Category: Patients

Grading Sir Hans Sloane’s Research Paper

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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.

Filberts. Credit: Agnieszka Kwiecień, Wikimedia Commons.

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.”

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.

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

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.”

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.

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…?

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!

The Twelve Days of Christmas

Inspired by the season, I started playing with my database of Hans Sloane’s correspondence to see how many items from The Twelve Days of Christmas to my wondering eyes should appear. Although some substitutions were required, all twelve days are represented—and, in turn, hint at the breadth of Sloane’s collections, medical practice and epistolary network.

Above, a partridge (perdix californica); below, a pigeon (columba cruenta). Engraving by Manceaux after E. Traviès. Credit: Wellcome Library, London.

Above, a partridge (perdix californica); below, a pigeon (columba cruenta). Engraving by Manceaux after E. Traviès. Credit: Wellcome Library, London.

On the first day of Christmas, my true love gave to me… an account of the King hunting partridge from 8 in the morning until four in the afternoon in August 1724. It is unspecified whether any partridge was also in a pear tree. In a stunning twist for the song, George was also hunting rabbits and the trip had to be cut short because of a storm. Safety—and partridges—first, everyone. In any case, the King and his party were very tired after such a long day.

For the second day of Christmas, I found no turtle doves, but there are pigeons. And they are just as good, maybe even better, since I’ve never heard of anyone eating dove. Thomas Hearne, in an undated letter, reported that he was coughing up blood and receiving medical help from the Duchess of Bedford. All he was able to eat was milk and pigeon. Not my usual choice of dinner, but to each one’s own.

For the third day of Christmas, I was unable to locate any foreign hens. There was, however, an odd pheasant hen sent by John Hadley in 1721. He thought that Sloane might enjoy dissecting the hen because her feathers had changed several years previously from the usual hen colours to that of a cockerel.

I hoped to find collie birds (blackbirds) or calling birds (song birds) for the fourth day of Christmas—and I found several of each in one letter! In 1721, Richard Richardson sent Sloane the eggs and nests of several types of birds, including larks, thrushes, crows and blackbirds. Thank you, Mr. Richardson for being so obliging.

Gold ring with container, supposedly--but unlikely--held poison. Swiss; undated, possibly 16th or 17th century. Credit: Wellcome Library, London.

Gold ring with container, supposedly–but unlikely–held poison. Swiss; undated, possibly 16th or 17th century. Credit: Wellcome Library, London.

But what about five gold rings? I happily settled for one with a fancy, though indecipherable, inscription from Charles Preston in 1699. One ring to rule them all?

The geese, laying or otherwise, posed the greatest trouble. Goose does come up in the database, but only as a description. Mark Catesby in 1724 compared another bird specimen to a goose in size and Emelyn Tanner in 1727 described a deformed baby as having down like a goose.

The only swans mentioned in the letters are pubs, though the drinkers may or may not have been swimming in their drink. For example, Richard Richardson (1729) referred to a carrier from Preston who would be staying at the Swan in Lad Lane, London. Or Antony Picenini stayed at the Swan Tavern in Chelsea, hoping that a change of air would benefit him while he recovered from (unspecified) surgery on his thigh.

There were some maids mentioned in relation to milk, but only one maid doing any milking—in this case, drinking milk rather than fetching it. In 1725, Matthew Combe was treating Sophia Howe, Maid of Honour to Queen Caroline, for a bad cough. The patient had been drinking asses’ milk, commonly given to people suffering from chest troubles.

Akan drum owned by Sloane and acquired beyween 1710 and 1745. Made in West Africa and collected from Virginia. Credit: British Museum, London.

Akan drum owned by Sloane and acquired beyween 1710 and 1745. Made in West Africa and collected from Virginia. Credit: British Museum, London.

Although there were no drummers drumming, there is at least a drum. In 1729, Elizabeth Standish of Peterborough was planning to send Sloane “a Negro drum”. No other details were given, such as where the drum came from or how Mrs Standish had acquired it. Could this be the same Akan drum still held at the British Museum?

Travelling smoking set, Europe, 1815-1820. Credit: Science Museum, London, Wellcome Images.

Travelling smoking set, Europe, 1815-1820. Credit: Science Museum, London, Wellcome Images.

