remedies for the treatment of the plague certainly called for the use of pigeons. No less a publication than the London Pharmocopoeia issued by the College of Physicians in 1618, contained a remedy for the plague which involved pulling off the feathers of living pigeons, holding their bills shut and holding the bare patch to the plague sore “until they die and by this means draw out the poison”.

William Kemp’s 1665 ‘Brief Treatise of the Nature and Cure of the Pestilence’ noted that some writers advised cutting a pigeon open, and applying it (still hot) to the spine of a person afflicted with melancholy, or to a person of weak intellect. The English Huswife of 1615 advised those infected with the plague to try applying hot bricks to the feet and, if this didn’t work, “a live pidgeon cut in two parts”. Even the by-products of pigeons could come in useful. Physicians treating the ailing Charles II applied a plaster to his feet containing pigeon dung.

672px-Dodelycke_Uytgang_van_Syn_Hoogheyt_Fred._Hendrik_Prince_van_Oranje_etc._Anno_1647

(Image from Wikimedia Commons)

Several sources suggest that the ‘pigeon cure’ was often a remedy of last resort. Writing of the last illness of her father in 1707 (dying of a “broken heart, which the physicians called a feaver”, Alice Thornton reported that, just before his death, pigeons were cut and laid to the soles of his feet. Seeing this her father smiled and said “Are you come to the last remedy? But I shall prevent your skill”. The diarist John Evelyn, in the ‘Life of Mrs Godolphin’ noted that ‘Neither the cupping, nor the pidgeons, those last of remedyes [my emphasis], wrought any effect’.

The ‘cure’ was evidently so popular that it made its way into popular culture, such as in Webster’s ‘Duchess of Malfi’. Speaking to the ‘Old Lady’, the character Bosola says that he would “sooner eate a dead pidgeon, taken from the soles of the feete of one sicke of the plague, than kiss one of you fasting”.

What were the perceived medical benefits of the pigeon and its various products? Some prominent physicians had plenty to say on the matter. William Salmon’s Pharmacopoeia Londonensis, Or the New London Dispensatory in 1716, (p. 200) held that “cut in the middle and laid to the feet, [pigeons] abate the heat of burning fevers, though malignant, and so laid to the Head, takes away Headaches, Frenzy, Melancholy and Madness. On the matter of pigeon dung, Dr Alleyne’s Dispensatory of 1733 stated that “we may judge of the nature of this [dung] from that of the birds…consists of subtle hot parts, which open the pores where it is applied, and by rarifying and expanding them, occasion a greater flux of fluid that way”. In other words the hot dung caused the body to open its pores and expel the bad humours causing the illness.

Matthias_Stom_-_St_Gregory_-_WGA21806

Saint Gregory (and a pigeon!) – image from Wikimedia Commons

The particular significance of the pigeon is interesting too. One hint is given by the apparently strong connections in folklore between the pigeon and death, ranging from the belief that pigeons flying near a person – or indeed landing on their chimney – were supposed to indicate approaching death, to the “common superstition” (recorded in 1890) that no one can die happy on a bed of pigeon’s feathers. The symbolic power of the pigeon may therefore have been applied in reverse. Killing the bird perhaps imparted its vital power onto the dying person. Beliefs in the power of ‘anima’ – the vital life spirit – being able to be transferred from animals to humans were common in the early modern period.

If some of this seems like it belongs firmly to the 17th century, it is worth mentioning that the ‘pigeon cure’ was still apparently in use in Europe in the 20th century. A fleeting and poignant reference in Notes and Queries refers to a woman in Deptford in 1900, who unsuccessfully attempted to use the cure on her infant son when the medical attendant pronounced that there was no hope for him. He died shortly afterwards of pneumonia.

An article in the Pall Mall Gazette in 1900, though, reported that a Paris physician was casually told by one of his patients that she had “tried the pigeon cure for meningitis”, with some success. The physician, one Dr Legue, expressed his ignorance of the cure, and the patient described it to him.

“The head of the patient to be treated is shaved, and then the breast of the (freshly-killed) pigeon is ripped open by the operator, and the warm and bleeding carcass immediately applied to the bared skull”.

