Author: Lisa Smith
Eighteenth-Century Pain and the Modern Problem of Measuring Pain
The offending machine. A Saskatchewan example. Image credit: Daryl Mitchell, Wikimedia Commons.
I read the news about the recent study using fMRI to measure physical and emotional pain intensity right after a visit to the physiotherapist for help with my migraines. (I’ve been a migraineur since the age of eleven when a Tilt-a-Whirl ride gave me a case of whiplash.) Although there is not always a close relationship between life events and scholarly work, my migraines have shaped my interest in patients’ illness narratives. It is as both scholar and sufferer that I am troubled by the fMRI study’s implications.
Running through much of the pain scholarship is the assumption that it cannot be adequately represented by language or truly understood by others.[1] Chronic pain’s invisibility makes it difficult even for people close to a sufferer to sympathise. There has been a recent shift to trying to understand pain holistically, with the development of pain clinics where sufferers can receive treatment from a variety of health practitioners and the focus is on mind-body integration. But scientific studies of pain still often come down to one question: can you tell how much pain a patient is experiencing, either in relation to his own pain, or that of others? To this end, many have tried to find ways of measuring pain.[2]
The news is all abuzz, with headlines such as “Study shows pain is all in your head, and you can see it”. Like many previous studies, the latest attempts to provide, as Maggie Fox at NBC News puts it, an “objective way to measure pain”. Researchers applied heat-based pain to volunteers, then measured the changes within the brain using fMRI. They were able to identify a person’s relative pain, such as when one burn feels worse than another, as well as the influence of painkillers. The results of this study have the potential to be very useful when treating patients who are unable to talk or unconscious.
But there is an unsettling aspect to the study—or at least to the way in which it is being reported—in that it tries to distinguish between a real, objective pain and the experienced pain. According to the lead researcher Tor Dessart Wager quoted in the above article, the tests reveal that people really do feel pain differently: “Let’s say I give you a 48-degrees stimulus and you go ‘This is okay; I can handle it’ and I might say ‘Oh, this really hurts’… My brain is going to respond more strongly than yours. We are using this to track what people say they feel.” In other words, some people are wimps and some are stoic—and patients cannot be trusted to report the truth.
An unhelpful distinction at best: it misses out the psycho-social experience of pain of why one person might feel the pain more keenly. Age, ethnicity, status and sex all play an important role not just in a sufferer’s experience of pain, but in how others perceive what the experience should be and the trustworthiness of a sufferer’s account of pain.
It is also a potentially dangerous distinction, reinforcing as it does the idea that pain needs to be measured objectively and that technology provides the answers. The problem, as Daniel Goldberg tweeted yesterday, is that:
A report in Scientific American explains the study’s implications for chronic sufferers. The fMRI was also used to measure coping tactics for the heat-induced pain, such as mindfulness, meditation, imagination or religious belief, revealing that such methods reduce pain. Pssssst… about that: we’ve known this for a while. These sorts of methods were used long before we had effective painkillers and are frequently used by modern chronic illness sufferers.
Will measuring pain ‘objectively’ really benefit the sufferer? The use of technology for chronic pain provides a mere (if very expensive) bandaid and, to make matters worse, undermines one of the most important elements in a successful doctor-patient relationship: trust. Sometimes looking at a historical case can pinpoint the modern problems.
Lady Sondes just before her marriage. Miniature of Lady Katherine Tufton by Peter Cross, 1707. Image Credit: Victoria and Albert Museum, London.
Catherine Watson, Lady Sondes, wrote to Sloane several times between 1722 and 1734 about an unspecified illness.[3] Although she was in her late 30s, she had a litany of complaints that made her feel as “old and decayed” as someone aged fifty or sixty. Her pains ranged from headaches, gnawing leg pains, and “fullness” in her head to a stiff lip, constant fear, memory loss and “rising nerves”. She described the ways her daily life was affected. Besides being constantly distracted by pain, she worried about her legs giving out from under her or losing her memory so she would be unable to do the household accounts. These were problems for a woman who prided herself on running a large household successfully. Her descriptions were circular and repetitive, even boring, but reflected her ongoing experience: the physical pains, often not severe, nagged constantly at her throughout the day, and the fear and anxiety of what the pain might mean was all-encompassing.
Her symptoms did eventually pass, allowing her to once again go “about Busiynesse”, but the treatment had been difficult. Lady Sondes began to consult Sloane by letter when she disagreed with her regular physician’s diagnosis of hysteria. While Dr. Colby considered her ailment to be hysteria, Lady Sondes did not feel that she could trust her full story to him. Hysteria was associated with overly delicate women and a mixture of imagined problems alongside real ones, suggesting that such a diganosis may have predisposed Colby to disregard her accounts of pain. She wrote instead to Sloane who treated her “with great kindness and care”. It was not until Colby rediagnosed her as having a blood condition that she began to trust him again. A large part of Lady Sondes’ healing came from the ability to express her narrative. Sloane was not physically present; the greatest therapy he could have provided was reading her letters and answering her specific, stated concerns.