There is only one reference to a piper actually piping. In 1723, Timothy Lovett reported that he had been treating his long-standing phlegmatic cough (forty years) by smoking a pipe: “I have used my selfe to smoking several years about 5 pipes a day but it is ready to make me short breathed. I find it opens and loosens ye body.” Smoking as a cure… it worked until it didn’t, apparently.

Now, the Lords and Ladies were apparently too dignified to mention their leaps and dances to Sloane, but the subject of their exercise does occasionally come up. I offer you one Lord, the Earl of Derby, and one Lady, Lady Clapham. Derby suffered from swelling and bad breathing in 1702. He was “most pusled what to do about exercise, which is so necessary, but the least causes my legs to swell so”. Lady Clapham was also ill in 1702 and her regular physician despaired of the elderly woman’s skin disorder, hard swellings all over her body. He wasn’t sure if “the cause of this disease may proceed from a great stomach & little exercise or a great surfeit of cherries in London”. Tough one…

St. Giles is in the background of Hogarth's "Noon", from Four Times of Day (1736).

St. Giles is in the background of Hogarth’s “Noon”, from Four Times of Day (1736).

Since I clumped Lords and Ladies together, I’ll end with an 1842 version of Twelve Days which has twelve bells ringing.  After Sloane was elected President of the Royal Society in 1727, the bell-ringers of St. Giles-in-the-Fields honoured him by ringing the bells. St. Giles only has eight bells today and, in 1727, would only have had four bells. But no matter, it’s the thought that counts and a four-bell honour is pretty darned fine!

And on that (ahem) note, I wish a Merry Christmas to all.

Looking after your family until the end: the cost of caregiving in historical perspective

A very old man, suffering from senility. Colour stipple engraving by W. Bromley, 1799, after T. Stothard. Image credit: Wellcome Library, London.

A very old man, suffering from senility. Colour stipple engraving by W. Bromley, 1799, after T. Stothard. Image credit: Wellcome Library, London.

Another day, another governmental exhortation that families just aren’t doing enough to keep society going… This time, it is Simon Hughes (the UK coalition’s justice minister) who suggested that British people had lost a sense of duty to care and were neglecting the elderly. Caregivers regularly bear the brunt of governmental disparagement, especially at a time when an ageing population puts increasing stress on limited resources. The solution, Hughes proposes, is that we look to immigrant cultures who understand the necessity of sacrifice for the good of elderly family members.

Gee, that’ll do the trick… (There’s a thorough dissection of Hughes’ statements  over at (Dementia Just Ain’t) Sexy.) But what I want to discuss here is the problematic view of the past underpinning Hughes’ assertions. He ignores the daily experience of modern caregivers and instead assumes that British family responsibility was much more important back in the halcyon olden days.

Let me introduce you to the Meure family in the early eighteenth century, whose case suggests the high costs of caregiving at a time when there were no other options. The Meures were naturalized Huguenot immigrants who had moved to London shortly after Louix XIV had revoked the Edict of Nantes in France. The family’s immigrant status is worth noting, given that the myth of dutiful families relies on the belief that they remained in one place.

The location of the French Academy, where a different sort of dancing now takes place. Image source: my own photograph.

The location of the French Academy, where a different sort of dancing now takes place. Image source: my own photograph.

Abraham Meure (senior, hereafter “Meure”) established a boarding school for French Protestants in Soho, but the school—which taught fencing, dancing, drawing and languages—quickly attracted of the English nobility. Times must have been good for the family, as Abraham Meure (junior, hereafter “Abraham”) styled himself as “Gent.” when he married Elizabeth Newdigate in 1707.

Somewhere around 1708, Meure’s son-in-law Moses Pujolas wrote to Hans Sloane. Sloane had previously acted as a legal witness on behalf of Meure who suffered from dementia and senility. The father’s need for care was not disputed within the family; rather, this was a matter of ensuring that Abraham could take over his father’s interests. Unsatisfied with the facts of the case, the jury at the Court of Chancery wanted Meure to attend court. Moses worried that ‘he isn’t in a fit state to conduct himself without embarrassment’ and hoped that Sloane would attest to treating Meure’s senility over time.[1] The family appears to have been protecting Meure by preserving his dignity. The Court treated the debility as temporary, but then removing Meure’s power irrevocably wasn’t the family’s goal, either. The Meures delayed three more years before seeking a permanent ruling.

