Category: Remedies

Grading Sir Hans Sloane’s Research Paper

Posted on December 3, 2015 by - Botany, Early Modern History, Hans Sloane, History of Medicine, Patients, Remedies

It’s that time of year when grading is on an academic’s mind. With first-year assignments still fresh in my head, I recently found myself frustrated by Sir Hans Sloane’s “Account of Symptoms arising from eating the Seeds of Henbane” (Philosophical Transactions, volume 38, 1733-4).

Letters by Sir Hans rarely feature on this blog—and that’s for a good reason: there aren’t very many by him in his correspondence collection. But he did, occasionally, send in reports to the Royal Society… some of which were better than others. I love reading the early eighteenth-century Philosophical Transactions; many of the authors knew how to tell a cracking story, with a clear narrative arc of event, evidence and interpretation.

Not so much this offering from Sloane.

Filberts. Credit: Agnieszka Kwiecień, Wikimedia Commons.

auyopzionibinarie Filberts. Credit: Agnieszka Kwiecień, Wikimedia Commons.

bufala probinary option Sloane’s account began in 1729 when “a Person came to consult me on an Accident, that befell four of his Children, aged from four Years and a half, to thirteen Years and a half”. The children decided to have a foraged snack from the fields by St. Pancras Church, thinking that the seeds they’d found were tasty filberts. But foraging can be a risky business and the children took ill. Their symptoms included great thirst, dizziness, blurred vision, delirium and sleepiness. For Sloane, the symptoms suggested henbane poisoning; Sloane’s initial diagnosis was reinforced after examining the seeds that the father had brought in to show him. Sloane prescribed bleeding, blistering at multiple points, and purging at both ends: “And by this Method they perfectly recovered.”

autopsioni binarie com This could have made for a solid medical case study: who better to bring together clinical observation with botanical detective work? But for Sloane, the real story was the seeds rather than his diagnostic prowess. I withheld judgement. At this point, I was curious to see where Sloane, the narrator, would take his readers.

Four poisonous plants: hemlock (Conium maculatum), henbane (Hyoscyamus niger), opium lettuce (Lactuca virosa) and autumn crocus (Colchicum autumnale). Credit: Wellcome Library, London.

http://coleface.com.au/welcome/feed/ Four poisonous plants: hemlock (Conium maculatum), henbane (Hyoscyamus niger), opium lettuce (Lactuca virosa) and autumn crocus (Colchicum autumnale). Credit: Wellcome Library, London.

http://makse.com/?kremel=dating-site-las-vegas&119=58 Sloane went on to describe how the symptoms of delirium can offered important clues. Henbane delirium was very different from regular fevered delirium, but had much in common to the delirium caused by datura (“a species of stramonium”) and bang of East-India (“a sort of hemp”–indeed). Unfortunately for the reader, he did not describe any of these forms of delirium.

He then noted that the delirium from all three herbs was different from that “caused by the rubbing with a certain Ointment made use of by Witches (according to Lacuna, in his Version and Comments upon Dioscorides)”. The witches’ ointment instead would “throw the Persons into deep Sleep, and make them dream so strongly of being carried in the Air to distant Places, and there meeting with others of their diabolical Fraternity; that when they awake they actually believe, and have confess’d, that they have performed such extravagent Actions.”

strategie opzioni binarie con metatrader I see. From faux-filberts to witches’ ointment in four easy steps…

A sculpture of a man with toothache. Wood engraving after Mr. Anderson. Credit: Wellcome Library, London.

che cos è trading online A sculpture of a man with toothache. Wood engraving after Mr. Anderson. Credit: Wellcome Library, London.

Henbane wasn’t all bad, though. Sloane recounted, for example, that several years before, a “Person of Quality tormented with this racking Pain [of tooth-ache]” was treated by an empiric who used henbane. The sufferer was desperate—“his Anguish obliging him to submit to any Method of procuring Ease”—and he allowed the empiric to funnel smoke into the tooth’s hollow before (allegedly) removing tooth-worms. If this case sounds familiar to regular readers, it should be. Sloane procured one of the maggots from the sufferer, then sent it to Leeuwenhoek who examined it in detail and found it to be an ordinary cheese worm rather than a so-called tooth-worm.