Chronic pain, with its messy emotional bits and day-to-day dullness, is encompassed within an entire life, not just a few moments spent inside a machine while clutching something uncomfortable. A crucial component of effective therapy is the trust between doctor and patient, allowing the patient to create a narrative, to be heard and to be understood. If a physician is primed to distrust a patient’s account, whether through a diagnosis or reliance on technology, the healing process will be thwarted. Sure we can measure pain, but when it comes to chronic pain, it’s not really the question we should be asking.
[1] This comes from Elaine Scarry’s influential book, The Body in Pain: The Making and Unmaking of the World (Oxford: Oxford University Press, 1985).
[2] For example, the famous McGill Pain Questionnaire. See R. Melzack, “The McGill Pain Questionnaire: Major Properties and Scoring Methods”, Pain 1, 3 (1975): 277-299.
[3] I discuss this case and others from Sloane’s letters in my article, “ ‘An Account of an Unaccountable Distemper’: The Experience of Pain in Early Eighteenth-Century England and France”, Eighteenth-Century Studies 41, 4 (2008): 459-480.
Hans Sloane and the Pit
Headlines today: “‘Black Death pit’ unearthed by Crossrail project“. It’s all very exciting when London starts to dig deep under its surface, with various plague pits, Bronze Age transport networks and more being unearthed. I can’t help thinking, sometimes, that it’s only a matter of time before we have a Quatermass and the Pit situation!
In the eighteenth century, building on a plague pit was a matter of national concern. On 16 March 1723, The British Journal (iss. XXVI) reported that Richard Mead and Sloane had been consulted on the matter of Lord Craven wanting to build over the Pest-House Fields. As I’ve discussed before, Sloane–who was no less than a court physician and President of the Royal College of Physicians–and Mead had advised the government about preventing an outbreak in London during the Marseilles plague of 1720-22.
Human bones and skulls in a brick-built pit. Credit: Wellcome Library, London.
During the plague of 1665, William, 1st Earl of Craven, stayed in London as a member of a commission to prevent the plague’s spread. The commission recommended isolating the sick by setting up pest houses and burying the dead in plague pits. A few years after the outbreak (1671), Lord Craven purchased land near Lancaster Gate, with a Pest House Field for the use of nearby parishes: St. Paul, St. Clement Danes, St. Martin-in-the-Fields and St. James.By 1700, however, London was growing rapidly and, without a recent outbreak of the plague, the unused land was increasingly seen as a problem. In any case, with so many people around, it could no longer serve as a place of isolation if an epidemic did break out.[1]
The answer to Lord Craven’s question in 1723 was “no”. The physicians had apparently
determin’d, that the Digging them [the land] up might be of dangerous Consequence, there having been many hundred distemper’d Bodies buried there in the Plague Time.
With the memory of the Marseilles plague still fresh in people’s minds, this was probably not the best time for Lord Craven to ask! The fact that the plague experts Sloane and Mead were called in for a consultation suggests that the disposal of Lord Craven’s land was a matter of national importance. If meddling with the land could cause a plague outbreak, threatening the health of people and the economy, it should not be done.
Eleven years later, the family had greater success in determining the use of their land. Although the government did not consult Sloane and Mead this time, their decisions still erred on the side of caution. The government specified that only a hospital could be built on the site.
By the 1820s, the family had divided and leased the land, but a curious clause was written into the leases: the leasees were required to turn over the land for use during a plague outbreak. The definition of ‘plague’ was a bit ambiguous: did this refer only to plague or to any infectious disease? This became a pressing matter during the 1833 cholera epidemic, but fortunately for the tenants, the lease remained limited to plague. With plague deemed unlikely ever to happen again, a wealthy neighbourhood soon spread across the area.
Then and now, London is frequently faced with the problem of its multitude of inconvenient corpses. The ghost of the plague that haunted eighteenth-century London’s plague pits still peeks its head out every so often, but we can greet it with curiosity instead of fear.[2]
[1.] A short history of the Craven Estate can be read here: http://www.corringham.eu/cravenestate.html.
[2.] UPDATED 16 MARCH 2013: Some of us, anyhow. A slightly strange article in The Telegraph has taken the angle of trying to scare readers about the possible dangers posed by old plague pits. Darin Hayton has also picked up on some media hyperbole and commenter anxiety about the discovery, which he discusses in his post “A Dozen Medieval Plague Victims?”
Choosing the Countryside: Women, Health and Power in the Eighteenth Century
To honour International Women’s Day today, I have decided to return to my roots as a women’s historian. I first became a historian for feminist reasons: to recover women’s past and to understand the relationships among culture, body, gender, and status.
