Category Archives: Medicine

Early Modern Breast Surgeries and Recipes

I’ve been a teaching assistant twice for a two-semester survey of the history of western medicine offered at the Johns Hopkins University. The full sequence takes undergraduates from Hippocrates to Obamacare, with the second semester covering the Enlightenment to the present. One of the pleasures of teaching a discussion section during the second semester is that it allows me to explore the history of our own institution with a group of undergraduates, many of whom themselves hope to work in healthcare and perhaps to study medicine at Johns Hopkins.

Halsted
William Halsted. Source: National Library of Medicine, IHM. 101417923.

A key, fascinating figure in the early history of Hopkins–and one who bridges central course themes as we shift from the early modern, to the modern, to the contemporary–is William Halsted. He was one of the “Big Four,” a brilliant surgeon, an accidental cocaine addict. Halsted is well known for his role in the history of mastectomy, and in this as in other areas of his career he can illuminate these themes for students. His life and career, for example, epitomize the promises and perils of developments in nineteenth-century surgery. I also believe that the history of radical mastectomy has particular power for many because the tensions that the measure introduced into the lives of sufferers continue to be recognizable in our own. We all have friends and family who have suffered from and with cancer and cancer therapies, and many have faced decisions over difficult breast surgeries. These tensions also persist at the level of public policy. For instance, just in the last few days, as I was preparing this post, I listened to a contentious panel discussion on the American public radio program “The Diane Rehm Show” about routine mammography.

I don’t want to suggest that our and our loved ones’ medical experiences are in any way the same as Halsted’s patients’, much less those of early modern people who contemplated going under the knife, but I do want to suggest here that making such connections may help us and our students think about and empathize with historical actors who often seem very foreign from us. Recipe books might seem like poor sources for doing this, but if we look closely I think that there is in fact evidence of a great deal of emotion and drama. It is visible, for instance, in recipes that heal breasts, especially breasts threatened by dire maladies and consequently surgeons’ tools.

Amputation
Halftone of Bodleian Library window. Source: National Library of Medicine, IHM. 101409068.

As scholarship such as Lucinda Beier’s on the London surgeon Joseph Binns has shown us, workaday early modern surgeons did not perform much invasive surgical work.1 Opening the body and reaching into it with tools and chemicals was usually a last resort, but it was one some surgeons and sufferers were willing to undertake. Operations like craniotomy, lithotomy, and, of course, limb amputation are the best known pre-modern measures. Surgeons also sometimes cut into afflicted breasts, removing portions of breasts or even amputating them entirely.

A vivid instance of an early modern breast surgery can be found in the writings of Richard Wiseman. Wiseman was sergeant-surgeon to Charles II and an influential surgical author. One of his published cases describes the sufferings of a twenty-six-year-old “Country maid.”The woman was afflicted with an ulcerated cancer of the right breast “arising from some accidental Bruise.” It had progressed to a grim stage. Wiseman decided the breast could not be cured, and urged that it should be cut off before “a Fungus” which he thought lay deep in the breast “should be fixed to the Ribs.”

Wiseman
Richard Wiseman. Source: National Library of Medicine, IHM. 101432120.

Wiseman won some sort of consent, though how ready it was is perhaps indicated by his explanation that she and her companions “were not unwilling that it should be cut off” and that their decision took a month. Wiseman himself seems to have been much more eager, having just received “the Royal Stiptick liquor” at the king’s command. He saw the surgery as “seasonable” for experimenting with it, in the presence of “some Friends who desired to see the efficacy.”

I should warn you that his description of the operation is difficult to read. Like many early modern surgeons’ description of operations, it also largely occludes the patient and her experience. I will quote it at length here, however, because I think that it gives a powerful glimpse of what an invasive procedure was like at this time. But please skip the next two paragraphs if that is not a glimpse you’d like to take. Wiseman’s associate, the physician Walter Needham,

pulled up the Breast while I made a Ligature upon the basis of it, and cut it off. The two Arteries bled forcibly out, till Doctor Needham applied a wet Button [lint soaked in the water] on the one, and… [an assistant] applied the other… [One] stopt the Bleeding at that very instant… but the bloud dribbled from under the other: which we supposed happened by reason of the bloud streaming upon it in the putting it on. But by the application of a fresh Button the Bleeding there also stopped. During this the Lips of the wound were brought nearer to each other by a cross stich. We then applied our Digestive with convenient Bandage over it, and laid the Patient in her Bed. [They left, and] In our absence she fainted, and upon the drinking a draught of cold water vomitted, and her Breast bled through the Dressings. Upon sight thereof I took off the Dressings, and seeing one of the Arteries seepe, I applied a fresh Dostil [dossil], and stopt it: but it being night, and dreading mischief might happen if it should bleed again, I sent for a small Button cautery, and that way secured it. (“I secured that Artery by the touch of a hot Iron,” he explained in another account of the operation.)

