Tag: health

The Sad Kiss of 1722

Today is National Kissing Day in the U.K.  I’m not normally in favour of faux holidays, but there’s nothing wrong with a day that “spreads a bit of joy” (as one of the organisers puts it). It also inspired me to wonder: did any of the people who wrote to Dr. Sloane about medical problems ever mention kissing? One thing I learned from my investigation: any kisses in medical letters are unlikely to spread joy…  I want to consider the saddest kiss of all that appears in Sloane’s correspondence: one between two of Lord Lymington’s children in 1722.

The dance of death: the family and children. Two children kissing on the right. Thomas Rowlandson, 1816. Credit: Wellcome Library, London.

The dance of death: the family and children. Two children kissing on the right. Thomas Rowlandson, 1816. Credit: Wellcome Library, London.

Dr. John Hughes wrote to Hans Sloane for advice about Borlace Wallop, aged two. The young lad suffered from a “tettering humour” in his face and stomach, along with coughing and fits. When you read “tetter”, imagine a skin disease with clusters of pustules in clusters that would harden and become scabby. It must have been painful: or, as Dr. Hughes described it, “very sharp and blistering”. Borlace remained, nonetheless, a lusty lad with a good appetite.

The family believed that Borlace had become ill after kissing his baby sister, Mary, who had also had similar symptoms. The real worry, though, was the prospect of death. Wee Mary had just died from the ailment, aged only eight months. Lord Lymington had a high opinion of Sloane and wanted to know how they could keep his son from dying, too.

Sloane prescribed an uncomfortable treatment of bleeding and purging. It might seem torturous to us to inflict further pain on the child, but the goal of the treatment was to remove the foul humour causing the problem. There wasn’t really much else that could be done apart from palliative care. The good news is that Borlace recovered.[1]

The letter itself is short, but it evokes a series of poignant images: the sweet affection of two infants; the suffering of small children; the fear and desperation of a loving family. A sad kiss, indeed.

[1] Borlace was still destined to die young, at the age of twenty-one from a fever caught after the attack on Fort San Lazaro.

Medical Advice by Post in the Eighteenth Century

The internet age has brought with it the phenomenon of patients seeking medical consultations online. We like to think of this as a new way of empowering patients, but—technology aside—this scenario would have seemed familiar to eighteenth-century sufferers. One of the reasons for Sir Hans Sloane’s voluminous correspondence (forty-one volumes at the British Library) is that wealthy patients, their friends and families, and their medical practitioners regularly consulted with him on medical matters by post. This method of medical treatment made sense in the eighteenth century, with its growing postal networks and continued focus on patients’ accounts of illness.

In her post on “Contracts and Early Modern Scholarly Networks”, Ann-Marie Hansen described the etiquette of scholarly correspondence. More broadly, there were popular manuals to provide guidance on letter-writing. In The Universal Letter-Writer (1708), for example, Rev. Thomas Cooke provided formulaic letters to discuss sickness and death (alongside topics such as “a young man inadvertently surprised with an immediate demand for payment”). There was another crucial change. Mail could of course be sent across the country and internationally in early modern Europe, but it was becoming increasingly efficient and inexpensive. From 1680, for example, the Penny Post allowed people within ten miles of London to send and to receive post within a day. It was possible to seek medical advice from the most famous physicians of the day without ever leaving home—at least for the well-to-do and literate. Medical advice by post wasn’t cheap: Sloane charged one guinea per letter.[1]

Most of the medical letters to Sloane discussed long-term or chronic ailments. Letter-writing, even at its fastest, would take at least two days, making it unsuitable for emergency or short-term problems. Mrs. J. Eyre, for example, had been suffering for over fourteen weeks by the time she wrote to Sloane. There was, however, usually some sort of incident that triggered the letter. Henry Ireton became worried in 1709 when he started to produce bloody urine and to vomit after riding a horse the previous week, but he had already been a long-term sufferer (and self-treater) of urinary complaints. The process of composing a narrative might, in itself, have been therapeutic for patients. In this way, the patient could impose order and meaning on an illness that had disrupted normal life. Such patients were also likely to be physically unable to make the trip to London to see Sloane, but could still receive the benefit of his expertise.