Although Sloane knew that the wormy tale was fake, he pointed out that “upon the whole”, the henbane would have offered pain relief. And in any case, presumably, a good tale about tooth-worms bears repeating. Sloane also took the chance in his conclusion to make a dig at empirics who, through “slight of Hand” acquired a reputation for their remedies’ success, “which from the Prescription of an honest Physician would be taken little Notice of.”

So ends the account

****

Essay Comments

Sir Hans,

There is much of interest in this paper: your medical cases on henbane and tooth-worms are intriguing and your ability to identify both seeds and poisoning is impressive. I also appreciate the historical perspective that you bring to this study with your discussion of witch ointments.

However, there are a few ways in which this essay could be strengthened. The essay lacks analysis as you move quickly between subjects–a recent case, types of delirium caused by different seeds, and an old case. These are all fascinating issues in their own right, but you lapse into storytelling with each instance without ever going into detail about their significance. For example, in the middle section, you aim to connect different seeds to different types of delirium, but you never provide any discussion about the specifics (apart from the witches’ delirium): how did the childrens’ delirium present? What does delirium caused by bhang or datura look like? In what ways are each of these similar or different? This would help the reader to understand your thought process in diagnosing the patients and in identifying poisons.

It is also worth more carefully considering the title you’ve chosen: “An Account of Symptoms arising from eating the Seeds of Henbane”. A good title should reflect the content of the essay. However, only the first section of your paper considers symptoms actually caused by eating henbane seeds. The second section is potentially related, but needed to be more closely linked to make the connection clear; this would have been done to good effect by comparing the specifics of each drug and their symptoms to the case of henbane poisoning you introduced. The third section is only tangentially related—although you discuss a medical case and henbane is involved, you consider henbane’s therapeutic qualities rather than symptoms arising from its use. You could usefully have omitted the case in its current state, particularly since the section focuses on making value judgements about empirics and examining tooth-worms. That said, if you really do think it necessary to keep the section, you needed to consider henbane’s effects in more detail. Even more crucially, you might consider changing the title: “An Account of the Effects of Henbane” would have neatly pulled the three strands together in a more coherent fashion.

This essay has the potential to be a wonderful example of your diagnostic and botanical mastery, especially if you took more time to consider the narrative arc. Rather than scattering your energies by telling several stories (henbane, witches or tooth-worms), focus instead on one strand. Don’t be afraid to toot your own horn by showing off what you know and how you know it, instead of just sharing a collection of interesting tidbits.

So what grade should we give it…?

Measles in History

The terror of smallpox lives on in popular memory, but measles are often dismissed by many as just a childhood disease: How much harm could it really cause? And aren’t childhood diseases useful for breaking in immune systems anyhow? We overlook measles at our peril, as recent outbreaks, such as the Disneyland one, have shown. It only takes one sick person for the disease to spread rapidly among those who can’t be vaccinated (such as babies), those whose vaccines are incomplete or unsuccessful, and those who opted out of vaccination.

But is measles really comparable to smallpox, or am I being a bit extreme? Well, in early modern Europe, measles—more specifically, its complications–was considered as deadly as smallpox.

Credit: Wellcome Library, London.

Credit: Wellcome Library, London.

In 1730, physician Thomas Fuller published Exanthematologia: Or, An Attempt to Give a Rational Account of Eruptive Fevers, especially of the Measles and Small Pox. Fuller addressed it to Sir Hans Sloane and the Royal College of Physicians. In part, this was a strategy to situate the book as part of the reformed and rationale medicine that Sloane championed as the College’s President.

But it would have appealed to Sloane who had promoted smallpox inoculation and had a longstanding interest in fevers. Not only did he help to popularise the use of Peruvian bark for treating fevers, regularly using it in his own practice, but he took an interest in the publication of Edward Strother’s Criticon Febrium: or, a critical essay on fevers in 1716 (Preface). Strother, perhaps not coincidentally, was also a fan of Peruvian bark (48).

Fuller classified and described the various types of fevers with rashes or pustules, concluding that the most dangerous were smallpox and measles. Although the two diseases were very different, they had something crucial in common, being contagions that could be spread through one’s breath or skin pores (93). These “venemous fevers” were produced by a venom that was mild, unless over-heated—then the fevers became “more killing than even the Plague itself” (119).

