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 19^th 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”.

(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.

(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.

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 17^th century, it is worth mentioning that the ‘pigeon cure’ was still apparently in use in Europe in the 20^th 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 17^th 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.

(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.

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!

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)

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

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

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

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

Sir Hans Sloane

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

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

A selection of bladder stones and calculus

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

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

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

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

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

Norovirus and the reporting of epidemics through history

This winter has already witnessed an unprecedented increase in cases of Norovirus – the so-called ‘winter vomiting bug’. For some reason, across the globe, the infection has spread with increasing virulence and also lingered longer than normal in parts of the world now moving from spring to summer.  Norovirus is an especially durable and adaptable virus. It is perfectly suited to what it does; spreading from person to person either through airborne contact with minute particles of vomit, or through surface contact with the virus…on some surfaces it can last for up to two weeks. Given that I have a pathological phobia of vomiting, this one is the stuff of nightmares!

In Britain, the Health Protection Agency is the public face of public health and is charged with providing a virtual barometer of sickness. Their website contains a list of the current maladies doing the rounds and, in the case of flu and norovirus, weekly updates on the numbers of the stricken. The site also contains tips on how to prevent the spread of the virus and some advice (if little comfort) to those who have already succumbed.

To my mind, the information on the HPA website is extremely reminiscent of the information disseminated to the public in past times of epidemic disease – say the seventeenth-century plagues. It strikes me that authorities throughout history have had to balance the need to provide practical details of encroaching sickness with the need to avoid spreading panic. The language of sickness reporting in fact has a long history, and show remarkably similar patterns.

The reporting of the numbers of sufferers, for example, is something that was certainly an important element in the way the Great Plague of 1665 was reported. In seventeenth-century London, the so-called ‘Bills of Mortality’ gave a weekly update on deaths in the city, in the form of a published pamphlet. Information for these pamphlets was gleaned from the ‘searchers of the dead’ – people (often women) who were employed to examine fresh corpses to discern the cause of their demise. Their diagnoses were diverse. In one bill dating from 1629, the causes range from predictable conditions such as measles, cold and cough and gout to other, stranger, ones such as ‘teeth and worms’, ‘excessive drinking’ and ‘suddenly’!

As the plague increased though, the Bills of Mortality became rapidly dominated by these numbers, and Londoners pored over the pages every week to gauge the seriousness of the situation. News of the contagion was a regular topic of conversation and people were eager to learn if things were getting better or worse. The newly burgeoning cheap presses of the mid seventeenth century went into action, with everything from treatises on the causes of the plague to ‘strange newes’ about the latest outbreaks or figures and even popular cures.

The authorities were clearly worried about the danger of epidemic sickness, and took measures to try and limit its spread. One of these was to try and restrict popular gatherings such as fairs, to try and prevent the disease running rampant. This Royal proclamation from 1637, for example, entreated people not to attend the popular Sturbridge Fair that year, the king ‘Forseeing the danger that might arise to his subjects in generall”.

So, the authorities published the numbers of sufferers, took preventative measures against the spread of contagion and, in general, maintained a dialogue with the public, updating them on disease types, currency and potential ways to avoid them. The popular press also served to stir up fears, however, and perpetuated public dialogue about infection. Disease and health have always been topics of conversation but, in times of contagion, they tend to become more concentrated, and people become more engaged in dialogue about them.

Fast forward to 2013 and it is remarkable how similar the situation still is. The HPA website, for example, gives a weekly update on numbers of norovirus sufferers, not only in terms of clinically-reported cases, but of an assumption that for every reported case there are a further 288 or so unreported cases – people who simply decide to stay home and self-medicate. Indeed, at the present time, people are being actively discouraged from attending doctors’ surgeries, and hospital wards are being closed to the public. The impression is one of a wave of contagion breaking over the British Isles and, for me at least, one that is coming to get me!

