Category: Early Modern History

Doctor Sloane and His Patients in Eighteenth-Century England

Posted on June 12, 2013 by - Databases, Early Modern History, Family, Gender History, Hans Sloane, History of Medicine, Letter-writing, Networks, News, Patients, Research and Writing

In April, I received the good news that the Social Sciences and Humanities Research Council of Canada had decided to fund my project “Reconstructing the Lives of Doctor Sloane and His Patients in Eighteenth-Century England” for three years.This may have resulted in an impromptu dance around the room, but fortunately the walls won’t talk…

The dance of death. Credit: Wellcome Library, London.

The dance of death. Credit: Wellcome Library, London.

This is in many ways a project born of snoopiness. I have always loved to read about the mucky details of daily life, and the letters written to Sloane offer much by way of gore, suffering and family quarrels. But one thing has always frustrated me in my research: the size of Sloane’s correspondence (upwards of forty volumes, depending on what is counted). So many letters, so many stories, so often hard to find!

The goal of this phase of the project is to complete the database, Sir Hans Sloane’s Correspondence Online, and to produce a series of microhistories about Sloane and his patients. While the collection remains indexed only by author (as it largely is still), it is difficult to navigate. The purpose of my database is to make it possible to search Sloane’s correspondence for details, such as people mentioned, social occasions, or specific illnesses. The database also makes it easier to find all references to a patient, whether made by a medical practitioner, friend or parent. This is when, to my way of thinking, things start to get really interesting.

The family records of the Newdigates, for example, show that Sloane treated several members of the family. Elizabeth Newdigate’s letters to Sloane reveal a troubled young woman, beset by family strife that included two siblings with insanity, a lawsuit by the eldest son, and the daughters’ mysterious suit before Parliament (which was dropped) for their father’s “unnatural acts”. Reading the family references in Sloane’s letters alongside the Newdigate papers will be useful in uncovering the family’s dysfunction and the wider context of Elizabeth Newdigate’s illness letters. Gender, age and status all played key roles in the disputes. By reading cases like these alongside available family archives, I can use the medical letters as a point of entry into understanding the moments of illness within the wider context of patients’ and families’ lives.

The database can also be used to trace relationships. Consider, for example, Sloane’s relationship with the Duchess of Albemarle.  Although Sloane went to Jamaica with the Duke of Albemarle, he remained the Duchess’ household physician when he returned to London and even after the Duchess remarried the Duke of Montagu. The Pierreponts were the Duchess’ birth family, while the Cadogans were related to the Duke of Montagu: both families were regular patients of Sloane’s. In 1719, Sloane’s daughter even married into the Cadogan family. The letters from this group of related families provide insight into the workings of patronage, kinship, and Sloane’s career, as much as their collective health.

Sloane himself is a fascinating subject of study. There are only a handful of letters about Sloane’s family and business in the correspondence, but there are also many small bits of scattered information: what he prescribed, others’ attitudes toward him, references to his opinions, details about property management, clues to his family and social life…  His family life, too, was important for his career. He married Elizabeth Rose (née Langley), who was from a well-to-do London family and a widow of a wealthy Jamaican landowner; her wealth aided his ability to maintain the appearance of a gentleman (important in attracting wealthy clients) and to collect objects from around the world (which reinforced the image of him as a man of science). At the height of his career, Sloane was President of the Royal College of Physicians, President of the Royal Society and a royal physician—a man very much at the centre of the medical and scientific community, with opportunity to influence the health of the nation.

Case histories such as these will allow me to examine the way in which social and political networks, state-building and power structures were reinforced in the everday life of the early modern household.

And, of course, maximise my snoopiness.

Medical Advice by Post in the Eighteenth Century

Posted on May 29, 2013 by - Early Modern History, Hans Sloane, History of Medicine, Letter-writing, Patients

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

Posted on May 23, 2013 by - Early Modern History, Environment History, History of Medicine, History of Science, Letter-writing

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.

An Unusual Case of Menstruation in Eighteenth-Century England

Posted on May 8, 2013 by - Early Modern History, Gender History, History of Medicine, History of Science, Patients, Remedies

“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

Posted on April 12, 2013 by - Early Modern History, Experimentation, Hans Sloane's Personal Life, History of Medicine, History of Science, Letter-writing, Patients, Remedies

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

Posted on March 15, 2013 by - Disease, Early Modern History, Hans Sloane, History of Medicine

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

Posted on March 8, 2013 by - Early Modern History, Family, Gender History, History of Medicine, Patients

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

Posted on March 5, 2013 by - Databases, Early Modern History, History of Medicine, Patients, Remedies

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“.