Measles, even in its most benign state, is a miserable experience. The symptoms include: coldness and shivering; yawning; queasiness and vomiting; anguish; headache and backache; quick and weak pulse; great heat and thirst; short, painful breathing and oppession of the breast; hypochondriac tension and pale urine; watchfulness and drowsiness; convulsions; weakness and heaviness; redness, swelling, and pricking of eyes, lids and brows; involuntary tears and sneezing; sore throat, hoarseness, runny nose, and perpetual cough (142).

Fuller noted that not only did the cough always come before the measles, but that the pain in one’s chest and shortness of breath were much worse in measles than smallpox (147-8). Measles could also become malignant, or as we’d call it today, develop complications. The fever would last longer than four days and the spots would erupt much more slowly. Worse yet, diarrhea and peripneumonia occurring afterwards could prove fatal (149-150). At this point, Fuller included excerpts from Thomas Sydenham’s observations of measles outbreaks during the 1670s (151-7).

Death carries off a child on his back. Etching by Stefano De Credit: Wellcome Library, London.

Death carries off a child on his back. Etching by Stefano Della Bella, Credit: Wellcome Library, London.

It is Sydenham’s references to the personal devastation from the illness that caught my attention. In 1670, measles “seiz’d chiefly on Children; but spar’d none in any House they enter’d into” (151). By day 8, the spots cleared up, as was typical, but that is when the cough set in: “we are to observe, that at this Time the Fever, and Difficulty of Breathing are increased; and the Cough grown so cruelly troublesome, as to hinder Sleep Day and Night”. The cause of the children’s terrible coughs, Sydenham suggested, was poor management of the disease; they had “been kept too hot, and have taken hot Medicines, to drive, or keep out the Measles” (153). As we know now, complications are more likely to happen in people who have chronic conditions, the very young or elderly, and the malnourished.

So, how did Sydenham and Fuller treat measles? With “much the same Method of Cure with the Small-pox”. Not surprising, given that they were both classed as venomous diseases. Above all, “hot medicines and regimen are extreamly pernicious”. The patient should “eat no flesh”, only water-gruel, barley-broth and roasted apples (sometimes). To drink, the patient was allowed small beer or watered down milk. The patient was to remain in bed for two to three days during the eruption, so the morbose particles would leave through the skin (155-6).

The cough should be treated with a pectoral decoction, linctus and diacodium (poppy syrup): “Very rarely, if ever, will any one that useth this Method die”. If the cough continued, it could “bring great Danger”. Bleeding was the clear choice in that case. “I have (with great Success)”, Sydenham promised, “order’d even the youngest Infants to be let Blood in the Arm; and where the Case requir’d it, I have not fear’d to repeat the same.” This rescued “truly many Children that have been at Death’s Door”. As a bonus, bleeding treated the diarrhea by ridding the body of sharp humours (156-7).

No wonder measles was so feared, with Sydenham declaring that the pneumonia “is so fatal commonly after the Measles, that it may well be reckon’d the chief Minister of Death, destroying more than even the Small-Pox itself” (157). They didn’t know yet about the potential for brain damage or deafness! In the West, we’ve forgotten the real horror of epidemic diseases that killed children.

For some other historical discussions of measles, see The Wellcome Trust Blog on the development of vaccination programmes and Historiann on the early eighteenth-century treatments proposed by Cotton Mather.

On Asses’ Milk

Donkey, from Buffon, Histoire naturelle des mineraux, 1749-1804. Credit: Wellcome Library, London.

Donkey, from Buffon, Histoire naturelle des mineraux, 1749-1804. Credit: Wellcome Library, London.

It’s not often that I have an a-ha moment when reading a Daily Fail article. And it chokes me to even admit that I had one on Boxing Day as I perused “Could DONKEY MILK be the elixir of life?”.

The Sloane Letters have several references to eighteenth-century patients drinking asses’ milk. It was never held up as an elixir of life, but was thought to be particularly useful in treating lung ailments (as with the Viscount Lymington in 1722), blood problems (in the case of Catherine Henley) and emotional troubles (the Duchess of Beaufort’s hysteria in 1705). But one thing that always intrigued me was the lengths to which patients would go to get asses’ milk; why, I wondered, did it seem like such a faff to find a lactating donkey?

In 1723, Robert Holdwsorth reported that Lady Middleton had provided his wife with a goat and an ass so she could drink milk, as per Hans Sloane’s prescription. Mrs Holdsworth had stopped drinking the milk, though, as it disagreed with her. (A common complaint!) On its own, this might just seem like an act of kindness on Lady Middleton’s part—but it was likely darned helpful for the Holdsworths to have a friend in high places who could help in finding an ass.

