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

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

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

17thc Wales

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

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

Cunning folk

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

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

Welsh registers

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

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

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

Pontrobert today

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

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

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

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

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

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

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

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

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

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

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

File:Hans Sloane.jpg

Sir Hans Sloane

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

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

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

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

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

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

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

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

Unpacking the ‘eccentric’ in popular memory: Local characters of old Cardiff.

Disclaimer!: This is not a fully-formed argument, just some thoughts about the ‘eccentric’ in reminiscences of childhood and popular memory. I’d be interested in hearing what others think.

I’ve been reading the ‘Cardiff Borough Records’ – a magisterial five-volume set of miscellany relating to Cardiff from Norman times through until the early twentieth century. It is fascinating. There is everything from court cases to inquests, slander suits to land rents and tithes. For a good Cardiff boy like myself, I find the references to land parcels very interesting in, say, the fourteenth century, which still have echoes in areas and street names to this day. There are, for example, several references to the ‘Weddle’ or “Weddal fields”. Wedal Road is now a busy conduit not far from the University of Wales hospital. But I digress…

One section that stands out for me is the ‘Reminiscences of Old Cardiff’, which contains a brief but fantastic list of ‘eccentric old characters of Cardiff’. These include ‘Pegg the Wash’, an apparently feisty and pugnacious old washerwoman, whose habit was to chase children away from her house with a stick, perhaps peppering her imprecations with a good Welsh oath or two.

“Dammy Sammy” was an apparently well-known schoolmaster, whose sobriquet relates to his colourful choice of language in front of his young charges. A dwarf sweet-seller, known as ‘cough candy’ took advantage of his appearance and, in fact, seems to have augmented it by using his top hat as an advertising hoarding, pasting shop adverts and flyers onto it. The list goes on, but also noteworthy is ‘Hairy Mick’, the lamplighter!

What, though, stands out about these reminiscences? For me, it is the fact that all of these figures involve, or have relevance, for children. They were clearly denizens of a childish world – larger-than-life characters who left an indelible mark on the memory.

Memory, and reminiscence, is an odd thing, especially in terms of using and interpreting these characters in context of, say, social conditions.  How can we separate the ‘truth’ (if such a thing exists) from misty-eyed, if not evocative, depictions of ‘characters’. It is an interesting question. History is full of ‘characters’. If we think of history taught in schools, it is most often done in terms of a cast of individuals (Henry VIII, Hitler et al) and set-piece historical events.

And yet there is a remarkable constant throughout history and human nature, in our ability to identify and remember people who, for one reason or another, were somehow different. I can illustrate this from my own memory. When I was little, there was an unfortunate character who frequented a main street nearby, and who would suddenly leap out and shout at the traffic, sometimes even accompanied by violent gestures and karate actions. A certain mythology built up around him; it was popularly supposed that his wife and children were killed in an accident, thus affecting his mind and causing his behaviour. Whilst it’s certainly possible, it is interesting that no hard evidence really exists; people simply ‘know’.

In his excellent study of the history of folklore in London, Steve Roud makes this important point relating to the endurance of certain types of popular myths – things that are still ongoing today. Aside from more obvious ones such as empty properties gaining a reputation for being haunted, or patches of waste land being attributed to plague pits, he also notes the spread of often baseless rumours, which are then taken as truth. One such is the belief that a certain portion of land or building can never be developed as it was, at some stage, ‘given to the people’. There is one of these on my doorstep; the Caerphilly Miner’s Hospital has long been said by locals to be the property of the people of Caerphilly. Unfortunately, this hasn’t stopped it from recent closure…and redevelopment! A mythology of the individual, perhaps especially when that individual is located within the context of childhood memory,  fits well into this type of folklore.

How could we interpret characters like ‘Dammy Sammy’? As a medical historian, I am loath to engage in ‘retro-diagnosis’ since it’s obviously possible that he just had a foul mouth! But it’s also plausible that a pathological condition, say Tourette’s syndrome, certainly unknown and undiagnosed at the time, might explain spontaneous expletives. If so, a historian of nineteenth-century attitudes towards such conditions might find a useful case study. In a sense, it is not the character himself, but the reason why (s)he stood out that renders them interesting.

Let’s speculate further. Was ‘Peg the Washerwoman’ simply a bad-tempered old woman? Highly likely. But dementia, or perhaps an underlying psychological or sociopathic condition might explain a fear of strangers and a desire to drive them away. Historians of witchcraft have long highlighted the fact that ‘difference’ was often a crucial deciding factor in suspicions of witchcraft. Old women, especially those at the margins of society, were vulnerable.

The point is that we sometimes need to look beyond the simple description or reminiscence and try and unpack the social context of the ‘other’ in society. That the names of these characters – and their apparent ‘eccentricities’ – have survived or achieved notoriety, whilst many others have not, tells us something of how difference was perceived in past societies.

Writing Welsh History (3)

A couple of weeks ago I took part in the ‘Writing Welsh history’ event at Swansea University. One of the main topics of the evening was how we approach Welsh history; is it somehow different to other countries or regions? Are there any specific problems facing historians that are uniquely Welsh? That last question is one that vexes me. The recent television series was titled The Story of Wales. As a participant in the television debate following the series noted, it is not The story, but A story. I believe that we are lacking a grand narrative of Welsh history. It is natural to think in terms of chronologies, but it is difficult to think of the sweep of Welsh history without using the broader British history as a reference point. In other words, could we even tell a story of Welsh history?

This problem is particularly relevant for me as I contemplate my next academic project. I’m thinking about tackling a narrative of Welsh medicine from earliest times to the present day. This hasn’t been attempted before, and there is certainly a need for such a study. The problem, though, lies in structure. From available source material, for example, is there enough evidence to fill chapters before, say, the tenth century? The obvious solution is to adopt a thematic approach, rather than a narrative chronology. But in other ways it highlights the fact that Welsh history cannot always be neatly compartmentalised.

There have been many ‘history of Wales’ volumes (I’m thinking of works by John Davies, Geraint Jenkins and Prys Morgan) and these ably take on the difficult task of constructing a narrative. Geraint Jenkins’s Concise History of Wales is excellently written on what he describes as a ‘formidable task’ of writing the entire history of a country. In terms of periodization, the first chapter, ‘the earliest inhabitants’, covers everything from Celtic and Roman Wales up until around 380AD. Chapter two covers around seven hundred years, up to 1063. But after 1063 the pattern changes to around two hundred years per chapter. This isn’t a criticism; it just underlines the reality for any chronological history of Wales that, before the 11th century, it is difficult to go into forensic detail.

But I also think that we do need more of these types of ‘stories’ to get a more fixed idea of what our history actually consists of. In my first book, I purposefully avoided a narrative, firstly because the evidence wasn’t suited to this type of approach, and secondly because I wanted to address a number of different themes in broader medical history. But this time I’m tempted to bite the bullet and try and answer my own question of whether we should think in terms of ‘Welsh medical history’ or ‘medicine in Wales’.