The woman had some difficulties after the operation, but she returned to the country a month and a half later. Once there, however, the cicatrix “fretted off” and the ulcer grew. She returned to Wiseman, who treated her successfully. “Since which time,” he concluded, “I have seen her often in Town in very good health, and her Breast firmly cicatrized, without pain or hardness.”3

It’s surgical measures like this that give us a sense of what what authors and compilers had in mind when they collected remedies that saved breasts destined for the knife or powerful chemicals. The Johanna St. John collection, featured in a number of earlier posts here, has a striking example. It is “For a Cancer in the Breast”:

A piece of a sheep skin taken off the Flank of the sheep lay the skin side to the breast changing it once in 12 hours & in hot weather once in 6 hours this was used to a woman whose breast was to be cut off but was not broke & it kept her very many years without any pain or trouble & at last died of another disease La Child knew the woman to whom it was taught by a French man.4

This tale, as well as the information about the provenance of the remedy and the presence of similar examples, indicates the involvement of collectors in a world of remedies for serious medical problems that offered them the chance to control the measures they used and offered them the hope of avoiding the most unpleasant. Quacks offered something similar when they peddled non-mercurial pox treatments.5

I am very interested to know whether you’ve found similar sorts of material in recipe books that might give evidence of therapeutic preferences. I’m also interested in how recipes (these sorts and others) have been or could be used in teaching the history of pre-modern medicine, especially to students in survey courses. In my favorite activity from the first half of our survey, we give groups of students a selection of seventeenth-century medical advertisements and ask them to think about what the advertisers were offering, how they offered it, and why it may have been appealing to consumers. Would it be possible to design similar sorts of lessons using selections from recipe collections? How else can we use collections and recipes in the classroom, especially when teaching students that are new to early modern history and working with primary sources?

 

 

1 “Seventeenth-Century English Surgery: The Casebook of Joseph Binns,” in Christopher Lawrence (ed.), Medical Theory, Surgical Practice: Studies in the History of Surgery (London: Routledge, 1992): 48-84, and Sufferers and Healers: The Experience of Illness in Seventeenth Century England (London: Routledge & Kegan Paul, 1987), chp. 3.

2 Michael McVaugh, “Richard Wiseman and the Medical Practitioners of Restoration London,” Journal of the History of Medicine 62 (2007): 125-40. He briefly discusses this case on 133-34.

3 Eight Chirurgical Treatises, 3rd ed. (London: for B.T. and L.M., 1697), Wing W3106A, pg. 108-109, “Observat. of a Cancerous Breast cut off.” Phil. Trans. 8 (1673): 6039. Italics removed.

4 Wellcome MS 4338, fol 18v. I’ve modernized the spelling here.

5 For instance: Andrew Wear, Knowledge and Practice in English Medicine, 1550-1680 (Cambridge: Cambridge University Press, 2000), 271.

Some “Fishy” Remedies for Madness and Melancholy

By Pamela Deagle

Johanna St. John’s recipe book contains many interesting and unusual recipes on the treatment of madness, melancholy, and fits of the mother early modern. These recipes offer clues to the domestic understanding of mental illness and its causes. There were very few similarities between the recipes in St. John’s book, suggesting that although there were only a few early modern categories of psychological disturbances, there was wide variation within each category. This has led me to discover some “fishy” recipes for the treatment of madness and melancholy that are certainly questionable as to their success. The domestic treatment of mental illnesses is an interesting point of study for seventeenth-century England, because the care of the mentally ill was left to their family and friends. Asylums before 1700 were relatively small, rare, and expensive (MacDonald, 262, 266).