More than this, Dr Legue apparently discovered a shop in the city’s Central Market, where a Madame Michel ran a shop selling nothing but live pigeons, specifically for the purpose of the cure. On interviewing Madam Michel, the good doctor ascertained that she was on the point of retirement after making a “small fortune” from her business, since “the pigeon cure is considered a sovereign remedy for Influenza”, and she had been struggling to keep up with demand. The term ‘sovereign remedy’ takes us straight back to the 17th century but, before the article finished, Madam Michel mentioned one last use for the pigeons. In the case of Typhoid fever, she suggested, two pigeons were necessary. And they should be tied to the soles of the feet.

1280px-Wood_Pigeon_(4753160110).jpg

(Wikimedia Commons)

As uncomfortable as they might sometimes appear to our eyes, early modern medicine involved all manner of plants, animals and substances, alive or dead. Rather than viewing them as ‘weird’, people at the time saw them as valuable ingredients, often with special properties, which they could use to help them in the fight against disease.

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

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

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

Old Bailey in the 19th century

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

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

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

Surgeon01.jpg

(Image from Wikimedia Commons)

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

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

Highway Robbery

(Image from Lewis Walpole Library)

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

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

A_quack_doctor_treating_her_patient's_chilblains._Engraving_Wellcome_V0011085.jpg

(Image from Wikimedia Commons)

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

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

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

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

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

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

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

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

Image from Wikimedia Commons
Image from Wikimedia Commons

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

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

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

Image from Wikimedia Commons
Image from Wikimedia Commons

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

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

L0011748 Title page: Report of the Society...recovery of persons

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

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

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

Fart catchers and Duck F***ers! The world of 18th-century slang

Often, whilst searching for sources in the archives, you come across something that you would perhaps never usually have found. This week was no exception. Whilst looking through Georgian books for evidence of bad posture I had a chance encounter with a rather unusual book –James Caulfield’s Blackguardiana or dictionary of rogues, bawds, pimps, whores, pickpockets, shoplifters etc (London: 1793).

Title page to 'Blackguardiana'

The stated aim of the book was to identify and catalogue the most notorious villains of the day, together with illustrations but, along the way, to provide ‘anecdotes, flash terms and cant songs’ all of which was ‘Intended to put society on their guard against Depredators’. It also sought to help unwary foreign travellers by equipping them with enough knowledge to guide them through the often-puzzling diversity of the English language. The book was fairly pricey, costing one guinea, and few copies were printed.

Arranged alphabetically, the book takes us through a huge range of terms, spanning over 250 pages. There’s not room here to go through the lot, but some specific examples will be enough to get a flavour of the whole thing! Many, for example, are general terms covering a range of aspects of daily life. We learn that to ‘Sham Abram’ is to pretend to be ill. Someone who ‘casts up their accounts’ is vomiting, while someone ‘in their altitudes’ is drunk. A wife scolding her husband was offering him a ‘dish of rails’! To be hungry was to have ‘a long stomach’.

Image from Joanne Bailey's excellent blog -https://jbailey2013.wordpress.com/2013/11/14/embodying-marital-behaviour-in-the-eighteenth-century/
Image from Joanne Bailey’s excellent blog -https://jbailey2013.wordpress.com/2013/11/14/embodying-marital-behaviour-in-the-eighteenth-century/

Interesting along the way are the various slang names for occupations. A maid might be referred to as an ‘Abigail’, while a servant in general was known as a ‘fart catcher’ because of their habit of walking behind their masters. A parish clerk might be referred to as an ‘Amen Curler’, while an innkeeper could be a ‘bluffer’.

Golf_caddy

An eighteenth-century 'punk'!
An eighteenth-century ‘punk’!

Perhaps reflecting the general lack of love for the medical profession, medical practitioners do not fare well in slang terms. According to Caulfield to ‘talk like an Apothecary’ meant to spout nonsense ‘from assumed gravity and affectation of knowledge’. A long bill might be termed ‘an Apothecary’s bill’ while ‘Apothecary’s Latin’ was ‘barbarous’. The reasons why are unclear, but an army or navy surgeon might be known as either a ‘crocus’ or ‘crocus metallorum’.