The Duke of Bedford, for example, wanted to drink asses’ milk in 1724, as Sloane had recommended for an eye problem. Unfortunately, the Duke had been unable to procure an ass in the country and had needed to send to Streatham (another family holding) for one. As the letter was sent from his seat at Woburn Abbey in Bedfordshire and Streatham is over fifty miles away in Surrey, the ass came from quite a distance.

Asses suckling children.  From: Infant feeding by artificial means : a scientific and practical treatise on the dietetics of infancy By: S.H. Sadler. Credit" Wellcome Library, London.

Asses suckling children.
From: S.H. Sadler, Infant feeding by artificial means : a scientific and practical treatise on the dietetics of infancy, 1895.
Credit: Wellcome Library, London.

As Sally Osborn tells us at The Recipes Project, there are lots of eighteenth-century recipes for artificial asses’ milk. One version included snails boiled in milk with eringo root and brown sugar. Yum.

Donkey milk is good stuff, by several counts, being the closest in composition to human milk. Although early modern people wouldn’t have known these details, Sloane and other physicians prescribed it regularly and patients were often curious to try it. Mrs Reynolds wondered in 1725 whether Sloane might recommend that she try asses’ milk to help her general weakness. He did, as he scrawled “lact. asen.” on her letter.

It turns out that asses’ milk is still hard to get today. Across Europe, the average price is over £40 per litre. Female donkeys produce only a litre of milk per day for about half they ear and can only produce milk when its foal is nearby. Not the easiest of milk to acquire… The eighteenth-century demand, it seems, outstripped supply. No wonder patients struggled to find lactating asses and settled for unappealing substitutes!

Sloane the Chocolatier: A Tasty Myth

By James Hawkes

Sir Hans Sloane is a man who is justly remembered for many things, as a philanthropist, President of the Royal Society, and father of the British Museum. But one thing it seems he shall always be remembered for is inventing milk chocolate. For that alone he would truly deserve to be remembered as one of the greatest luminaries of his own or any other age.  But…

Does Sloane deserve to be credited as the inventor of milk chocolate as he is so often lauded for all across the internet? Even the British Museum proclaims that “It was Sir Hans Sloane who introduced milk chocolate for drinking.” Unfortunately it seems that Sloane and milk chocolate is a myth with little basis in reality.

Three tin-glazed earthenware chocolate cups, ca. 1740-1745. Image Credit: British Museum.

Three tin-glazed earthenware chocolate cups, ca. 1740-1745. Image Credit: British Museum.

Chocolate had been in use long before Columbus, with the Mesoamericans drinking a bitter but spicy chocolate drink. Following the Spanish conquest similar chocolate drinks spread to Spain and gradually began to slowly make inroads throughout Europe. It was not until shortly before Sloane’s birth in the mid-seventeenth century that chocolate began to enter the English consciousness as both a medicine and an exotic treat for the English elite. Sloane’s life witnessed an increasing prevalence of chocolate in England, although it remained a luxury. Its status as a luxury good and status symbol is underscored by the beautiful chocolate cups Sloane imported from Italy. Chocolate was thought to have many different properties, it could serve as an aphrodisiac or help with hangovers.

Trade-card 'Sir Hans Sloane's Milk Chocolate'. Image Credit: Wellcome Library, London.

Trade-card ‘Sir Hans Sloane’s Milk Chocolate’. Image Credit: Wellcome Library, London.

But contrary to popular belief Sloane did not invent the concept of milk chocolate. In fact, a great variety of milk chocolates and even icy chocolate cream recipes had been published for the English market in the seventeenth century.[1] Shortly after Sloane’s death in 1753 an entrepreneur named Nicholas Sanders brought Sloane’s Milk Chocolate onto the market. Sanders claimed to have an original chocolate recipe from Sloane as he battled against others attempting to purvey chocolate with Sloane’s name.[2] Sloane’s name remained golden, so far as chocolate buyers were concerned. The famous Cadbury Company even sold chocolate under his name in the nineteenth century. And of course, there is the modern Hans Sloane Drinking Chocolate.