So what did people think caused mental illness? The herb borage, used for fevers and to comfort the spirits, was the only repeated ingredient used in two recipes for melancholy. As well, the recipe “For vapors euen to Madnes” calls for powder of holly leaves, used for the treatment of fevers. Fevers and psychological afflictions were thought to be linked. In a recipe “For Melancholly and madnes”, the main ingredient is ivy or ale-hoof, used for spleen ailments and melancholy. This suggests melancholy and spleen problems were connected. According to early modern medicine, physical ailments in one area of the body might affect an entirely different area (Wear, 134-135).

A Tench. Engraving by R. Carpenter after C. Hardy. Credit: Wellcome Library. 

One particularly strange remedy is literally fishy. “A medecine For Madnesse”, if taken in time, requires a fish (specifically the tench) to be cut open, rubbed with mithridate and tied around the neck, “guts and all”. Although more of a mystery as to what exactly the benefits of such a treatment would be, there is some suggestion of a belief that inanimate objects would allow the transfer of the illness away from the person and into the object. As well, the tench, also known as the “physician fish” supposedly had magical properties in its slime (OED).

This wide variety in the domestic treatments for madness and melancholy provides insight into how early modern people understood and treated mental illnesses. As well, these recipes indicate that individuals suffering from mental maladies were regularly treated at home. Today we would most certainly not treat depression by tying a fish, guts and all, around the neck, but our own understanding of mental illnesses is far from complete. Perhaps hundreds of years from now our methods may seem just as “fishy” as those used in the early modern period.

Works Cited
“Culpeper’s Complete Herbal Alphabetical Index.” Complete Herbal. http://www.complete-herbal.com/culpepper/completeherbalindex.htm#b, 2010.

Lindemann, Mary. Medicine and Society in Early Modern Europe. Cambridge: University Press, 1999.

MacDonald, Michael. “Women and Madness in Tudor and Stuart England.” Social Research 53, 2 (1986): 261-281.

“Tench, n1.” The Oxford English Dictionary. 3rd ed. 2002.

Wear, Andrew. Knowledge & Practice in English Medicine, 1550-1680. Cambridge: University Press, 2000.

The Early Modern Matter of Fecal Medicines

Whilst perusing some seventeenth century recipes for medicines I stumbled across a few curious ingredients. Granted, many of the ingredients found in Johanna St. John’s recipe book – aside from now common herbs and spices like cinnamon or saffron – might look odd to the modern eye. Some of the ingredients that struck me were spermaceti (sperm whale fat); the sole of an old but clean shoe, burnt to ashes; a crab’s eyes, and the black tips of its claws.

As I read I couldn’t help but assume that the addition of spices, or the use of wine, sugar, and brandy might have best served to make some of the recipes more palatable. But then something caught my eye that all the cinnamon, saffron, and distillation could not possibly conceal. To put it lightly, it was, well, poo. Precisely, for smallpox, “a sheep’s dung, cleane picked”. Clearly you would want to make sure you were getting pure, uncontaminated crap. The recipe goes on to instruct the user to mix a handful of the stuff into a pint of white wine, “mash it well” and after leaving it to stand a full night, to serve a spoonful or two at a time. But wait, there’s more! A note tucked into the margin recommends this smelly recipe for gout and jaundice. Fecal wine, if you will: good for what ails you.

Manure. Credit: Petr Kratochvil

In the mid-seventeenth century Nicholas Culpeper’s Pharmacopoeia Londinensis (1652) heavily criticized the Royal College of Physician’s required inventory for Culpeper and his fellow apothecaries. In his work, which translated the tome on medicine to English from Latin for the first time during the English Interregnum, Culpeper wrote this of a section featuring “living creatures” and “their excrements”: “alack! alack! the king is dead, and the College of Physicians want power to impose the turds upon men” (Culpeper, 52). Culpeper was right, it seemed many were holding onto ideas about fecal medicine. However, while most insisted that ordure altered by the art that was physick was medicinal, some practitioners had more radical ideas about the uses of feces and medicine.

Culpeper’s Pharmarcopoeia, Credit: Wellcome Library, London.