The phrase ‘that’s the Barber!’ was ‘a ridiculous and unmeaning phrase in the mouths of common people, signifying their approbation of any action, measure or thing’. A midwife was a ‘rabbit catcher’ while a surgeon’s assistant laboured under the name of the ‘loblolley boy’, named after the gruel often doled out to the sick. Before we feel too sorry for the medics, spare a thought for the person who looked after the poultry aboard ship, who was colloquially referred to as the ‘Duck F**ker’!

Insults naturally feature quite prominently. A ‘beastly, sluttish woman’ might have the name Fusty legges’ levelled at her. A drunk person was a ‘pogy’. A punk, according to Caulfield ‘was a little whore’, while a ‘sad, ignorant fellow’ was regarded as a ‘looby’.

As well as name-calling the dictionary gives us some insight into the language of crime. To ‘give someone his bastings’ was to beat them up, as was to give them a ‘rib roasting’. A burly ‘puff guts’ waving a knife at you might threaten to ‘let out your puddings’, whilst if a highwaymen instructed you to ‘tip off your kicks’, it was advisable to remove your trousers (kicks) immediately. If you were ‘kimbawed’ then you had been cheated, Any unfortunate man who was ‘bastonaded in his bawbells’ was likely to have been the recipient of a hefty punch in the testicles!

Image from www.oldbaileyonline.org
Image from http://www.oldbaileyonline.org

Again, unsurprisingly, a great deal of space is reserved for sex! A woman ‘riding St George’ was ‘uppermost in the amorous congress’. Two bodies engaged in sex were referred to as the ‘plaister of warm guts’. A man putting his ‘plug tail’ into a woman’s ‘dumb glutton’…or worse still her ‘pratts’ , was engaged in practices against which the stricter clergy would certainly object!

There are, however, many familiar phrases. ‘Against the grain’ is used to denote something that someone does against their will. ‘Riff raff’ were ‘low, vulgar people’ while busy shopkeepers were said to be doing ‘a roaring trade’. Someone talking too much might be told to ‘Shut your potato trap!’ – from which the more common ‘shut your trap’ probably derives. Someone who could not make a choice was ‘in a quandary’.

It’s perhaps easy to see these as humorous examples of eighteenth-century trash talk. Many of them are extremely funny and often surprising. They even still have something of the power to shock. But in terms of historical value they are incredibly important in offering a window into the often-earthy common language, spoken by ordinary people. Our view of eighteenth-century manners and politeness has been created and reinforced through things like literature and advertising and gives us the polite speak of literate elites. Caulfield, however, takes us to the village inn as well as the salon, and lets us hear some of the choice slang, insults and names that were perhaps closer to the daily speak of individuals.

Now, ‘Teddy my Godson’, away before I ‘let out your puddings’!

10 Seventeenth-century remedies you’d probably want to avoid!

Whilst I strongly advocate not poking fun at the medical beliefs and practices of our ancestors, now and again it does no harm to remind ourselves of just how…unusual they could sometimes appear. And so I give you my top ten early modern recipes!

10) An excellent good medisian for an Eye that is bruised or blood shott by any crust
Take ass soon as the eye is hurt; take a house pidgin & cut ye vain that is under the winge & let it bleed into a sauser: and while it is hot wett some cloth and presently lay it to ye eye: and the next day dress it in like manner and with out doubt it will help you”

9) For the bloody flux (ie. Dystentry or severe diarrhoea)
Take A handkerchief dipped in the blood of a hare harte newly killed, dry this handkerchief in ye sun & after straine your beer being at least three weeks ould always through it and drink of it every morning and evening a pint’

Image from http://www.doctorwellgood.com/clinic-a-z/diarrhoea.html
Image from http://www.doctorwellgood.com/clinic-a-z/diarrhoea.html

8) Aproved thing for the Collick
Distill hens codds (testicles!) and and when they are pretty tender do then with a soft fier: not burn it: and when the collick troubles you take two spoonfuls of this — with a little sugar to make it pleasant to your taste.

7) How to make a water to kill the worems in hollow teeth;
buy three pence of Mercury and grinde it smale on a stone, then put it in a glass bottle or other glass: and stir it well then let the pacient get a quill of a goose and drop some of it therin and put it in to the holow tooth :3: times and use it two or :3: dayes and it will kill the worem and the tooth actch and never troble you ageine but in any wise let the pacient take heed (not) to swalowe any of it downe, but spitte it out

(so, just to be clear, dropping mercury straight into your teeth. Although there are mercury fillings today, probably not a good plan!)