As James Delbourgo has argued, Sloane–a rich baronet–would have had little motivation to get into such a grubby business as chocolate selling. Particularly “in an era that prized the public fiction of gentlemanly disinterestedness,” a close association with an item which had such negative, even racy connotations, would not have served his hard won image of virtue.[3] Sloane was a doctor and as such had been known to prescribe chocolate medicinally now and again. He even appears to have enjoyed it as a treat on occasion.

Sloane’s time in Jamaica had given him first-hand experience of the exotic, including the use of cocoa. His scientific publications included high quality illustrations of cocoa and he preserved a botanical specimen in his collection.

Chocolate suffered a bit of a branding problem in England since first entering the market in the seventeenth century. Promoters often attempted to improve its reputation by claiming that their recipes had sanction from the high and mighty, whether a king, or like Sloane–a famed physician to royalty.

In the eighteenth century, the lower classes were unlikely to consume chocolate, while chocolate took on decadent, even subversive associations in elite culture. Chocolate houses often catered to gambling (such as the famous modern gentlemen’s club White’s which was founded as a chocolate house) and on the political spectrum it included the almost-Jacobite Ozinda’s, with the Cocoa Tree serving as an unofficial Tory headquarters.

White's Chocolate House, London c.1708 coloured lithograph published by Cadbury. Image Source: Wikimedia Commons.

White’s Chocolate House, London c.1708 coloured lithograph published by Cadbury. Image Source: Wikimedia Commons.

So why does the idea that Sloane invented milk chocolate persist? Well, it makes a nice story and, once a story becomes common, it can be difficult to correct. It is an easy and compelling tale to have the first inventor of something be a famous and important person who got it right the first time… Unfortunately the attribution of milk chocolate to Sloane is no more than just another tasty myth.

[1] Kate Loveman, “The Introduction of Chocolate into England: Retailers, Researchers, and Consumers, 1640-1730,” Journal of Social History, No. 47 Vol. 1 (2013): 34-35.

[2] James Delourgo, “Sir Hans Sloane’s Milk Chocolate and the Whole History of the Cacao,” Social Text 106, Vol. 29, No. 1 (2011): 86.

[3] Ibid.                                                                          

Recording Dr. Sloane’s Medical Advice

Sir Hans Sloane might have collected recipe books in search of knowledge, but patients in turn might record his medical advice for later reference. The Arscott Family’s book of “Physical Receipts”, c. 1730-1776 (Wellcome Library, London, MS 981), for example, contains three recipes attributed to Sloane, which provides snippets of information about his medical practice.

Although Sloane was best known for his botanical expertise and promotion of treatments such as Peruvian Bark or chocolate, the Arscott family recipes show a mixture of chemical, animal and herbal remedies. The treatment for worms (f. 129), for example, combined a mixture of elixir proprietatis and spirit. salis dulcis in either white wine or tea. Together, these aimed to sweeten the blood, strengthen the nerves and fortify the stomach.

A woman is carrying a tray with a cup of chocolate [or maybe the pleurisy remedy?] and a glass on it. Credit: Wellcome Library, London.

A woman is carrying a tray with a cup of chocolate [or maybe the pleurisy remedy?] and a glass on it. Credit: Wellcome Library, London.

The pleurisy remedy (f. 156) included pennyroyal water, white wine and “2 small Balls of a sound stone horse”—or, dung from a horse that still had its testicles. This was to be steeped for an hour, then strained. (Apparently this weakened the taste of the dung.) This delicious liquor would keep for three days. Are you tempted? Because the dose was a “large Chocolate Dish fasting in the morning and at 4 in the Afternoon”. “If the Stomach will bear it” (and whose wouldn’t?), the patient was to take the remedy for four to six days in a row. In this remedy, the dung was the most powerful ingredient, as it was considered a sudorific (causing sweat) and resolvent (reducing inflammation) that would aid asthma, colic, inflamed lungs, and pleurisies.

Sloane, of course, was also famed for his eye remedy, which he made public knowledge in 1745 when he published An Account of a most efficacious medicine for soreness, weakness, and several other distempers of the eyes. But how close to the published remedy was the Arscott version?  Fortunately, the most detailed of the three recipes is “Sr Hans Sloane’s Direction for my Aunt Walroud in ye Year 1730–when she perceiv’d a Cataract growing in one of her Eyes” (ff.79-80).

Sloane's remedy would have been preferable to being couched for a cataract. Heister, Operation for cataract and eye instruments, 1757. Credit: Wellcome Library, London.