The control women had over their bodies has often been a staple topic of feminism and women’s medical history. We love to dig out (largely nineteenth and twentieth century) stories about the horrors inflicted upon women’s bodies: clitorodectomies, forced sterilisation, and more. They make for chilling telling. Or perhaps we look back to Antiquity: women as monsters or inferior, inverted men. We find the tales about menstrual blood being poisonous. It’s easy, surrounded by such stories, to assume that the goal of medicine has been about controlling women.
But the reality is far more complicated.
In the early eighteenth century, the misogynistic medical theories of inferiority, for example, were seldom practiced. All bodies were treated as humoral bodies, with specific temperaments that were individual to a patient. Medicine was highly interventionist (and often ineffective) for both sexes. And, more to the point, medical practitioners were dependent on their patients for success. This was not just in terms of payment or patronage.[1] . In an age before anaesthesia, or even stethoscopes, doctors and surgeons were unable to look inside the living body: patients’ stories were invaluable tools in diagnosis. Women could have much control over their own health.
Promising? Not exactly. These women’s choices were still limited in a multitude of ways. The ability to make decisions about one’s own body, whether historically or today, is an important marker of women’s equality. An old argument, perhaps, but one that is as true now as ever. When talking about control in the modern world, it often comes down to topics such as abortion or female genital mutilation. The dullness of day-to-day inequality is easy to overlook when there are more pressing issues.
Back in the eighteenth century, the fundamental inequalities within society can often be seen within the household. Women might, for example, have been well-treated by physicians–but, as letters to physician Hans Sloane show, their ability to make medical decisions was limited by something even more fundamental: access to money.
John Constable, Wivenhoe Park, Essex (1816). From: National Gallery of Art, Washington, D.C., USA (Wikimedia Commons).
A husband could decide when and how a woman saw a doctor. In 1715, physician William Lilly commented that his patient Lady Suffolk was well enough to travel to London from her countryside residence in order to see Sloane, but only “if my Lord thinks fitt to bring her”.[2] Even when a woman was pleased with her medical care, her husband might choose another course of treatment, as one unnamed doctor complained. He had been treating Lady Salisbury in 1727, who agreed with his recommendation that she should go to the countryside while she recuperated. Lord Salisbury, however, had other ideas. He dismissed the unnamed physician, instead turning over his wife’s care to Dr. Hale. No reasons were given for the change.[3]
Whether or not a woman received care was also up to her husband. Although the head of a household was obliged to provide medical care for everyone within it, the extent of the care needed was open to dispute.[4] Mrs A. Smith, for example, found that her treatments in Bath were useful, but her husband refused to continue paying. Someone, she believed, “has told Mr Smith that I am very well and I only pretend illness to stay in Towne”. Her dependence on Mr Smith’s decisions was clear. She noted that she was unhappy, since “all my Ease depends a pone Mr Smith’s opinion of me”. Worried that she would become more ill if her husband sent her to the countryside, she begged Sloane to intervene by “tell[ing] him how you thinke me”.[5]
Family members might try to help if they believed a woman’s health was being affected by her husband’s choices, but this was complicated and not always successful. The law, after all, ultimately upheld the power of a husband over his wife. Jane Roupell wrote to Sloane about her daughter, Lady Anne Ilay, on the grounds that her son-in-law had weakened her daughter’s health through his lack of care. Mrs. Roupell asked if Sloane might visit before seeing her daughter, so she could “tell you somthings that she is ashamed to tell her selfe”. It would be best, she thought, if her daughter could recover away from her husband–perhaps, she suggested, Sloane might recommend that Lady Ilay be sent to the countryside.[6]
The countryside in these four letters becomes alternatively a place of health, a place of isolation or a place of refuge. Although we’ve moved on a lot since the eighteenth century, there are two basic women’s health issues that underpinned these seemingly simple disputes about going to the countryside: access to health care and finances.
Most often, the Sloane correspondence provides examples of women’s families wanting the best for their wives and daughters, but women were always in precarious positions. Each woman came from a wealthy background and had doctors (such as Sloane) who were potential allies, but as the cases show, women could not simply choose what treatment they wanted without consulting their families. One thing was clear: it was ultimately up to their husbands what a woman’s medical treatment should be.
[1] See for example, Wendy Churchill, Female Patients in Early Modern Britain (Ashgate, 2012).
[2] British Library Sloane MS 4076, f. 14, 28 July 1715.
[3] British Library Sloane MS 4078, f. 304, 26 March 1727/8.
[4] Catherine Crawford, “Patients’ Rights and the Law of Contract in Eighteenth-century England”, Social History of Medicine 13 (2000): 381-410.
[5] British Library Sloane MS 4077, f. 37, n.d.
[6] British Library Sloane MS 4060, f. 203, f. 204, n.d.
A longer version of this argument appears in: L.W. Smith, “Reassessing the Role of the Family: Women’s Medical Care in Eighteenth-Century England”, Social History of Medicine 16, 3 (2003): 327-342.