There is indeed a fine line to tread between reporting facts and sparking panic. When SARS first emerged, there was a great deal of information (and misinformation), with various ‘experts’ calling it variously a massive threat to humanity, or simply the latest in the processional line of epidemics to afflict humankind.  A few years ago, a virtual global panic was instigated by the apparent mutation of avian flu, or bird flu. This outbreak made ‘pandemic’ the buzzword of the late 2000s and, again, much space was devoted (and indeed still is to some degree) on educating people on what it is, who has got it, and how to avoid it. In 2005, a UN health official warned that bird flu was capable of killing 150 million people worldwide. According to Dr David Nabarro, speaking to the BBC at the time “”It’s like a combination of global warming and HIV/Aids 10 times faster than it’s running at the moment,”. The World Health Organization, perhaps seeing the potential panic that this could cause, immediately distanced itself from the comment. The fact that the outbreak was ultimately relatively mild emphasises the problem that epidemic disease causes for health officials. How to alert people without scaring them?

None of this is helped by the press who, like their seventeenth-century counterparts, are keen to give the largest mortality figures, or emphasize the spread of diseases. In June 2012, for example, Reuters were still warning that a global bird flu pandemic could happen at any moment.  http://www.reuters.com/article/2012/06/21/us-birdflu-pandemic-potential-idUSBRE85K1ES20120621

The same pattern is now happening with the norovirus – although clearly this does not carry the same levels of danger. Here we are talking about contagion, rather than mortality.  Let’s take the headline on the Western Mail newspaper of 20^th December though: “Norovirus: Now more wards are closing as hospitals in Wales hit”. The breathy style of this banner line emphasises its rapidity, not just a straight report, “NOW” it’s coming. What purpose do these reports ultimately serve? Put another way, why do we need to be told? Logically, if preventative measures are possible then it makes sense to tell as many people as possible. But often this is not the purpose of newspaper copy in times of sickness which, to me, almost seems at times to be deliberately provocative.

The answer seems to be a deeply-set human interest in sickness, ultimately linked to our own mortality. Even in this apparently scientific and modern age of medicine, there are still many things which are incurable, and many diseases which have the ability to wipe us out at a stroke. It is this uncomfortable reality which perhaps continues to fascinate and frighten us. We live in an age of control, but some things are still beyond our control, and it is perhaps this innate fear of disease – of our own transience – which makes these headlines ultimately so compelling.

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.

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

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

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

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

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

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

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

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

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

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

Constructing the Sufferer (part 1)

I’ve always been interested in the ways that people construct narratives of sickness, and the sickness persona. I was watching a comedian recently who brought up the subject of the ‘phoning in sick’ voice; the slightly husky, weak and tired tone people adopt when they have to convince the boss that they really are ill, and not having a ‘duvet day’. One day there’s going to have to be a study of the language and art of phoning in sick – stuff like having been ‘up all night’ being ill, ‘really don’t think I can make it in today’, ‘see how I feel tomorrow’ are all stalwarts. But sufferers have always constructed and deployed sickness in some measure. When I was researching for my book I looked at petitions by the sick poor in the seventeenth century, written to try and convince the parish authorities to give them money.

Consider this example written to a wealthy lady in Cardiganshire in the eighteenth century – the spelling is original. (National Library of Wales, MS 182D)

“Madam Lloyd, by submission to your Honour, my little grand Child whome I nurs’d since he was a year old, happen to fell sick, this day fortneight (sic), and had been very low, I hope that he begin to recover. He is longing for rosted meat that ever he had in my cottage, and I sure that he cannot distinguies between any sort of rosted meat. If your honour please to send a bit, or order me to wait for it, I will be very glad and in so doing you will add to the obligation of your honest old shoemaker, and your most humble servant, John Jenkin, alias, little shoemaker”

Here, we have the heart-wrenching tale of a sick [and presumably orphaned] child, desperately ill and longing for something substantial to eat. The writer of the letter appeals to the charitable nature of ‘Madam Lloyd’, but it is interesting to note the language used, of the humble, honest old shoemaker, trying to use whatever personal connections he has to secure something for his grandchild.

