Category Archives: Medicine

Nursing and Nutrition: Treating the Influenza in 1918-9

By Ida Milne

Monster representing the influenza virus. E. Noble, c. 1918. Credit: Wellcome Library, London.

This season’s higher than normal influenza cases has inevitably drawn comparisons with the 1918-19 influenza pandemic, the worst in modern history.  It killed more than 40 million people, according  to the World Health Organisation.  It punctured medical doctors’ newfound confidence in the power of bacteriology to fight infectious disease. In Ireland, it killed at least 23,000 people (the number of certified deaths from influenza and excess pneumonia) and infected about 800,000 people, one fifth of the population. Entire communities fell silent as it passed through.

Laboratories churned out vaccines, but the general consensus was these vaccines, made from bacteria suspected to cause influenza like illness such as Pfeiffer’s bacillus (haemophilus influenza), were ineffective.   Physicians threw everything in their medical bag at it, trying desperately, and in vain,  to find a cure for a disease they found baffling. Ultimately, doctors came to realise that the most effective treatment was good nursing – which included nutritious food – and strong liquor.

From a school journal The Clongownian, 1919. By kind permission of the editor, Declan O’Keeffe.

There was little consensus amongst the medical profession on what medicine worked best. Some suggested quinine and grains of aspirin to reduce fever and grains of opium for sleeplessness.  Calomel (mercurous chloride)  was liberally prescribed, as doctors then were very keen on keeping the bowels open.  Strychnine, which we tend to view now as the villain’s poison of choice in James Bond movies, was injected as a stimulant.

D.W. McNamara, a young house doctor in Dublin’s Mater Hospital during the crisis, later wrote that one of the popular treatments in the hospital was an injection of camphor in olive oil, which he described as ‘the very nadir of therapeutic bolony’. Instructed by his seniors to use it, he felt guilty that he had inflicted further pain and suffering on the very ill.  Some doctors, especially his older colleagues, favoured brandy or whiskey ‘in heroic doses’.  Alcohol had, he considered, a good deal to recommend it, as it was ‘probably no less worthless than any of the other nostrums, and at least its customers had a merry spin to Paradise’.

The demand for whiskey was so strong that some flu-stricken communities wrote to the Chief Secretary’s office to see what could be done to improve supplies. Non-prescription medicines were in high demand. As well as compounding regular medicines, pharmacists worked long hours to prepare huge quantities of tonics, cough medicines and poultices. The poultices were usually a mixture of boiling water and ground linseed, reputed to aid decongestion, enclosed in cloth and placed on the chest or throat.[1]

Journalists passed on tips on cures to their readership. The Irish Independent related that Major R. T. Herron, Medical Officer, Armagh Union infirmary, had suggested gargling with a solution of permanganate of potash as a useful preventive measure. Sir R. Winfrey, MP, a qualified chemist, recommended a prescription of thirty drops pure creosote, half-ounce rectified spirit, three-quarter ounce liquid extract of liquorice, two drachms salicylate of soda and twelve ounces of water, with the recommended adult dosage of two tablespoonfuls three times daily.[2]

While good nursing with bed rest, plenty of liquids and nourishing food offered a better chance of survival than medication, this was not always possible when every member of the family was sick. In some areas, the Women’s National Health Association, the St Vincent de Paul and neighbours set up community nursing schemes and community kitchens to cook and deliver nourishing soups and stews to those too weak to care for themselves. Local farmers often donated vegetables and meat.

Sinn Féin’s Dr Kathleen Lynn, who opened a hospital to treat influenza sufferers and vaccinate people, suggested that sufferers should be given milk, barley water and egg flip, while those in good health ought to fortify themselves with butter, eggs, fresh meat, vegetables and porridge.

Many newspapers reported that people were carrying handkerchiefs doused in eucalyptus oil in front of their mouths as a preventive measure.  Macnamara considered this practice about as effective against influenza as ‘a black beetle would be to halt a steamroller.’

Advertisement in Abel Heywood and Son’s Influenza: Its cause, cure and prevention, 1902. Credit: Wellcome Library, London.

Beef extracts Bovril and Oxo were in heavy demand, and production was sometimes halted when they ran out of bottles when sales went up. Beef extract or tea was understood to strengthen the body as a defence against infection. Goodbody’s Flour Mills in Clara, Co Offaly supplied Bovril to their 300-strong workforce  during the pandemic.