Suffering Venereal Disease in the Early Eighteenth Century
Lindsey Fitzharris (@ChirurgeonsAppr) recently discussed deformities caused by syphilis and the problems of prevention using early condoms (“Syphilis: A Love Story”). She also regularly tweets horrifying pictures of syphilis sufferers in the past, or the raddled syphilitic bones that remain. Evocative stuff.
One of the less revolting images. Head illustrating syptoms of syphilis, 1632. Credit: Wellcome Library, London.
But the day-to-day life of someone suffering from venereal disease wasn’t always so dramatic. Some Sloane letters hint at the physical and emotional experiences of those suffering from long-term venereal complaints.
In the early eighteenth century, many venereal symptoms were not immediately obvious to people. The skin rashes, pustules and chancres of late stage gonorrhoea might easily be confused with syphilis, which in turn could be mistaken for scurvy. Treatments for syphilis and scurvy might even be the same: the underlying problem seen as being hot and corrosive or a matter of poisoned blood. As William Salmon explained in a popular remedy book (1703), his family pills would cure, along with other diseases, “the Scurvy (the only reigning disease in this Kingdom) when it is grown so bad, as to become scandalous, so as many People think it to be the POX”.[1] To further confuse matters, any whitish discharge from the genitals—known as ‘whites’ in women, ‘gleets’ in men or ‘running of the reins’ in all— was potentially classed as a gonorrhoea. Gonorrhoea, they believed, might be caused by masturbation or accidents to the lower back, not just sexual intercourse.
The problem of diagnosis can be seen in the letters of Thomas Hewitt, Roger Cook and J. Hopson. In 1721, Hewitt treated an unnamed gentleman aged 60, described as being scorbutic (e.g. ulcerated skin, lethargy and pallor). The patient’s main troubles, though, were a continual need to defecate and rectal pain. He had several rectal growths, which were voiding a frothy substance. Hewitt was obviously of two minds about the cause of the ailments. Although he had administered mercurial purges (treatment for syphilis), he also insisted that the patient was “an honest trustworthy gentleman”. Sloane, incidentally, also prescribed a typical syphilis treatment: salivation. Cook, in his undated letter, reported suffering from weakness caused by a constant gleet and nocturnal pollutions. Although he didn’t specify gonorrhoea, this would have been a suspicion. Hopson, for example, immediately suspected gonorrhoea when he had “running of the reins” for a couple days.
The physical experience of venereal problems and their treatments was inevitably painful, though they varied widely. Henry Downing reported that he’d had a three-month salivation to treat venereal disease when he was in his twenties. By 1726, he was ricketty, frail, and sedentary. His physical symptoms included pain throughout his body; heart palpitations; heat and pain in his anus, scrotum and urethra; difficulty urinating; and scaly rough skin. A pretty miserable existence.
Hewitt’s patient took opiates to deal with his pain, or indeed perhaps some of his other treatments. In order to drain the pus, Hewitt had dilated his patient’s anal supporation with a sponge. Mercurial treatments also generally required extensive bed rest, owing the various leakages, skin eruptions, and tooth loosening. Not so different from the symptoms of syphilis it was meant to be treating!
The case of Mr Campbell, aged 63, also suggests the long-term health problems that people thought might occur. Thomas Molyneaux and other medical practitioners wrote to Sloane on Campbell’s behalf in 1724. While not obviously venereal symptoms, Molyneaux saw Campbell’s experience of clap in 1685 as significant. Campbell had trouble urinating afterwards. By 1724, Campbell had a blockage in the bladder, pain while sitting, and a hot and burning sensation in the urethra. He was also voiding slime instead of urine.
Worse yet, failure to disclose one’s venereal condition could be fatal. In August 1725, J. Hetherington wrote to Sloane about the death of a young man after being inoculated for smallpox. The underlying concern was that the inoculation, a novel treatment championed by Sloane, might have caused the death. Hethrington was adamant that the patient, who had not been in the “correct habit”, was the one to blame. The young man had failed to tell the inoculation surgeon about his venereal disease and recent treatment. (A physician applied a plaster to his swollen scrotum.) The treatment had successfully reduced the inflammation, but a fever started the next day. This, Hetherington was certain, caused the complications with the inoculation.
Given that these men were blamed for their poor bodily condition, stemming from lack of self-control, no wonder shame and fear were constant companions for the venereal sufferer. There are relatively few letters to Sloane discussing sexual problems of any kind, and some—such as that by E.W.—were anonymous.[2] Embarrassment might also suggest why Hetherington’s patient did not tell the surgeon. Once his problem was apparently gone, there was no need to tell anyone else, including the surgeon, about it. A sufferers’ physical condition also needs to be considered alongside his emotional one. Patients listed fear (Downing and Hopson), weariness (Downing), and melancholy (Hewitt’s patient) among their symptoms. Pain in early modern England was seen as simultaneously physical and emotional.