Meure’s last will dates from 1703 and was proven in 1716.[2] Although it’s hard to know when exactly Meure’s dementia began, the will makes it clear that his daughter Magdalene Pujolas and her family were living with him. According to the will, Abraham received the bulk of his father’s estate, but was to pay Moses £500 as specified in the marriage articles and, within six months of Meure’s death, Magdalene would receive a further £500. Meure declared:

Further, I give my daughter Magdalen Pujolas her board for all the time she lived with me since her marriage, and for three months after my decease, as alsoe the Board of her Husband Moses Pujolas his Children, and servants, and I doe prohibite my Eldest son or his Executors ever to make any demand thereon upon any amount whatever.

In addition, Moses could take back everything in his two furnished chambers and any Pujolas possessions elsewhere in the household. There were bequests to other family members: Robert Pujolas (Magdalene’s son), £500; Andrew Meure (son), £450; and Magdalin Meure (Andrew’s daughter), £100. The particularly generous bequests to the Pujolas family hints that Meure expected them to remain with him indefinitely and that they may already have been providing him with domestic assistance. The Meure family was not wealthy, although the school provided a sufficiently comfortable living to remunerate the Pujolas family for their long-term assistance.

The evidence is, admittedly, patchy. No family records or other letters to Sloane refer to Meure’s deteriorating state, though Moses’ reference to Meure’s likely embarrassment in court suggests that he was in a bad state a mere five years after writing the will. It must have been agonizing for those closest to him who continued to care for him until his death circa 1714, which was when Abraham took over as ratepayer for the property.

Moses and Abraham for many years had a friendly relationship. For example, Moses was Abraham’s guarantor in his marriage settlement of 1707. Not long after Meure died, there were growing tensions within the family. And it is these letters that suggest what the real cost of long-term caregiving was for Magdalene.

In 1719, Abraham wrote to Sloane to question Moses’ treatment of his sister:

I beg the favour of you to lett me know when you saw my sister Pujolas last, and how you found her, her husband saith that he locked her up by your advice.

Sloane replied that he had not treated Mrs Pujolas for several years, but had looked into the matter for Abraham. Magdalene had, apparently, ruined her health, by ‘coveting and drinking large quantities of hott liquors’.

The case must have been severe. Sloane was concerned enough to advise Moses to consult a lawyer about locking Magdalene up in order to limit the quantities of alcohol that she consumed.

Coincidence?

[1] British Library, Sloane MS 4060, ff. 142-3. Pujolas thanked Sloane for an affidavit in BL MS 4060, f. 141,

[2] London Metropolitan Archives, PROB 11: Will Registers – 1713-1722 – piece 554: Fox, Quire Numbers 173-208 (1716), Will of Abraham Meure.

Nursing Fathers, Slacking Dads and False Assumptions

Things I learned on the weekend… Slacker dads watch sports instead of read their children stories. They avoid housework and childcare as much as possible. They prefer work-life to domesticity. And above all, they look upon “Wet Wipe” daddies—those who are prepared with things like spare nappies and who concentrate on what their children are doing—with contempt. Or so claims Alex Bilmes, editor of Esquire, who shared his “Confessions of a slacker dad” in The Guardian. Bilmes wonders when being a good father became so complicated, concluding that “[t]he expectations of fathers have changed. More is demanded of us.” Righto. And off he went at speed, riding on his false assumptions about fatherhood in the past!

A father feeding his infant whilst the mother attends to domestic jobs and a small child plays with its food. Etching after A. van Ostade, 1648.  Image Credit: Wellcome Library, London.

A father feeding his infant whilst the mother attends to domestic jobs and a small child plays with its food. Etching after A. van Ostade, 1648. Image Credit: Wellcome Library, London.

Joanne Bailey, author of the excellent Parenting in England 1760-1830, certainly has much to say on the complexities of fatherhood, identity and parent-child relationships. Being a dad was not, historically, exactly a walk in the park (with or without a Scandinavian buggy). As Bailey points out in one of her blog posts, Georgian fathers experienced (and were expected to experience) a profound range of postive and negative emotions.