Monaural stethoscope, early 19th century, designed by Laennec. Credit: Wellcome Library, London.

The first stethoscopes were not invented until the early 19th century. Monaural stethoscope, designed by Laennec. Credit: Wellcome Library, London.

One of the reasons that consultation letters made so much sense is that medical practice relied, by and large, on the patient’s narrative. Whereas surgeons treated the exterior of the body, physicians treated the interior. But, of course, they had no way to examine the insides of living bodies. There might be some physical examination, but this tended to focus on checking the eyes, ears, skin and pulse or looking at bodily excretions. With so much emphasis on the patient’s account, an actual physical presence was less important. Ideally, the patient would recount everything, saving time and money, since the doctor was unable to ask further questions immediately. Physicians could observe their patients during ordinary consultations, but in a letter, the patient’s story really was everything.

A patient’s narrative provided important clues to the patient’s humoral temperament and previous medical history. Mrs J. Eyre in 1708 noted that she did not trust local physicians to understand her choleric temperament; she did, nonetheless, report to Sloane their diagnosis of hysteria. Most importantly, though, only a patient could describe any internal symptoms to the physician. In 1725, Jane Hopson (aged over fifty) wrote to Sloane about her leg pain, a cold humour that she felt “trickling down like water”, which “the least wind pierces”. Although Elaine Scarry (and a number of other pain scholars) has claimed that pain isolates sufferers through its inability to be verbalised, eighteenth-century sufferers eloquently described their illnesses.[2] Clear narratives might have helped to elicit understanding from friends, family and physicians—and to persuade physicians that the descriptions were reliable. Only patients could provide the crucial details about internal symptoms that could help the physician in diagnosis and treatment.

Whatever rhetorical strategies might be used when composing a medical consultation letter, the correspondence had a distinctly functional purpose: to obtain the most useful treatment from a physician. The letters reflected the reliance of physicians on their patients’ stories and provided sufferers with a way of making sense of their illnesses. When it comes to electronic consultations, modern medicine has much to lose if this is primarily a cost- and time-saving measure, but much to gain if it is a real attempt to focus more on sufferers’ experiences.

[1] According to the National Archives currency converter, was about £90 in 2005 terms, or eleven days’ labour from a craft builder in 1720.

[2] Elaine Scarry, The Body in Pain: The Making and Unmaking of the World (Oxford and New York: Oxford University Press, 1985).

For a very short bibliography on medical consultation letters, see here.


The Moon and Epilepsy in the Eighteenth Century

A long-standing myth about epilepsy is that it is tied to the lunar cycle, worsening during the full moon. Just Google it to see what comes up in the search… But the boundary between what we see as myth and what eighteenth-century people saw as medicine is blurry, as a quick search of the Sloane Correspondence database for epilepsy shows.

A man suffering from mental illness or epilepsy is held up in front of an altar on which is a reliquary with the face of Christ, several crippled men are also at the altar in the hope of a miracle cure. Credit: Wellcome Library, London.

In February 1739, physician Christopher Packe consulted with Sir Hans Sloane about Mr Roberts’ recent epileptic fit (BL Sl. MS 4076, f. 220). Before describing the fit, Packe specified that it occurred on the morning of the full moon. Before the fit, the patient appeared wild and suffered from a numb leg and a swollen nose. In the hopes of preventing a seizure, Packe prescribed a vomit. Mr Roberts, moreover, had been diligent in following Sloane’s orders: a restricted diet and various medicines. Everything was being done that could be done, to no avail, and Packe was “apprehensive” of the next full moon.

An undated, unsigned letter came from a gentleman aged 28, who had been “seized with epilepsy two months ago” after having no fits between the ages of 16 to 20 (BL Sl. MS 4078, f. 329). Epilepsy ran in his family, he reported, with his mother being “subject to it or at least violent hysterick disorders from girlhood” and his father having seizures for several years before death. The patient wondered if the trigger had been his change from winter clothes to spring clothes, as well as drinking more than usual for several weeks prior to the recurrence. The timing of his changed lifestyle could not have been worse, since “about three days before the full moon immediately preceeding the Vernal equinox he fell into that fitt”.