As their bodies leaked in unseemly ways and their skin turned ulcerated or rough, the sufferers who wrote to Sloane must have been terrified at what fate might yet await them: the fallen noses, blindness or ulcerated skin of syphilis or the swollen testicles and impotence of gonorrhoea. And above all, they had only themselves to blame.
[1] William Salmon, Collectanea Medica, the Country Physician (London, 1703), p. 452.
[2] Women in particular are absent. This may partly be because of the many ways in which the ‘whites’ might be interepreted medically, if symptoms were present at all. Hopson had asked “the woman”, but she claimed to have no symptoms. As we know today, many women never have any symptoms. Women and their physicians might, deliberately or not, be able to avoid a more shameful venereal diagnosis that called the woman’s behaviour, or that of their husbands, into question.
On shame, see for example K. Siena, Venereal Disease, Hospitals and the Urban Poor: London’s Foul Wards, 1600-1800 (Rochester: University of Rochester Press, 2004).
On the moral implications of leaky bodies, see L.W. Smith, “The Body Embarrassed? Rethinking the Leaky Male Body in Eighteenth-Century England and France“, Gender and History 23, 1 (2011): 26-46.
Two great blog posts on v.d. (by Jennifer Evans) appeared just after I’d published this one! One is on “The Secret Disease” and the other is on “Beauty and the Pox“.
Domesticity and Astronomy in Eighteenth-Century England
This past week has been an exciting time for portents! What with a meteor blasting into Russia, an asteriod passing close to earth, St. Peter’s Basilica being struck by lightning, and the Pope resigning, early modern people would have been getting a bit nervous…[1] As it is, some people believe that the lightning strike was a sign that God approves the Pope’s decision. Perhaps we live in a more optimistic era.
There are several letters in the Sloane Correspondence database about early modern astronomy, although only two that mention comets.[2] By the eighteenth century, there was a growing shift away from seeing dramatic astronomical events as portents. Clergyman William Derham (1657-1735), for example, wrote to Sloane regularly about natural philosophy and his letters (dated 28 March 1706) reveal a careful attention to matters of fact rather than a concern with religious signs.[3]
“Part of a Letter from the Reverend Mr W Derham, F.R.S. Concerning a Glade of Light Observed in the Heavens”. Philosophical Transactions, vol. 25, no. 305 (1706), p. 2221.
In one of Derham’s letters, which also appeared in the Philosophical Transactions (vol. 25, 1706), he described his star-gazing just before Easter. While observing the satellites of Saturn, he spotted a “glade of light” in the constellation of Taurus. The light had a tail like a comet, but a pointy upper end instead of a rounded one. This, Derham was certain, was similar to what Joshua Childrey and Giovanni Domenico Cassini had observed. When the following nights were cloudy, Derham was unable to spot the glade again–and, although Easter Day was fair, he “forgot it unluckily then”. By the time he was next able to look at the skies, the glade of light was gone.
This was the only bit of Derham’s rather long letter that was published in the Phil. Trans. this time. In the letter, Derham also dicussed sunspots and requested advice about his wife’s eye problems. This was typical of many of Sloane’s correspondents, whose letters blurred the boundaries between scholarly, social and medical matters.
Anna Derham, aged about 31, was suffering from eye problems. Sloane had recommended that she take a variety of medicines, including a purge (and rather revoltingly, woodlice), in addition to eye drops. The eye drops, Derham reported, did not agree with his wife and had caused an inflammation. The purge, moreover, had left Mrs. Derham with violent pains spreading from above her eye to throughout her head and face. Derham believed that the eye medicine had resulted in his wife’s cornea wasting away. The outcome of the eye problem was not noted, but a letter from later that year (30 August 1706) mentioned Mrs. Derham’s increasingly severe headaches, which worried both her and her husband. Whether her health improved (or Derham simply distrusted Sloane’s advice in this case) is unclear, but Derham did not mention his wife’s health again until November 1710 when he feared that she might die from peripneumonia. (Mrs. Derham didn’t, managing to outlive her husband.)
What strikes me as particularly interesting in Derham’s account is the small detail that he forgot to look at the skies on Easter Sunday. As a clergyman, he was no doubt very busy in the week leading up to and including Easter. It would be entirely understandable that he might forget… but he did manage to look out his telescope in the nights prior to Easter.
The rather pressing matter of his wife’s health, on the other hand, is the most likely reason. It’s clear that her symptoms were alarming and disabling (as would have been the treatments, as purges kept one very close to the chamberpot). To compound the domestic disruption, the couple had four children between the ages of two and six in 1706. At the very least, Derham was monitoring his wife’s health and overseeing her medical care.[4] Even with domestic help, Mrs. Derham’s poor health would have posed a challenge for the household at the best of times, but even more so at the busiest time of year for a clergyman’s family.
Early modern scientific endeavours often took place within the early modern household, meaning that these activities were inevitably subject to the rhythms and disruptions of daily life. With his ill wife, several young children, and Easter duties, Derham simply did not have time to remember.