In another post, she explains that Georgian society expected men as well as women to be emotional beings, resulting in an ideal that fathers should be “tender” or “nursing” or—to use a modern term–“involved”. Victorian and mid-twentieth century fatherhood, by contrast, emphasised less emotional expression (particularly in men), shifting the cultural focus to fathers’ roles as breadwinners.

The anti-Wet Wipe father Bilmes would, I expect, be surprised by (what I now call) the Medicinal Plaister Papas of the early eighteenth century: the men who performed a wide range of caregiving roles within the household, including nursing and remedy preparation. The Sloane Correspondence is filled with concerned fathers who oversaw the health care of their children.

Many fathers provided detailed reports of their children’s health and administered treatments. In a letter dated 1 February 1697, John Ray grieved for his daughter who had died of an apoplectic fit after three days of delirium. He blamed himself for giving her one of his own remedies, only to see it fail on this crucial occasion.

William Derham was concerned about his “little daughter”, aged nine, on 3 November 1710. She had been “seized immediately with a great suffocation like to have carried her off divers times”. Derham reported his daughter’s symptoms (sore throat and lungs, heart palpitations and blindness) and described her treatments, including the use of a microscope to examine her eyes. It is possible that a local physician had undertaken the microscopic examination, as the language is ambiguous. But knowing Derham’s scientific interests, it seems more likely that Derham examined his daughter’s eyes himself.

Others were concerned that their own sins might be visited upon their offspring with terrible consequences. Edward Davies, on 8 July 1728, was worried that his son’s joint pain might affect his head. In addition to reading up on John Colbatch’s remedy for convulsive distempters ( A Dissertation Concerning Mistletoe, 1723), Davies had treated his son with Daffy’s Elixir. Davies had two main questions. First, he wondered if his own past mercury treatments (for venereal disease?) had caused his son’s ill health: “my blood was poyson’d in my youth with a Quicksilver-gird & I wish my off-spring do not suffer that”. Second, he was also unsure whether teaching his son Latin to prepare him for public school would do him more harm than good in his condition. Raising a child was a fraught venture, from passing on one’s own health problems to training them well for the future. In any case, Davies was deeply involved in his son’s upbringing.

Fathers also exchanged useful medical knowledge. In August 1723, Mr. Townshend wrote to Sloane that his daughter Ann had been on her way to visit Sloane about her blindness, but  Townshend had such trouble parting with her that she would be “14 days longer”—and he would have preferred it if Sloane could come to Exeter! A month later, Townshend expressed his gratitude for Sloane’s help, although Ann was no better. Townshend had, nonetheless, suggested that Mr. Farrington and others contact Sloane for assistance.

Sure enough, that same day, Mr. Farrington had written to Sloane about his daughter’s eye problems. Farrington noted that when his daughter (now 21) was ten, she’d suffered from such violent head pain that she was expected to die. She eventually lost sight in both her eyes and although she was able to move around the home and gardens, she was unable to travel beyond them. Farrington described the nature of her limited sight, as well as the treatments and diagnosis that she had received. By the next month, Farrington waivered between hope and despair based on Sloane’s (unknown) response, but he sent Lady Yonge to collect Sloane’s remedies. As of 23 November 1723, Farrington noted that Sloane’s treatments seemed to be working “and the load she hath had above the eyes taken off”.

These last two cases reveal two worried fathers, both of whom were familiar with the details of their daughters’ treatments. Townshend’s recommendation of Sloane’s assistance to his friends also suggests a network of fathers who exchanged medical knowledge—in the case of Townshend and Farrington, about their daughters’ shared problem.

Distant dads? Not at all! These early eighteenth-century Medicinal Plaister Papas who wrote to Sloane had far more in common with the modern Wet Wipe fathers than Bilmes and his Slacker Dad ilk.

An Eighteenth-Century Case of Cotard Delusion?