Manufacturers changed their regular advertising to offer their product as a useful treatment. Readers of the Enniscorthy Guardian were urged to ‘pour a little Cousin’s lemonade into a saucepan and warm it, to provide the perfect drink for influenza sufferers.’ A pharmacist in Gorey, Co Wexford, advertised his cod liver oil emulsion as offering  protection from influenza.  Purveyors of snake oils – the cure-all nostrums – swiftly added curing influenza to their list. Such claims preyed on the general fears created by an untreatable mass disease.

The use of whiskey as a treatment crops up frequently in written records and oral histories I captured from survivors or families of sufferers. Raphael Sieve, whose family lived in south Dublin at the time, told me that his father kept his teenage brother constantly mildly drunk with whiskey at the time, until he pulled through. When I presented this idea in a paper, a medical doctor suggested that there might be good science behind it.  He said that the reason that young healthy adults may have suffered more than normally in this flu was because of cytokine storms, where the immune system overreacts. He thought that small regular doses of whiskey might help prevent this.

One survivor I interviewed, Tommy Christian, from Boston, Co Kildare, was administered gruel, a type of watery porridge, which he said ‘had an awful lot of responsibilities’, a hint perhaps that it was intended to open his bowels. His family put a poultice made of linseeds and hot water wrapped in cotton on his chest, another common treatment. Tommy had his first taste of whiskey, in a hot toddy – made from sugar, whiskey and hot water – as that five-year old flu sufferer, a taste he said he continued to enjoy for the rest of his life.  Despite being extremely ill in 1919, he lived to his 99th year. Proof that the old remedies can sometimes be best?

Editor’s Note: Ida Milne’s book on the influenza epidemic in Ireland comes out in May 2018 and can be ordered through Manchester University Press.

[1] Telephone communication with a family member of Phillip Brady, who worked as a pharmacist at Kelly’s Corner, Dublin, during the epidemic; further details with author.

[2] Irish Independent, 4 March 1919.

Placing Historical Recipes in Fiction: The Lady of the Tower

By Elizabeth St.John

Sir Walter Raleigh and Mr. Ruthven being prisoners in the Tower, and addicting themselves to chemistry, she (Lucy St.John Apsley) suffered them to make their rare experiments at her cost, partly to comfort and divert the poor prisoners, and partly to gain the knowledge of their experiments, and the medicines to help such poor people as were not able to seek physicians. By these means she acquired a great deal of skill, which was very profitable to many all her life. She was not only to these, but to all the other prisoners that came into the Tower, as a mother. All the time she dwelt in the Tower, if any were sick she made them broths and restoratives with her own hands, visited and took care of them, and provided them all necessaries; if any were afflicted she comforted them, so that they felt not the inconvenience of a prison who were in that place.

Lucy Hutchinson
Biographical Fragment
Memoirs of the Life of Colonel Hutchinson

Leaping from the pages of Lucy Hutchinson’s memoirs, this insight to a seventeenth-century woman’s life within the Tower of London immediately set me on a hunt for more information about Lucy St.John and the world she inhabited. Writing about her mother, Lucy Hutchinson chose to focus on the attributes of medicinal skills and recipes she used to tend to the prisoners within the Tower. This paragraph inspired the writing of my debut best-selling novel, The Lady of the Tower, and sent me on a glorious journey into the methods and curatives that were an everyday part of Lucy’s life.

Portrait of Lady Johanna St.John by kind permission of Lydiard House & Park.

These  seventeenth-century remedies were precious commodities exchanged by family and friends alike. And since Lucy St.John would have known her nephew’s wife, Lady Johanna St.John, it was no stretch of the “probable” for me to think that Lucy would be familiar with the recipes within Johanna’s collection, or may even have contributed some of her own.

Already acquainted with Lady Johanna and the Lydiard estate through my own family records, I delved into her recipe book, which is archived at The Wellcome Library in London. (Ed. note: this recipe book has been of much interest to many of us here at The Recipes Project, too! See these posts.) The beautifully preserved leather-bound book contains recipes designed to help a knowledgeable and educated woman manage the health of her family, servants and livestock. Relying on a great deal of herbal wisdom, as well as the more exotic ingredients found in the London apothecaries, Lady Johanna’s book is a testament to the importance placed on remedies, in an age where so little was still known about the body and its infirmities. When I decided to use extracts from the book to illustrate Lucy’s learnings in The Lady of the Tower, I was fascinated to discover that many of the herbal properties and therapies Lady Johanna recommend are still used in pharmaceutical production today.