[1] For other recent blogging on historical comets, see Darin Hayton on “Meteorites and Comets in Pre-Modern Europe” and Rupert Baker on the comets in the Philosophical Transactions (“Watch the Skies“).
[2] The other letter was from Leibniz (5 May 1702), which was an account in Latin of a newly discovered comet.
[3] On Derham and his family, see Marja Smolenaars, “Derham, William (1657-1735)”, Oxford Dictionary of National Biography. Oxford University Press, 2004. [http://www.oxforddnb.com/view/article/7528, accessed 7 June 2011.]
[4] For more on men’s medical caregiving roles within the family, see my article “The Relative Duties of a Man: Domestic Medicine in England and France, ca. 1685-1740”, Journal of Family History 31, 3 (2006): 237-256.
Hans Sloane’s New York Connections
I was just in New York at a rather fun Cookbook Conference, speaking on medicinal remedies in manuscript recipe books. As I was preparing for my first trip to New York, I idly searched the Sloane database, wondering whether Sloane had any New York connections. I found two letters that refer to New York.
Central Park, New York, February 2013. Photo Credit and Copyright: Mark Gudgeon. Used with permission.
The first is from Patrick Gordon, a naval chaplain, who wrote to Sloane in late April 1702. Gordon apologised for missing the last Royal Society meeting and recent Philosophical Transactions. He asked if there were any commands from the Royal Society for his upcoming residence in New York. Gordon noted that he would be residing in New York for several years. The Royal Society (and Sloane) relied on the reports of men deemed reliable (such as Gordon) for information about medical and scientific matters from across the world.
At present, no subsequent letters from Gordon are in the database, but letters from other men in North America suggest how this relationship might have functioned. Col. William Byrd, for example, wrote a few letters from North America between 1706 and 1710. He clearly referred to Royal Society directives in the information he gathered. Byrd even sent samples, such as roots to cure snakebites.
Sometimes requests for assistance came to Sloane from the other side of the world. On 30 October 1716, William Vesey of New York wrote to Sloane to thank him for medical advice.
The spires of the third Trinity Church (c. 1846) against the backdrop of 1 World Trade Center. Credit and copyright: Lisa Smith.
Vesey had been receiving Sloane’s advice for smallpox and was now recovering from it. Vesey, who was one of the early rectors of Trinity Church in Manhattan, had visited England in 1714-15.(1) As payment, Vesey enclosed five guineas. This was the equivalent of about £444 in 2005 and would have bought one cow in 1720.(2)
Sloane’s reputation as a physician was indeed international! That said, most of his patients from outside Britain and Ireland came from Jamaica, France and the Netherlands. Many were people who had travelled abroad (such as Isabella Pierrepont, the Duchess of Kingston) or, like Vesey, had heard of Sloane while in London (such as the Swedish ambassador, Count Carl Gyllenborg).
Although Sloane’s New York connections are not in themselves particularly impressive, they were a small part of a much wider global network of travellers and shared ideas.
(1) This I discovered on an amble about Lower Manhattan after writing this post. Vesey has a street named after him and is mentioned on the sign outside Trinity Church. See also the Wikipedia entry for William Vesey.
(2) This was calculated using the National Archives historical currency converter.
Note: this entry was updated on February 13, 2012 with the information about Vesey’s occupation and travels.
Preparing for an Epidemic in the Eighteenth Century
Tonight BBC2 will be airing a show called Winter Viruses and How to Beat Them. The news was recently filled, of course, with reports on rapidly spreading epidemics of influenza and norovirus; medical historian Alun Withey even blogged about the contemporary and seventeenth-century fascination with the spread of disease. What intrigues me, however, is the actions people took to deal with their fear of disease.
In late May 1720, the plague entered Marseilles, the major trading port in South France, on ships coming in from Levant. The plague rapidly spready throughout the city in the next few months, disrupting commerce and daily life. The French government intervened with strict quarantine measures for both sick people and incoming ships.
Contemporary engraving of the Marseilles plague in 1720, the Quartier Belsunce. Source: Wikimedia Commons.
Meanwhile: back in England… South Sea stocks had been rising in an unrealistic way over the summer months, only to crash in September, resulting in bankrupt investors and panic spreading like an epidemic. Health suddenly became of national interest: protecting the teetering economy became of paramount importance. The fear? That the Marseilles plague might infect Britain via the trade routes.
The Lords Justices called in physician Richard Mead to consider how the plague might be prevented “for the Publick Safety” in 1720. That autumn, the Board of Trade and Plantations investigated methods of quarantine used elsewhere and recommended that Parliament bring in more border control and wider quarantine powers. But it was not until October 1721 that more decisive action was taken.