Sloane’s remedy would have been preferable to being couched for a cataract. Heister, Operation for cataract and eye instruments, 1757. Credit: Wellcome Library, London.

Although there are measurements and preparation details, just like a recipe, it was also a summary of Sloane’s successful medical advice to Mrs Walroud. Of course, what early modern patients deemed success in a treatment differs from our modern concept. For Mrs Walroud, it was enough that after she started the treatment at the age of 67, her eyes did not get any worse for ten years and “she could write & read tolerably well”. When she died at the age of 83, she still had some of her sight.

The Arscott instructions begin by recommending that the sufferer have nine ounces of blood taken from the arm and a blister applied behind the ears. Next, take a conserve of rosemary flowers, pulvis ad guttetam (ground human skull mixed with various herbs), eyebright, millipedes, fennel seed and peony syrup. Last, the patient was to drink a julap (medicine mixed with alcohol) of black cherry water, fennel water, compound peony water, compound spirit of lavender, sal volat oleos and sugar. Mrs Walroud took both twice daily and kept a “perpetual Blister between her shoulders”.

One crucial difference between Sloane’s published remedy and the Arscott one is that no mention is made in Mrs Walroud’s treatment of using an ointment made of tutty (oxide of zinc), lapis haematites, aloes, prepared pearl and viper’s grease. Three possibilities for the ointment’s absence occur to me.

  • The Arscott family may have simply assumed that the listed directions were intended to accompany the purchase of Sloane’s ointment and didn’t specify something so obvious.
  • The reference to using the ointment was lost when the instructions had been passed between family members.
  • Or, Sloane did not always prescribe the ointment.

The remaining directions, though, do have overlaps. In his Account, Sloane prescribed drinking a medicine that also contained rosemary flowers, pulvis ad guttetam and eyebright—though he included more ingredients: betony, sage, wild valerian root and castor. This was to be followed by a tea (rather than julap) with drops of compound spirit of lavender and sal volat oleos. In this case, it was the Arscott version that included extra ingredients.

The type of bleeding in the Account was also slightly different than Mrs Walroud’s, with the recommendation that six ounces of blood be taken either from the temples using leeches or by cupping at the shoulders. Sloane’s eye remedy was supposed to be useful for many types of problems, he did not prescribe it exactly the same each time. Variations were possible, according to the patient and the problem.

The Arscott recipes suggest not only what advice from Sloane the family had found most useful, but what sorts of remedies Sloane might prescribe to his patients. But whatever Mrs Walroud’s rave review, the next time I suffer from eye strain at the computer, I won’t be reaching for Sloane’s drink with pulvis ad guttetam and millipedes in a hurry.

Sloane Family Recipes

In his Recipes Project post, Arnold Hunt focused on the recipe books owned by Sir Hans Sloane. The Sloane family may have had an illustrious physician and collector in their midst, but they, too, collected medical recipes like many other eighteenth-century families. As Alun Withey points out, medical knowledge was of part of social currency. Three Sloane-related recipe books that I’ve located so far provide insight into some of the family’s domestic medical practices and interests.

Elizabeth Fuller: Collection of cookery and medical receipts Credit: Wellcome Library, London.

Elizabeth Fuller: Collection of cookery and medical receipts
Credit: Wellcome Library, London.

Two books are held at the British Library, donated in 1875 by the Earl of Cadogan. A book of household recipes, primarily for cookery, was owned by Elizabeth Sloane—Sloane’s daughter who married into the Cadogan family in 1717 (BL Add. MS 29739). The second book, c. 1750, contained medical, household and veterinary recipes (BL Add. MS 29740), including several attributed to Sir Hans Sloane. A third book, which belonged to Elizabeth Fuller, is held at the Wellcome Library (MS 2450) and is dated 1712 and 1820. Given the initial date and name, it is likely that the book’s first owner was Sloane’s step-daughter from Jamaica, Elizabeth Rose, who married John Fuller in 1703. Sloane’s nephew, William, married into the Fuller family as well in 1733.

Elizabeth Sloane, of course, compiled her collection long before her marriage; born in 1695, she was sixteen when she signed and dated the book on October 15, 1711. This was a common practice for young women who were learning useful housewifery skills. The handwriting in the book is particularly good, with lots of blank space left for new recipes, suggesting that this was a good copy book rather than one for testing recipes. There are, even so, some indications of use: a black ‘x’ beside recipes such as “to candy cowslips or flowers or greens” (f. 59), “for burnt almonds” (f. 57v) or “ice cream” (f. 56). The ‘x’ was a positive sign, as compilers tended to cross out recipes deemed useless.