The focus of these letters on full moons and clothing changes may seem superstitious to us today—and the parallel between epilepsy and hysteria perplexing—but reflected the wider medical understanding of the time. Botanist Joseph Pitton de Tournefort (with whom Sloane studied in France) and physician Thomas Sydenham (with whom Sloane worked in England) considered hysteria and epilepsy to be related: convulsive disorders that affected the brain.[1] According to contemporary treatises, other related ailments included vertigo, palsy, melancholy, fainting, and rabies.[2]

Well-known physicians Thomas Willis (1621-1675), Richard Mead (1673-1754) and John Andree (1699-1785) discussed some of the old stories about epilepsy. Willis and Andree noted that epileptic fits were so shocking to observers that they had, in previous times, been attributed to demons, gods or witchcraft.[3] Willis’s remedies may appear just as magical to modern eyes, but they would have been common in early modern medicine. There was also a key difference: he treated epilepsy as natural rather than supernatural. Willis began his treatments with a careful regime of vomits, purges, and blood-letting to prepare the body for preventative remedies. These included concoctions of male peony, mistletoe, rue, castor, elk claws, human skull, frog liver, wolf liver, amber, coral (and so much more), which would help in tightening the pores of the brain. Some of the medicines were also to be worn on the body rather than ingested, perhaps a silk bag (elk hoof, mistletoe and peony roots) at the waist or an elder stalk amulet at the neck.[4]

By the time Andree was writing, some of Willis’ seemingly magical recommendations had been lost, although most of the remedies remained the same. Andree, however, looked beyond the brain for the source of the problem. He emphasised that it was important to identify the underlying cause of the epilepsy: humoral obstruction, plethora of blood, head injury, worms or fever.[5]

The moon, viewed in full sunlight. Stipple engraving, 1805. Credit: Wellcome Library, London.

The moon continued to be important in Mead’s and Andree’s understanding of epilepsy. Mead argued that the human body was intimately affected by the influence of the sun and moon, with epilepsy and hysteria being particularly subject to lunar periods. The most critical of these were the new or full moons around the vernal and autumnal equinox, moments of important change. Mead was particularly interested in periodicity within the human body, which included periodical hemorrhages (including menstruation). Using the same rationale for explaining men’s periodical hemorrhages, Mead seemed to suggest that weak or plethoric (too much blood) bodies were particularly subject to the lunar cycle.[6]

Andree took the effects of the moon on epilepsy as a given, recommending that epileptic patients be given vomits around that time. He focused on the necessity of regulating the body through good management to prevent weakness and plethora. Drunkenness and gluttony, erratic emotions or sudden frights, overuse of opiates, excessive sexual intercourse could all trigger epilepsy. Puberty, with its rapid changes to the body, was a dangerous time when epilepsy might go away altogether, or worsen. Epilepsy that did not go away was thought to result in gradual degeneration—stupidity, melancholy, palsy, cachexia (weakness)—that would be difficult to treat.[7]

No wonder Sloane’s patients were so worried! For Dr Packe, Mr Roberts’ condition would have appeared to be deteriorating, in spite of the best efforts of doctor and patient. And the unnamed gentleman, given his family’s medical history, must have blamed himself for making potentially disastrous choices at one of the worst times of year. Timing was everything when it came to epilepsy. In Sloane’s lifetime, many old ideas about epilepsy had been relegated into the realm of myth, but a connection between the full moon and epilepsy remained as firm as ever.

 [1] Joseph Pitton de Tournefort, Materia medica; or, a description of simple medicines generally used in physick (1716), pp. 84, 265; Thomas Sydenham, Dr. Sydenham’s compleat method of curing almost all diseases, and description of their symptoms (1724), p. 150.

[2] See, for examples, Richard Mead, Of the power and influence of the sun and moon on humane bodies (1712); John Andree, Cases of the epilepsy, Hysteric Fits, and St. Vitus Dance, & the process of cure (1746); Thomas Willis, An essay of the pathology of the brain and nervous stock in which convulsive diseases are treated of, 2nd edition (1684).

[3] Willis, p. 11; Andree, p. 7.

[4] Willis, pp. 18-20.

[5] Andree, pp. 3, 10-12.

[6] Mead, pp. 31-42.

[7] Andree, pp. 10-12, 25.