This time, Sir Hans Sloane, John Arbuthnot and Mead were summoned. In Sloane’s papers (British Library Sloane MS 4034), there are rough drafts of their advice for the Council on how to collect better information about contagious diseases from Bills of Mortality and how to set up barracks near London for quarantines. By December 1721, a Bill was passed that allowed the King to stop trade with infected countries, order fire on any potentially infected ship, establish a domestic military presence, quarantine towns, and remove the sick to lazarettos. The bill was widely criticised for being un-British and something that would only cause more fear. The French, critics argued, were more used to a standing army and harsh measures that limited people’s rights.
Even after the Bill was passed, complaints continued. Some of Sloane’s correspondents scolded him for allowing these “somewhat severe” recommendations. ‘Belinda’ dramatically claimed that the country was “almost ruined by south sea” by a corrupt government, while “to complet the misery by the advice of Mead that scotch quack [Arbuthnot] wee are to be shutt up in pest houses garded by soldeirs and hired watchmen”. She begged that Sloane intervene: “it is commonly said that you Sr. was not for this barbarous act and I am very willing to… belive you were not haveing alwayes approved your self a person of great charity to thee poor”. The name ‘Belinda’ probably did not refer to a real woman, but was a pseudonym referencing Alexander Pope’s poem, “The Rape of the Lock”, in which Belinda appears as a satiric personification of Britain. Belinda’s letter, nonetheless, captures the fear that many people had about the Bill. The message was clear: the proposed cure for the nation was worse than the disease.
Little did Belinda know just how harsh the initial report by Mead, Arbuthnot and Sloane had been! In their rough draft, the doctors had actually recommended that searchers report any cases immediately to the Council of Health “on pain of death”, that medical practitioners and household heads face severe financial penalties for not alerting authorities, and that any Officers dealing with the plague wear special markings. These, at least, had not appeared in the Bill…
By February 1721/2, Parliament was forced to reconsider the Act and repealed the clauses about domestic measures. When the plague ended in 1722, the British government had not needed to invoke its new act. Sloane may have appeared to the concerned citizens as a possible ally because of his reputation of being charitable, but he also acted to represent and enforce state power.
Giants’ Shoulders #55: Curiosities, Utility and Authority
Welcome to the 55th edition of The Giants’ Shoulders, a blog carnival that rounds up history of science blogging from the last month. This carnival takes as themes three issues that would have been very familiar to eighteenth-century collector and physician, Sir Hans Sloane: curiosities, utility and authority.
Richard Greene’s museum at Lichfield, the “Lichfield clock”
Credit: Wellcome Library, London.
Curiosities for Sloane were wide ranging and could include interesting natural objects, strange stories, or ingenius man-made ones. Over at depictedscience there is an excerpt from Robert Hooke’s Micrographia (1664): a detailed picture of a fly as seen through a magnifying glass, along with a short description. Strange stories always captured the interest of early modern scientific minds. Adrienne Mayor at Wonders and Marvels writes on Sir Arthur Conan Doyle and a sea monster, while Laetitia Barber at Morbid Anatomy has some ideas on making your own ghosts. New inventions showed human ingenuity, such as the umbrella-vator from the 1780s (The Appendix tumblr) and the stethoscope (The Rose Melnick Medical Museum). Richard Carter at The Friends of Darwin porposes a theory for what some ancient Roman jars might be, reminding me of early Philosophical Transactions letters. But the greatest curiosity of all this month is the ideal historian of science spotted over at The Renaissance Mathematicus, though perhaps Thomas Young the polymath, discussed at OpenScientist, might have fit the bill.
Sloane, like many eighteenth-century people, believed that knowledge should be beneficial, especially to society as a whole. From Seb Falk we learn that knowing how to use an astrolabe could save your life, while Jonathon Keats at Culture Lab wonders whether the science in Sherlock Holmes stories would actually have worked. Maria Popova (Brain Pickings) recounts the tale of Charles Babbage’s fight against noise pollution, a battle that he eventually (sort of) won. Jai Virdi has a series of posts, starting with “The Pretensions of Dr. Turnbull“, that look at the nineteenth-century debates about the efficacy of Turbull’s treatments for deafness. Turnbull’s methods may have been in question, but Alfred Russel Wallace’s 1876 map of evolution in the natural world has stood the test of time, since it was only just updated in 2012. RIP to Rita Levi-Montalcini, a truly useful person who brought benefits to society throughout her life. She recently died at the age of 103 after a full life in which she overcame anti-semitism, a male-dominated establishment and scientific dogma — and won the Nobel prize.
Sloane lived at a time when medical and scientific authority was in flux, as they tried to establish who should be considered reliable–a question that hasn’t gone away, just changed form. Seth LeJacq discusses the different treatments for breast cancer preferred by early modern surgeons and their patients, while Vanessa Heggie considers the history of dieting advice. Kirsten Walsh at Early Modern Experimental Philosophy suggests that Isaac Newton and his contemporary experimental philosophers had fundamentally different worldviews, while Thony Christie asks who kept Stephen Grey from publishing in the Philosophical Transactions. Possibly Sloane… In December, there was a hullabaloo about science, authority, and criticism, which is summed up nicely by Rebekah Higgit who wonders what scientists and historians each bring to the analysis of science in society.