The Cadogan family’s book of medicinal remedies appears to have been intended as a good copy, but became a working copy. In particular, the recipes to Sloane are written in the clearest hand in the text and appear to have been written first. Although there are several blank folios, there are also multiple hands, suggesting long term use. There are no textual indications of use, but several recipes on paper have been inserted into the text: useful enough to try, but not proven sufficiently to write in the book. As Elaine Leong argues, recipes were often circulated on bits of paper and stuck into recipe books for later, but entering a recipe into the family book solidified its importance—and that of the recipe donor—to the family.

Sloane’s recipes are the focal point of the Cadogan medical collection. Many of his remedies are homely, intended for a family’s everyday problems: shortness of breath, itch, jaundice, chin-cough, loose bowels, measles and worms. There are, however, two that spoke to his well-known expertise: a decoction of the [peruvian] bark (f. 8v)—something he often prescribed–and “directions for ye management of patients in the small-pox” (f. 10v).

Elizabeth Fuller compiled her book of medicinal and cookery recipes several years after her marriage and the book continued to be used by the family well into the nineteenth century. The book is written mostly in one hand, but there are several later additions, comments and changes in other hands. The recipes are  idiosyncractic and reflect the family’s particular interests: occasionally surprising ailments (such as leprosy) and a disproportionate number of remedies for stomach problems (flux, biliousness, and bowels). The family’s Jamaican connections also emerge with, for example, a West Indies remedy for gripes in horses (f. 23). There are no remedies included from Sloane, but several from other physicians.

This group of recipe books connected to the Sloane Family all show indications of use and, in particular, the Cadogan medical recipe collection and the Fuller book suggest that they were used by the family over a long period of time. Not surprisingly, the Fuller family drew some of their knowledge from their social and intellectual networks abroad.

But it is the presence or absence of Sloane’s remedies in the books that is most intriguing. Did this reflect a distant relationship between Sloane and his step-daughter? Hard to say, but it’s worth noting that his other step-daughter, Anne Isted, consulted him for medical problems and the Fuller family wrote to him about curiosities.

Or, perhaps, it highlights the emotional significance of collecting recipes discussed by Montserrat Cabré. Sloane was ninety-years old when the Cadogan family compiled their medical collection.

Hans Sloane Memorial Inscription, Chelsea, London. Credit: Alethe, Wikimedia Commons, 2009.

Hans Sloane Memorial Inscription, Chelsea, London. Credit: Alethe, Wikimedia Commons, 2009.

It must have been a bittersweet moment as Elizabeth Cadogan (presumably) selected what recipes would help her family to remember her father after he died: not just his most treasured and useful remedies, but ones that evoked memories of family illnesses and recoveries.

A Welsh Doctor, Sir Hans Sloane, and the disappearing catheter

By Alun Withey

Editor’s note: Alun would like to warn all readers that this post contains some graphic description of a particularly uncomfortable surgical technique…

Woodcut preparatio of patient for lithotomy, 1628. Credit: Wellcome Library, London.

Woodcut preparatio of patient for lithotomy, 1628. Credit: Wellcome Library, London.

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 poor transport 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.

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 the application of a dressing, and strict recovery routines, the doctor hoped that he had cured the condition for good. This proved to be premature.

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.

Left, Raw's grooved catheter; right, bladder of a male. Engraving with etching. Credit: Wellcome Library, London.

Left, Raw’s grooved catheter; right, bladder of a male. Engraving with etching. Credit: Wellcome Library, London.

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.

(This post originally appeared on Alun Withey’s blog http://dralun.wordpress.com. Thank you to Alun for cross-posting his Sloane story here!)

An Unusual Case of Menstruation in Eighteenth-Century England

“Mrs Wilson’s Case”, undated and unsigned, appears in the final volume of Hans Sloane’s Medical Correspondence and Cases (Sloane MS 4078, f. 372). Mrs Wilson’s troubles began the previous spring. She noticed in May that her tongue was occasionally sore when she ate, which she assumed must have been the result of a loose tooth cutting it. An obvious conclusion, with a seemingly obvious treatment: having the tooth pulled. But she waited until July before taking “a Friends Advice” to do just that.