6) Excelent for a consumption, Dropsey, Scurvey or Most Sickness whatever
Take cow dung fresh in May, dry it in ye oven to a fine powder, Give as much as will lye upon a sixpence in a draught of warme stronge beer 3 times a day, or you may distill cow dung in an ordinary still & take half a gill of ye water at a time, more or less three times a day

Image fromhttp://www.bioenergyconsult.com/anaerobic-digestion-of-cow-manure/
Image fromhttp://www.bioenergyconsult.com/anaerobic-digestion-of-cow-manure/

5) To make oyle of swallowes
Take as many swallowes as you can gette as 20 or 25, and put unto them lavender cotton, spiked, knotgrasse ribworte Balme valerian, rosemarie topps, strings of vines, cothan, plantain, walnut leaves sayd of virtue, mallows, alecroft etc etc

4) To Cuer the dead Palsey
Take a Fox, cleanse him, mince the flesh very smalle then dress a goose, pull out the Gutts; putt all the flesh of the fox into the goose and sowe her upp close; then roste them whilest any moisture will dropp out. Take the dripping and putt into it Rosemary; Lavender; Sage; Bettiny; The Weight of Ffower pints of each of them powdered, Anniseede; Ffennellseede, nutmeg, mace, Cloves, Pepper, ginger, Ffrankencence, the weight of sixpence of a peece of each of them Powdered, Boyle all twoe or three wallmes on a softe fire, put itt being strayned and Cooled into a pott. Annoynt the partye on the place grieved therewth and Rubb it in well before the fire.

Image from Wikipedia - creative commons
Image from Wikipedia – creative commons

3) For the falling sicknesse (epilepsy)
Take a live mole and cut the throat of it into a glass of white wine
And presently give it to the party to drink at the new and full of the moon
(viz) the day before the new, the day of the new, and the day after, and soe at the full. This will cure absolutely, if the party be not above forty yeares of age.

2) For the Frenzie or inflammation of the cauls of the brain,
Cause the juice of beets (beetroot juice) to be with a syringe squirted up into the patient’s nostrils, which will purge and cleanse his head exceedingly, and then give him posset ale to drinke in which violet leaf and lettice has been boiled and this will suddainly bring him to a verie temperate mildness’

And this week’s number 1…

1) For the bloody flux,
take a stag’s pizzle dried and grate it and give it in any drink, either in beer, ale or wine and it is most sovereign for any flux whatsoever.

Image fromhttp://www.nhm.ac.uk/natureplus/blogs/whats-new/2011/02
Image fromhttp://www.nhm.ac.uk/natureplus/blogs/whats-new/2011/02

Narrowly missing out were directions for constipation, which involved the aggrieved person squatting over a bucket of boiling milk ‘for as long as the party can bear it’…

And the cure for hydrocele (grossly swollen testicles) which involved injecting port wine into the affected parts!

Overcrowded and Underfunded: 18th-Century Hospitals and the NHS Crisis

The problem of overcrowded hospitals in Britain is now an annually recurring one. Every year, especially in winter, operations are cancelled, treatments postponed and patients sent home because there simply isn’t bed space for them. A combination of increased admissions of the elderly in the winter months, seasonal outbreaks such as flu and norovirus, and the impact of weather-related accidents all serve to pile on the pressure to an already-embattled healthcare system.

Embattled Doctor!

According to the BBC, NHS and social care services are ‘at breaking point’, with an open letter warning the government that ‘things cannot go on like this’.http://www.bbc.co.uk/news/uk-29501588. The story is now a perennial one. Every year (and in fact every couple of months) a mix of underfunding, overcrowding and staff stress puts the NHS in the headlines. Winter almost always exacerbates the problem. A year ago the outgoing NHS Chief Executive David Nicholson warned that the “toxic overcrowding” of accident and emergency departments in Britain not only impacted upon service levels but could have far more serious effects including higher levels of patient mortality and unsustainable levels of staff stress. The president of the ‘College of Emergency Medicine’ went even further, stating that the whole system was sailing dangerous close to complete failure. With the Daily Telegraph claiming that many patients were afraid to ask for help from staff pushed almost to their limits, the United Kingdom is perhaps still in the midst of what it last year called, “David Cameron’s care crisis”.