Others appealed to the charitable nature of people in their surrounding areas to provide support or relief (National Library of Wales, MS 434B):

“To all faithfull people to whome it doth appeare or may concerne, 3^rd October 1656

Whereas John Owen, being a poore ould man borne and breed in the parish of Llanfydd being grievously troubled with a disease…that he is not able to travel and seeke or get his bodily foode & sustenance by reason it is broken out in several places of his body, the quantity of seven or eight places…so beseeching all good and charitable people out of charitie to commiserate his distressed state to bestow their benevolence towards payment to the churgeon…”

Another, Mary Jones of Llandenny, petitioned the parish to offer her support as her husband had fallen sick for ‘five quarters of a year’ and was ‘sick now’. Unable to raise the money herself to feed her family, and facing eviction from her cottage on the waste by the Duchess of Beaufort “to punish the poor man in spite and malice’, Mary was forced into desperate measures.

It is interesting to note, though, that although occasionally such letters were written by the parties involved themselves, they were more often written by an amanuensis – someone who knew the people involved but had more skill in writing. These notes are usually deliberately constructed to emphasise the individual’s suffering. They often highlight the symptoms and use emotive language to highlight the particular suffering.

The reasons for this are clear; the petitioner wanted and needed money, and thus needed to convince the authorities that their need was special. They make interesting reading not just for the language of sickness, but for the ways that it could be deliberately deployed.

I think there could be another post to follow on the ‘heroic sufferer’, but enough for today!

There’s a bug ‘going round’.

Again last week I had to nurse a poorly toddler as he was sent home from nursery with yet another variety of stomach upset. There is, I’m told, something going around. I need to confess here to being a terrible hypochondriac. When I worked in an office I hated it when people used to come in, green-faced, and that say that they’d been ‘up all night’ being sick. In my mind, it is only a matter of time before this thing finds its way to me! If I read on the internet (as has recently occurred) that the norovirus has closed hospital wards anywhere near where I live, the sense of a creeping tide of contagion gets worse. In fact, there always seems to be something ‘going around’.

Talking to a colleague last week, we were speculating about whether the same conception was true in the early modern period – whether people believed that the same nasty bit of pathogenics was doing the rounds. It would be interesting to know whether early modern people had any sense of one particular ‘bug’.

In some ways this seems unlikely. Humoural beliefs held that illness was a personal thing; it was one’s own humoural balance that generally dictated sensitivity and vulnerability to sickness. If, for example, someone was naturally sanguine (i.e. had a predominance of blood in their humoural makeup) that made them naturally more susceptible to apoplexy, plethora and venery!

But there certainly was some conception of a sickness that moved around populations; what, after all, were epidemics of plague and smallpox if not mobile and progressive conditions? But it also seems clear that people were aware of flare-ups of particular diseases or conditions in their vicinity. The letters of Owen Davies, an Anglesey parson in the early eighteenth century, certainly reveal evidence of this, noting episodes of epidemic fevers in his area. The diarist Phillip Henry of Broad Oak in Flintshire referred to an outbreak of fever in seventeenth-century Glamorganshire, which was particularly affecting children. In fact, when we look closely, there was a constant dialogue about illness, and people were ever vigilant for what sorts of things might affect them.

If we think about domestic recipe/remedy collections (books of favoured remedies sometimes accumulated in literate households), it is possible to see them as part of a domestic arsenal against sickness. They were in some ways a pragmatic response to disease; it made sense to have some sort of weaponry in your arsenal to attack whatever symptoms you might have. In other ways though, they were also an insurance policy. They provided at least some means of recourse in an environment where sickness was almost always lurking. And it wasn’t just remedies that were written down; people simply knew remedies, and were able to memorise and internalise information in a way that in today’s internet-dominated world we would find impressive.

The terminology of sickness has certainly shifted. When people in the past referred to the local presence of conditions, it is more likely that they were referring to something deadly, rather than a minor stomach upset. Nevertheless, something of the fear of contagion must be innate. While we might not all regard ‘bugs’ to the same degree of pathological hatred as I do, we feel uncomfortable when sickness gets too close.

Now where’s my antibacterial spray? This keyboard looks filthy…