Extract and Photograph is of Lady Johanna Saint John’s Recipe Book, archived at The Wellcome Library, London, MS 4338.

One particular recipe of interest is that for “Gilbert’s Water.”

It is bad for nothing it cures wind and the colick restoreth decayed nature good for a consumption expels poison & all infection from the Hart helps digestion purifies the blood gives motion to the spirits drives out the smallpox for the grippes in young children weomen in labor bringeth the Afterbirth stops floods for sounding and faintings

Lady Johanna St.John
Recipe Book
1680

Lady Johanna devotes two pages of her precious recipe book to Adrian Gilbert’s Cordial Water, which was perhaps indicative of the importance she placed on its curative powers. The recipe itself was complex, requiring Dragons Burnett leaves (probably the simple dragon’s mace, a common weed), and then moving on to a page full of rarer ingredients, such as “Crab’s eyes taken in the full of the moon.”  Promoting the contemporary belief man shared the virtue of the plants digested, Mr Gilbert was taking no chances with his curative, empowering the recipient with dragon strength to fight his condition.

But there is more to the story. Adrian Gilbert was a well-known alchemist and amateur scientist, and half-brother to Sir Walter Raleigh, himself a distinguished botanist. Adrian’s brother, Humphrey Gilbert, was under the patronage of Robert Cecil and Robert Dudley who maintained an alchemical laboratory in Limehouse. Now it gets interesting. When Sir Walter Raleigh was under the care of Lucy St.John during his imprisonment in the Tower of London, Lucy funded his scientific experiments, lending him her hen house in which to perform his alchemy. I don’t believe it is that much of a stretch to think that Sir Walter and his half-brother Adrian Gilbert traded medicinal recipes, nor that Lucy St.John would keep a record of any precious curatives that came into her possession. For her to then pass these on to her niece, who shared her passion for botany, gardens and curatives, would be a natural occurrence.

Writing credible historical fiction is always about linking the probables, and in connecting Lucy St.John with Lady Johanna and using their common interest in medicinal curatives, I brought truth to my narrative. What is undisputed is these interesting women’s common desire to protect their families and charges from the dangers of seventeenth-century life, and a shared concern for health, hope for treatment, and the rewards of recovery.

The Lydiard Chronicles. Available on Amazon and Kindle Unlimited.

Biography

Elizabeth St.John was brought up in England and lives in California. To inform her writing, she has tracked down family papers and residences from Nottingham Castle, Lydiard Park, and Castle Fonmon to the Tower of London. Although the family sold a few castles and country homes along the way (it’s hard to keep a good castle going these days), Elizabeth’s family still occupy them – in the form of portraits, memoirs, and gardens that carry their imprint. And the occasional ghost.

https://tinyurl.com/AmazonElizabethStJohn
www.elizabethjstjohn.com

Following Valerian: New Name, Old Idea

Katherine Foxhall

In late August, 1781, Sir Charles Blagden, physician, Francophile, army surgeon and Fellow (later to be Secretary) of the Royal Society of London received a letter from his friend, Thomas Curtis. Curtis was concerned about the health of his son, who for more than a decade had suffered a ‘very peculiar kind of head ach’ with ‘a dizziness, or partial vision’, and which recently seemed to coincide with the fortnightly full or changed moon. Curtis had sought the opinions of plenty of doctors, but their prescriptions had failed. Blagden responded swiftly. He proposed that the young man was suffering from what the French called migraine. Blagden was not convinced that the moon’s phases were causing Curtis’ illness, but if the young man’s disease returned on 12 September 1781 (the date of the next full moon), Blagden instructed that the young Mr Curtis should have twelve ounces of blood taken a week later, and then to trial valerian ‘in considerable doses’, increasing the dose until his stomach could bear no more.

'Valerian'. Credit: Wellcome Collection: https://wellcomecollection.org/works/rw9eqv2m.
‘Valerian’. Credit: Wellcome Collection: https://wellcomecollection.org/works/rw9eqv2m.