Ann-NHS-demonstrator-dres-007 Image from http://www.TheGuardian.com

It is indeed easy to think of this situation as a uniquely modern one, linked to the seemingly continual squeeze on budgets. Surely this wouldn’t have happened in the past, where well-run hospitals staffed by starchy matrons ran their (spotlessly clean) wards with military precision? In fact, if we peer back through time to hospitals even before the NHS, the situation can look remarkably familiar.

In 1772 Dr John Sharp, a philanthropist and trustee of the charity established by the late Lord Crewe, established a charitable infirmary in the impressive medieval castle at Bamburgh on the north east coast of England. Sharp’s brother William was a celebrated surgeon at St Bartholomew’s hospital in London and so the infirmary was able to benefit from the advice of a top medical man. As such it was equipped with the latest medical technologies, from mechanically operated hot and cold seawater baths to electrical machines and even an infirmary carriage to take invalid patients down to the beach for a restorative dip. In terms of many other institutions this was state of the art.

Dr Sharp

Many hospitals of the time relied on subscriptions – donations by wealthy benefactors – for their building and running. For patients to be admitted required a letter of recommendation from a subscriber. It was therefore very difficult just to turn up and ask for treatment. Bamburgh was different. Funded completely by the charity it had an open surgery – effectively an accident and emergency centre – on weekends, which meant that anyone, but especially the poor, could attend and be seen with relative ease. A quick note from a local clergyman confirming their status as a poor ‘object’ was sufficient. Unsurprisingly, though, this very accessibility meant that it was extremely popular.

In the first year of the charity, the numbers of patients through its doors was a modest 206. In 1775 this had more than doubled, and in 1781 it treated 1106. By the end of that decade, the infirmary was regularly treating more than 1500 patients every year, and was expending more than £250 every year on treatments and drugs. As well as outpatients, the infirmary contained around 20 beds. To give some perspective, these numbers were at times comparable with some of the ‘flagship’ hospitals in major Georgian towns such as Bath and Birmingham.

Bamburgh Castle

A staff consisting of a surgeon, two assistants and several ancillary staff, alone catered for the influx of patients. On any given attendance day between 60 and 100 patients could attend, and this put immense strain on both facilities and staff. In 1784 a freezing winter and ‘melancholy weather’ caused many poor people to perish, and admissions to rise dramatically. Outbreaks of infection also increased the pressure. The ‘malignant smallpox’ in neighbouring parishes was a constant threat to families, while the winter of 1782 also brought an outbreak of influenza at the neighbouring military barracks at Belford. This elicited a plea for infected soldiers to be treated at Bamburgh – a request declined by Dr Sharp for fear of infecting the rest of his patients.

The resident surgeon, Dr Cockayne, keenly felt these increasing pressures. Writing to Dr Sharp in the 1780s he noted both the continual increase in duties and the ‘vast number of patients admitted’ all of which added to his great worry and trouble. In the politest possible terms he asked for a rise in his wages, a request that led to him moving from ad hoc payments to a permanent wage.

The overcrowding at Bamburgh certainly chimes with the problems faced by the NHS on a daily basis. In simple terms there are simply too few staff to look after too many patients. The demands of an ever-changing medical environment increase the workload for staff, and these lead to further questions about pay and conditions. But it is interesting to consider that while Bamburgh infirmary faced the same socio-medical conditions as do hospitals today the question of funding was markedly different. Bamburgh was a well-funded institution. It had abundant money to spend on facilities and equipment and did so. And yet, the pressures of increasing numbers, and the unpredictability of admissions, still threatened to overwhelm it. Does this suggest that at least some problems are not simply reducible to finance?

Many suggestions have been put forward, from streamlining the allocation of beds to increasing the range of conditions treatable by pharmacists and GPs and even treating some conditions in the patient’s own homes. Whatever the answer it is clear that hospital overcrowding is not a new problem. Medical professionals in the past were all too familiar with the challenge of meeting increasing and uneven demand with limited resources.

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

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

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

L0048991 Arms of the London Barber Surgeons' Company. Engraving

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

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

Tallow candles

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

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

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

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

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

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

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

Barber-surgeon with Scared Patient

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

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

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

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