Recently, I found myself doing a little seat dance in the British Library when I came across a fascinating series of letters (Sloane MS 4076) from 1715, written by apothecary William Lilly about the Countess of Suffolk, Henrietta Howard. Historians of medicine, of course, are generally loathe to engage in retrodiagnosis, but sometimes it’s just too tempting… What Lilly seemed to be describing was a case of Cotard Delusion!

Cotard Delusion, or Walking Corpse Syndrome, was first described as a cluster of symptoms by Jules Cotard in the 1880s. The symptoms include insensitivity to physical pain, a preoccupation with guilt and despair, and the belief that one is already dead, damned or possessed (or, conversely, immortal). Cotard was not the first to observe this sort of case, but he categorised it as a syndrome: hypochrondriac delusion and anxious melancholy, or lypemania—drawing on an earlier classification from Jean-Étienne Dominique Esquirol (1772-1840).

The corpse of a lady wearing a ruff and an elaborate head-dress. Credit: Wellcome Library, London.

The corpse of a lady wearing a ruff and an elaborate head-dress.
Credit: Wellcome Library, London.

According to modern studies, Cotard Delusion starts off with a sense of general anxiety that could last weeks or years, but increases over time until the patient believes s/he is dead and is preoccupied with guilt and despair. Sometimes this is accompanied by muteness or paralysis. In some cases, the disorder might be accompanied by physical problems, such as a brain tumour or injury, multiple sclerosis, or Parkinson’s disease.

So what were Lady Suffolk’s symptoms? In a letter dated 20 July (ff. 7-8), Lilly noted that Lady Suffolk was taking little rest, but

“when she waked from her slumber call’d out in a frightfull manner for half an hour that she was deceased and a great deal of such Language”.

Once this “raveing fitt” ended, she became profoundly drowsy and “lay still without any motion”. She needed help with the bedpan, even “though she walk’d severall turns in her Bed Chamber yesterday”. Lilly bled her nine or ten ounces, which he hoped would prevent worse lethargy. Lady Suffolk’s blood was viscous and sizy. Lilly thought it suggested, along with her stopped urine, a “phrenites [acute inflammation of the mind and body] with the Mania”. Lilly also applied blisters on her legs to draw the bad humour down and out, laid pigeons to her feet (sometimes used to treat headaches and migraines) and shaved her head to relieve the excess heat in the head.

Four days later, Lilly had administered Sloane’s prescriptions “without the desired effect” (f. 9). Lady Suffolk no longer had a fever, but her other symptoms continued and she was drowsy, “which made me fear her turning lethargical or some other distemper on her Braine which I perceved to be already affected”. Lilly gave Lady Suffolk a glister, inducing her to flow in several ways. She produced a large stool and plenty of urine and spoke more than she had in two days.

On 26 July, Lilly reported that Lady Suffolk had vomited phlegm and choler, as well as had three stools. She could walk around her chamber, but “still continues very melancholy and silent and seldom speaks without being importuned to it”. Lilly was deeply worried. He hoped that Lord Suffolk would take his wife to London “where you may see her oftener”, as her “present indisposition will not quickly be removed”. Lilly again suggested that it might be an affectio hypochondrica [melancholy] or mania, and provided details about Lady Suffolk’s conversation:

“for what she sayes is that she is undone in soul and body that she is sure she will be damned at other times when I urge her to speaks she tells me she is dead and has been so for some time”.

After M. de Vos, A woman beleaguered by demons, death and deceiving angels; representing faith resisting the evils of the world. Source: Wellcome Library, London.

After M. de Vos, A woman beleaguered by demons, death and deceiving angels; representing faith resisting the evils of the world. Source: Wellcome Library, London.

In an undated letter that seems to come at this point in the series (ff. 12-13), Lilly listed Lady Suffolk’s symptoms as diarrhoea, fever and head pain and insisted again that the disorder was hysterical, not feverish. Given Lilly’s repeated attempts to persuade Sloane that the real problem was hysterical, it’s not clear that Sloane initially trusted Lilly’s diagnosis.

But by late July, Sloane had started prescribing anti-hysterical medications, including cordials and drops (29 July, ff. 10-11). Even so, Lady Suffolk “is more than usually melancholy” and complained of heart palpitations and swimming in the head: more symptoms of hysteria. Since Lady Suffolk’s fever had not returned, Lilly hoped that the danger had passed.