Having long been known as an anticonvulsant, by the middle of the eighteenth century the herb Valerian had become something of a fashionable prescription for treating migraine. The distinguished physician Richard Mead, author of the famous Treatise concerning the influence of the sun and moon upon human bodies (1748) recommended frequent use of valerian root for periodic diseases of the head ‘pulverized before it shoot out its stalk’.[1] This seems to have prompted the Scottish physician John Fordyce to try it for his own hemicrania. Finding it of very great benefit, he recommended taking drachm doses of valerian three or four times a day in his essay De Hemicrania (1765). Erasmus Darwin included both bleeding and valerian in Zoonomia as treatments for the symptoms of hemicrania, and physicians throughout the nineteenth century would continue to recommend the herb. Such influential texts explain why Blagden turned to valerian for his young patient’s periodic ailment, but it struck me that this had not been one of the herbs that I had come across during the many months I had spent researching the Wellcome Library’s collection of recipe books for seventeenth century migraine remedies, though Nicholas Culpeper talked of valerian’s warming properties, and recommended the root for headache, diseases of the eyes, wounds splinters and thorns. I forgot about Curtis, and moved on. Then, by accident, I discovered that the valerian family also contains a plant called spikenard, and the penny dropped. Like valerian root, spikenard has an earthy musky odour, and a similar effect on the body – having sedative and relaxing properties. Suddenly, valerian didn’t appear to be an eighteenth-century story, but an episode in a longer history, which I’ve written about here before.

But the story goes back even further. The dispensatory of the Nestorian physician and pharmacologist Sābūr ibn Sahl, from southwestern Iran, is one of the earliest pharmacopeia written in Arabic. Dating from the ninth century CE, it provides important evidence of medieval Eastern Arabic medical practice. In Chapter Four of the dispensatory instructions set out the preparation of nard oil, an expensive essential oil with sedative properties used to treat hemicrania, among other things. This was an expensive recipe requiring a large investment to collect over twenty herbal ingredients (including cyprus, laurel, elecampane, citronella, myrtle leaves, wild caraway, forget-me-not, sweet marjoram, stalkless roses, fresh myrtle-water, myrrh and grape ivy), and prepare them with different liquids in three stages taking several days. The third stage took Indian spikenard (the ingredient that gave ‘nard oil’ its name), pounded together with cloves, storax, nutmeg, added to fresh water, balm oil and the strained oil from the previous two stages. Then the whole concoction should be boiled until the water had disappeared, before being bottled, stored and used as required.

Remedies for 'Mygreyn' in a Fifteenth century leechbook. Credit: Wellcome Collection MS.MSL.136: https://wellcomelibrary.org/item/b19295467#?c=0&m=0&s=0&cv=192&z=0.0194%2C0.2362%2C0.8409%2C0.673.
Remedies for ‘Mygreyn’ in a Fifteenth century leechbook. Credit: Wellcome Collection MS.MSL.136: https://wellcomelibrary.org/item/b19295467#?c=0&m=0&s=0&cv=192&z=0.0194%2C0.2362%2C0.8409%2C0.673.

Several centuries later, we find a mid fifteenth-century English ‘leechbook’ contained a recipe for migraine attributed to ‘Galen the good philosopher’ that required several of these same ingredients: nutmeg, ginger, cloves, a pennyweight of ‘spiknard’, anise, elecampane, liquorice, and sugar. By the sixteenth century, spikenard was appearing in print. In 1526, the anonymously published A New Book of Medecynes gave a recipe for migraine, postume and dropsy requiring ‘iiii peny weyght of the rote of Pyllatory of Spayne / a half peny weyght of Spygnarde’, ground together and boiled in good vinegar. The compilers of recipe books (including this blog’s favourite Mrs Corlyon) adapted these remedies to local conditions, substituting herbs of similarly warm, dry and aromatic qualities (such as sage and rosemary) that they could more easily obtain or grow. Following translations is notoriously hard, as Sietske Fransen’s post shows, but spikenard and valerian have weaved their way through more than a thousand years of migraine history. Does it work? Perhaps. It certainly has sedative properties, so today it’s more commonly used for insomnia.

[1] Richard Mead, A Treatise concerning the influence of the sun and moon upon Human Bodies and the Diseases thereby produced trans. Richard Stack (London: J. Brindley, 1748), 84-6

*****
Katherine Foxhall is Lecturer in Modern History at University of Leicester. Her new book, a history of migraine, will be published by Johns Hopkins University Press in 2019.

“Bonny-Clabber Physicians”: Eating Clean in the Seventeenth Century

Michael Walkden

NPG D31284; Thomas Tryon by Robert White, after Unknown artist, line engraving, 1703. Credit: WikiCommons.
NPG D31284; Thomas Tryon by Robert White, after Unknown artist, line engraving, 1703. Credit: WikiCommons.