Museums are sites where authority, utility, and curiosity all come together, much as they did in Sloane’s own collections. At American Science, Lukas Rieppel ponders the rise and fall of a research mission in a natural history museum: what does it say about the broader society when a museum decides that research is no longer important? Sloane, who collected so that he might understand the world around him, would have been troubled by the lack of curiosity in curiosities.
Giants’ Shoulders #56 will be hosted by Michael Barton (@darwinsbulldog) at The Dispersal of Darwin on February 16. See you there!
Sir Hans Sloane’s Will of 1739
Sir Hans Sloane died on this day, 11 January 1753. Sloane, as I’ve noted before, is notoriously tricky to find since his letters are scattered and he wrote relatively little. His will is, oddly enough, one of the few documents that provides hints of the man behind the collection. Here, I’ll focus on the 1739 version of his will.[1]
Portrait of Sir Hans Sloane. Credit: Wellcome Library, London.
Sloane’s wishes were simple in the first instance: to be buried in Chelsea, to have his intimates invited to the funeral, and that his friends be given rings worth twenty shillings. His landed estates were divided into thirds for his eldest daughter Mrs Stanley, youngest daughter Lady Cadogan, and his niece Fowler (who was in the Elsmere family). He also left any of his “live rare animals” to the care of the Duke of Richmond.
Considering the size of his collections and properties, he left relatively modest bequests. Perhaps he was cash-strapped. Indeed, he made alternative provisions for his heirs in case the sale of the collections didn’t raise sufficient funds! He left fifty pounds each to his nephew William Sloane, sister Alice Elsmere and to her son Sloane Elsmere, but £200 to each of her two daughters. His grandson Hans Stanley and a John Roberts of Lincoln’s Inn received £100. Notably, the most vulnerable family members–unmarried nieces and young men–received the largest gifts.
His bequests to servants were comparatively generous. Two of his named servants, Henry Darlington and Martha Katling, were to receive an annuity of ten pounds for the rest of their lives, while all of his servants would receive one full year’s wages in addition to wages owed and five pounds to buy mourning clothes.[2]
What he saw as his greatest legacy, however, were the intangibles. When it came to his daughters, relations, and friends, he “earnestly recommend[ed] to them the practice of moral and religious duties, as being of greater use to them than any thing I can leave them”. This would help them “through the difficulties of [life], with more inward quiet, satisfaction and better health than otherways, and with the esteem and respect of their friends and acquaintance”.
Sloane also valued his collection not for its worth or objects, but for the reasons why he had collected. He wrote at length about how and why he had built his collections.
From my youth I have been a great observer and admirer of the wonderful power, wisdom and contrivance of the Almighty God, appearing in the works of his Creation; and have gathered together many things in my own travels or voyages, or had them from others.
One of these “others” was William Courten, his “ever honoured, late friend”, who had left him an entire collection. To this collection, Sloane had added printed and manuscript books, “natural and artificial curiosities, precious stones, books of dryed samples of plants, miniatures, drawings, prints, medals”. Sloane’s collection was now valued at over £50000.
Sloane hoped that his executors (son-in-law Charles Lord Cadogan, nephew William Sloane and Chelsea rector Sloane Elsmere) would keep the collection together as something that would not just outlast him, but because it had wider uses: “the manifestation of the glory of God, the confutation of atheism and its consequences, the use and improvement of physic, and other arts and sciences, and benefit of mankind”. For Sloane, it seems that he real importance of his collections was knowledge of the natural world and a deeper understanding of God.
More specifically, though, his will and desire was that the government of Great Britain would understand the collection’s true value and purchase it at the bargain price of £20000. To this end, Sloane requested that his friends who had access to the King, George II–the Duke of Richmond, Lord Cadogan, Sir Robert Walpole, Sir Paul Methuen and Mr. Edgcombe–would intercede on his behalf. If Britain refused, the collection should be offered to (in this order) the Royal Society, Oxford University, Edinburgh College of Physicians, Paris Academy of Sciences, St. Petersburg Academy of Sciences, Berlin Academy of Sciences or Madrid Academy of Sciences.
Later codicils to the will are intriguing, hinting at Sloane’s changing self-perception and public interest in his collections over time. Servants received more money. He rethought the list of potential buyers for the collection. And, above all, he emphasised the ways in which his collections would benefit the British nation. But that is subject enough for another post!
[1] Sir Hans Sloane, The Will of Sir Hans Sloane, Bart. Deceased (London, 1753).
[2] 10 pounds in 1753 is worth approximately 850 pounds today, while 100 pounds is worth approximately 8500 pounds. For a sense of what these bequests could buy during the eighteenth century, see Old Bailey Online.