This sort of delusion was distressing to observers, including Lilly who was uncertain of his ability to help, but Lady Suffolk’s disorder was readily classified as hysteria or hypochondria—ailments that were as much physical as mental. The diagnosis and treatment for Lady Suffolk was humoral in nature, treating her emotions as fluids and using remedies to make her body and mind flow.

Although retrodiagnosis is tempting in Lady Suffolk’s case, eighteenth-century medicine already had a place for her religious delusions. Robert Burton, for example, included a lengthy section on religious melancholy in his famous Anatomy of Melancholy  (1621). Eighteenth-century books on hypochondria also emphasised the often religious nature of sufferers’ fears, such as despair and damnation, especially in women (e.g. Nicholas Robinson, A New System of the Spleen, Vapours, and Hypochondriack Melancholy, 1729).

Retrodiagnosis is unhelpful in another way. Lady Suffolk was ill with problems besides the delusion, which had even lessened toward the end. In particular, Lady Suffolk’s ailments progressed rapidly in less than a month.

Lady Suffolk never made it to London to see Sloane in person. The danger had not passed: she died on the 10th of August.

 

References
G.E. Berrios & R. Luque, “Cotard’s Delusion or Syndrome?: A Conceptual History”, Comprehensive Psychiatry 36, 3 (1995): 218-223.

Hans Debuyne, Michale Portzky, Frédérique Van den Eynde, Kurt Audenaert, “Cotard’s Syndrome: A Review”, Current Psychiatry Reports 11, 3 (2009): 197-202.

An Eighteenth-Century Love Story

The Newdigate family became Hans Sloane’s patients around 1701, starting with Lady Frances Sedley (née Newdigate), her husband, and father-in-law. By 1705-6, Sloane was treating Elizabeth Newdigate (b. 1682) for colic, hysteria and fever (BL Sl. MS 4076, 1 July 1705, f. 173; 4077, 21 December 1706, f. 164). But Elizabeth’s complaints went far beyond the medical.

A letter of 1 November 1706 detailed her illness, penury, and unhappy family situation. Specifically, she blamed the “distruction of my health if not to the loss of life” on her brother and sisters who were “miserably unkind” to her. This was partly financial, as her brother Dick

wou’d not help me to one peny of money when I was sick in London but forsed me to borow of strangers.

Dick had apparently even written to “all my Relations [that] I unjustly demanded mony of him when he was not in my debt”.

But the siblings were being unreasonable in another way, too. They had dismissed her illness, telling everyone “that I was distracted and had no illness but that of being in love”. She swore innocence in the matter, insisting that she had not even really spoken to the man.

Theodore Lane, A young woman escapes down a rope of sheets, intending to elope with her lover, n.d. Credit: Wellcome Library, London.

Theodore Lane, A young woman escapes down a rope of sheets, intending to elope with her lover, n.d. Credit: Wellcome Library, London.

Of course, she must have done… or perhaps her siblings had put the idea of an unsuitable match into head. A year later, she married Abraham Meure, the son of a Huguenot schoolmaster–self-styled a “Gent.” in the marriage contract of 3 September 1707 (Warwickshire County Record Office, CR 136 C2734).

For a woman from a good gentry family, this was a bad choice of husband. A torn-out page from the family Bible makes clear that Elizabeth had “married herself” (WCRO, CR 136/B830). Her father made the point again in the marriage settlement, promising “That for and notwithstanding the consent and good likeing of the said Sr Richard Newdigate is not obtained”, he would still pay her portion. Abraham, nonetheless, does appear to have been a man of some means. Not only did he renounce his claim on and interest in Elizabeth’s portion, “out of the great love and affection” he had for her, but he would provide an annuity of £300.

Elizabeth’s letter reads like a cry for pity.  Perhaps, by playing upon her defenselessness, she hoped to persuade Sloane to mediate on her behalf. Given her eventual success in marrying Abraham, it is entirely possible that Sloane did help. Sloane certainly continued on as physician to the Newdigate and Meure families. And over time, Abraham became a close member of the family, helping his brother-in-law William Stephens during financial difficulties.

Unfortunately, Elizabeth and Abraham’s match was short-lived. Elizabeth died on 9 July 1710, just two weeks after giving birth to their son John.