The concept of ‘clean eating’ is nothing new, but ideas about what constitutes ‘clean’ or ‘dirty’ food have varied within and across cultures. In the later seventeenth century, the popular health writer Thomas Tryon promoted a “radically clean” vegetarian diet as a route to longevity and clarity of mind. However, Tryon’s meat-free menu was rather different from the quinoa bowls and kale smoothies of modern-day clean-eaters. His 1694 Pocket-companion contains the following recipe (easy to follow, but emphatically not to be tried at home):

Boniclabber is made by letting your Milk stand till it sowers, which will be in Twenty-fours hours, if the weather be very hot. [1]

Tryon’s ‘bonny clabber’ – an Irish country dish that was later enjoyed by immigrants to the USA – would have great difficulty in meeting twenty-first century Western standards of food hygiene. Writing well before the advent of pasteurization, Tryon would likely have used raw milk straight from the cow, which would have been rich in bacteria that could be both beneficial and harmful to the human body. If it was left at just the right temperature and for the appropriate length of time, the finished product would be a thick, fermented milk, similar to yoghurt or kefir.

Perhaps unsurprisingly, not all of Tryon’s contemporaries shared his enthusiasm. Gideon Harvey wrote that “Bonny-Clabber Physicians” routinely endangered their patients by their over-use of milk products, which he viewed as highly corruptible and prone to curdling in the belly. [2] Harvey had the weight of medical tradition on his side. Humoural physicians since Hippocrates frequently expressed mistrust or even fear over the coagulability of milk, with Galen writing that it “turns to wind in the stomachs of most people, and there are very few who avoid this.” [3]

Clabbered milk. Credit: WikiCommons.
Clabbered milk. Credit: WikiCommons.

Tryon attempted to forestall this sort of criticism in his own writing. Since he believed that digestion operated by a process of fermentation, it logically followed that fermented foods should be easier on the stomach, having already undergone the initial stages of this process. While he was prepared to admit that it “may not be so agreeable to the Pallat at first”, Tryon assured his readers that “a little Custom will make it familiar and pleasant.” [4]

Attitudes towards the healthiness of clabber were also closely tied up with racial stereotypes about the Irish, whose perceived gluttony and barbarism were ridiculed by many English Protestants. In 1652 the parliamentarian Samuel Sheppard wrote of an anonymous royalist that “his Intellect is as foule, as an Irish Firkin of Bonny Clabber”, suggesting that many viewed it as a disgusting or dangerous substance. [5] By contrast, in a 1635 letter from Dublin, the English royalist and Lord Deputy of Ireland Thomas Wentworth described clabber as “the bravest freshest Drink you ever tasted.” [6]

The example of bonny clabber raises some interesting questions about the relationship between ideology and diet. As Carla Cevasco has flagged up elsewhere on this blog, the categories that shape affective responses to food can be highly variable, ranging from the genetic makeup of a population to its social norms. Disgust that feels instinctive or biologically hard-wired might just as easily be the product of a specific cultural moment. As the debate over clean eating continues to rage, we need to pay closer attention to the ideological fault-lines upon which we construct our ideas about food and hygiene.

[1] Thomas Tryon, A pocket-companion, containing things necessary to be known by all that values their health and happiness (London: Printed for George Conyers, 1693), 6.

[2] Gideon Harvey, The art of curing diseases by expectation (London: Printed for James Partridge, 1689), 38.

[3] Galen, Galen on Food and Diet, ed. Mark Grant (London and New York: Routledge, 2000), 165. See also Ken Albala, “Milk: Nutritious and Dangerous,” in Milk: Beyond the Dairy: Proceedings of the Oxford Symposium on Food and Cookery, 1999, (Devon, UK: Prospect Books, 2000), 19-30.

[4] Tryon, Pocket-companion, 7.

[5] Samuel Sheppard, The vveepers: or, the bed of snakes broken (London: Printed for Thomas Bucknell, 1652), 6.

[6] Thomas Wentworth, The Earl of Strafforde’s Letters and Dispatches, Volume 1, ed. William Knowler (London: Printed for the editor, by William Bowyer, 1739), 441.

Michael Walkden is currently completing his doctoral thesis in History at the University of York, UK. His research explores understandings of the relationship between emotions and digestion in early modern English medicine. He is particularly interested in the intersection of diet, health and spirituality in the seventeenth century.