Watercolour drawing of a Hunterian chancre situated on the dorsum of the tongue, 1892. The patient was a young woman, aged 22. Credit: St Bartholomew’s Hospital Archives & Museum, Wellcome Images.

Mrs Wilson’s tongue continued to worsen and she called in “an old experienced surgeon”, who prescribed medicinal gargles of all kinds. By August, it was clear that the gargles were not helping. Mrs. Wilson had a noticeable ulcer on her tongue. This time, the surgeon prescribed other remedies to treat internal blockages, possibly caused by a scorbutic or venereal problem. He gave her mild mercurial pills and purges.[1] He salivated her.[2] He applied a seton to the back of her neck.[3] He gave her a linctus.[4]

Nowadays, we might think these sorts of remedies were overkill in treating a mere mouth ulcer, when surely a topical treatment like Bonjela would do the trick! But the use of the term “ulcer” to describe Mrs Wilson’s problem is misleading for modern readers; in early modern usage, “ulcer” referred specifically to an open sore that seeped morbid matter. This was a much more serious problem. She had other symptoms, too, such as a pinching in her throat and pain in her ear and head. The swelling of her tongue kept increasing.

During treatment, the sore had been “ebbing and flowing”, which initially gave some hopes of a cure, but when a fungus developed over it, the surgeon “confessed it to be a discouraging case”. He consulted a second surgeon, who seemed to have more success. The fungus cleared up within a week, allowing the second surgeon to focus once more on the ulcer—at least until the fungus reappeared within a fortnight. This was treated quickly, but the fungus again returned again two weeks later, and started to spread up the tongue. This was becoming cyclical. Another fortnight passed, at which point both surgeons decided to consult Sloane.

One section of the case, marked “N.B.” to indicate its importance, explained that the salivation had “brought her Courses [menstruation] uopn her before the Time, but she has never had them since.” Indeed, the situation took an odd turn: “Some time after the salivation the Tongue voided Blood wch the old surgeon acknowledged might be the Courses flowing to the Part & bled her in the Foot.” Mrs Wilson had since been bled twice, but “the Blood continues to flow thither periodically”.

Mrs Wilson, it appeared, was menstruating through her tongue. This process, known as vicarious menstruation, has been neatly described in a blog post by Helen King: nature seeking an alternative path out of a woman’s body when her menstrual flow was suppressed. The dominant explanation for menstruation was that the body needed to purge itself of a plethora of blood, which men ordinarily excreted through sweat; plethora would continue to build up in a person’s body, leading to a variety of health problems if it was not released. Common forms of vicarious menstruation included nosebleeds, coughing up blood, or bleeding haemorrhoids.[5] These alternative flows might have been ‘natural’, but they certainly weren’t desirable; the new pathways had been created by the acidity of the stagnant, corrupted mass of blood.

So what did the eminent physician Sloane think? His response is cryptically indicated by the prescription that he scrawled on the top of the page in two lines of Latin abbreviations. He agreed with some of the first surgeon’s treatments, recommending first that Mrs Wilson be bled from the foot. This was a common method of drawing down a woman’s menstruation and re-establishing its correct path. He also aimed to treat the corrupted blood, which was causing the ulcer, by means of a cathartic electuary (a strong purge). Sloane, however, may have been a bit sceptical about the mercurial treatments, as suggested by his prescription for gold powder—a treatment to counteract mercury poisoning.

The tongue itself was an unusual location for vicarious menstruation, but certainly not impossible: any open sore offered a potential exit for retained blood. Helen King wondered in her blog post how patients suffering from vicarious menstruation might have reacted. Mrs Wilson’s case describes her physical pains, as well as the discouragement of the first surgeon, which hints at her experience. But perhaps the simple list of symptoms is evocative enough: swollen tongue, ulcer, fungal growth and periodically bleeding tongue. Enough said. It puts my teeth on edge.

[1] Mercury was used to treat venereal and scorbutic problems, which were thought to result from a hot, poisonous humour.

[2] A treatment that aimed to drain bad humours of the body through a continuous flow of saliva.

[3] A small surgical hole in the skin, kept open to allow drainage of bad humours.

[4] A cough medicine, presumably in this case an expectorant one to expel the phlegm in the lungs.

[5] On menstruating men, see my Wonders and Marvels post. On a periodically bleeding leg ulcer, see Sara Read’s post.

 

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.

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“.