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.

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!)

Checking Tongues in the Eighteenth Century

A bored physician looks at the tongue of an old lady; suggesting the waste of physician's time by hypochondriacs. Credit: Wellcome Library, London.

A bored physician looks at the tongue of an old lady; suggesting the waste of physician’s time by hypochondriacs. Credit: Wellcome Library, London.

Miley Cyrus must, by now, have the most photographed tongue in history. My friend Jennifer Marotta recently  sent me this link about the diseases that Miley might pick up or spread by licking sledgehammers, mirrors and so forth. Although Jennifer had asked whether there were any nasty early modern equivalents, I became mesmerized by the sight of Miley’s tongue… and the secrets that it might reveal. Checking the tongue was a crucial part of diagnosis in early modern medicine.  

One of Hans Sloane’s correspondents, Giorgio Baglivi, was an Italian physician known for his work on medical practice. Baglivi, like Sloane, believed in the importance of bedside observation. In The Practice of Physick (1704), Baglivi outlined what a full medical examination should entail: “the Sick Persons Excrements and Urine, his Tongue and his Eyes, his Pulse and his Face, the Affections of his Mind, his former way of living, and the errors he has been guilty of in the way of Conduct” (30).

Physicians, of course, had no way to see or hear inside the human body. Examining the tongue was perhaps the best tool available, as it would provide

“a more certain and naked view of that state of the Blood than any other Sign”.

This included the taste, colour, “and other qualities of the Tongue” (157). In their letters to Sloane, several patients mentioned the state of their tongues.

Tongues were variously described as moist, clammy, or dry. Mrs Conyers, who had stomach pain, wheezing and shivering, apparently had a moist tongue and hands. In 1710, William Derham wrote that his wife had a “moist, & not very white” tongue, but by the following morning the tongue had become drier. Thomas Isted, according to his doctor, suffered from a clammy tongue, as well as sweating and sizy (viscous) blood.

Taste was also an important detail. Mr Campbell, who “had indulged his palate and rarely exercised as his business was very sedentary”, suffered from a foul and dry tongue. This was in addition to terrible urine (“thick and muddy”, “foul and turbid, gray, ropy and tough”) and a “muddy complexion”. The foulness had spread throughout his body.

The colour of tongues was most often described as black or white. In 1720, Dr Allen had several chest and stomach problems that were on the mend, but he also had a “slow fever, a brown but afterwards black Tongue” and low spirits. A “young gentleman” in 1725 had a violent peripneumonick fever accompanied with a “dry black tongue”; his strength was failing so rapidly that the physician did not want to try bleeding the patient. Sir William Thomson, in 1739, had a dry throat and “soon after the edge of the tip of his tongue grew hairy, white and almost transparent”. The physician believed “that an aphthous [blister] crust would creep down the throat and probably pass as a thorough thrush to the anus”. Unpleasant.

These details revealed the body’s interior. As Baglivi noted,

“if the Tongue is moist, so is the Constitution of the Blood; if dry, than the Blood is of a dry inflammatory Nature”.

An acidic taste, for example, revealed an acidic blood, or a salty taste meant salty blood (296). A canny physician could also make a prognosis, based on the evidence. For a patient delirious with an acute fever and a parched tongue (signs of inflamed viscera), the physician should avoid applying blisters, otherwise the patient would likely be “seiz’d with Convulsions before they die” (424). In malignant fevers, “a foul Tongue and trembling Hands are always dangerous in acute Diseases” (165). Black tongues were a bad sign. When a patient had an acute disorder, “a black Tongue is almost always followed by a Delirium” (88). Worst of all, though was a cold tongue: “Death follows soon after” (174).

Although displaying the body is part of the act for many female pop stars, the visibility of Miley’s tongue allows us to see inside her body in a surprisingly intimate way. The good news is, she is at present no danger of a mortal distemper.

The bad news is, her tongue does appear a little white. (Others have provided modern diagnoses here and here.) Baglivi did not mention white tongues specifically, but white-coated blood suggested inflammation of the internal organs. In any case, I sincerely hope that Miley doesn’t develop Sir William Thomson’s creeping thrush.