Paracelsus was an enthusiastic alchemist, whose writings from the mid sixteenth century blasted Galenic based humoral models that were then commonly taught at European universities. Historian Philip Ball explains that Paracelsus’ particular alchemy “was concerned not with gold making, but with medicines” (Ball, 164). The Swiss magus claimed that regular doctors forced “worthless, bookish remedies” on the sick  “by following ancient methods” strictly for gain (Ball, 165). Paracelsus claimed to have found an alternative to the medicines of the ancients by experimentation, which left him with the conclusion that alchemical processes could render the virtues of nature by separation: “a parting of the detritus and waste of mundane reality from the vital healing forces of nature” (Ball, 165).

Line engraving of Paracelsus, Wellcome Library no.7594i. Credit: Wellcome Library, London.

And he just loved manure, as you may have guessed by now. Paracelsus was convinced by his alchemical experimentation that “‘decay is the beginning of all birth’ – and of all health, for ‘that which prevents putrefaction also will prevent health'” (Ball, 205). This is how Sir Robert Boyle, eminent scientist of the Royal Society would come to recommend human excrement, dried into powder, and blown into the eyes as a treatment for cataracts (Sugg, 152).*

During the period of the English Civil War, the writings of Paracelsus polarized the medical community, and Ball argues that as civil war approached, Paracelsians formed line with Parliamentarians while Galenic minded scholars went with the Royals (Ball, 358). Historian Richard Sugg explains,  “Paracelsianism flourished during the Civil War and Interregnum, congenial to many of those who – like Culpeper – practised iconoclasm at various levels” (Sugg, 39). Despite congeniality in iconoclasm, Culpeper wasn’t having the dung. Unfortunately for him, however, the divergent views of medicine both found their respective reasons to prescribe crappy remedies, with Paracelsians and Galenics promoting poop for years to come (Sugg, 163-168).

*Boyle’s manuscript reads: “Take Paracelsus’s Zebethum Occidentale (viz. Human Dung)”. Boyle explains that his recipes are classed by letter: “whereof A, is the Mark of a Remedy of the highest classes of these”. The recipe for cataracts was marked with an ‘A’.

Works Cited:

Ball, Philip. The Devil’s Doctor: Paracelsus and the World of Renaissance Magic and Science. New York: Farrar, Straus and Giroux, 2006.

Boyle, Robert. Medicinal Experiments 5th edition. 1712. Gale DocNumber: CW10708275

Culpeper, Nicholas. Pharmarcopoeia Londinensis, or The London Dispensatory. 1652.

Sugg, Richard. Mummies, Cannibals, and Vampires: The History of Corpse Medicine from the Renaissance to the Victorians. London: Routledge, 2011.

The Wonders of Unicorn Horns: Preventions and Cures for Poisoning

Johanna St John’s Book, Credit: Wellcome Library, London

In Johanna St. John’s recipe book, the mysterious “Banister’s Powder by Dr Bates” lay nestled between the equally intriguing “Mrs Archers way of makeing My Lady Kents Powder” and the beginning of the letter “R” section of St. John’s efficiently organized recipe book. There is no indication what type of recipe this “Banister’s Powder” was, besides a powder, or what it’s intended use was. Following several pages of recipes for “pox” and “pills” this “Powder” is the tail end of St. John’s letter “P” section, however, even knowing this context offers little information. An analysis of the “Banister’s Powder” ingredients suggests a link between St. John’s early modern medicinal recipes and the presence of magical beliefs associated with medicine in the early modern period.

The first three ingredients required to make the “Banister’s Powder” are: powdered Unicorn horn, east bezoars, and the “bones” of a stag’s heart. Each of these ingredients had longstanding associations with the belief they were capable of preventing or countering the effects of poisoning. To a modern eye, these appear strange items to reside alongside many complicated recipes which rely on an expansive knowledge of medicinal, rather than magical, properties. These ingredients indicate that magical beliefs remained acceptable practices among home practitioners in the early modern period. This is possibly because the science to disprove them was not advanced and medical practitioners were only beginning to be skeptical and move away from such unreliable remedies.

The prevention and cure of poisoning was a genuine concern before and throughout the early modern period. It was quite common to be bitten or stung, to consume poisonous berries, roots, or herbs, or to believe a spell had been cast by a witch (Jackson, 96). It was also common for physicians to diagnose poison as the cause when they could not determine the source of an ailment (Auble, 17). This led to the necessity for remedies to detect, prevent and cure poisoning.

Rhinoceros Horn Vessel, Credit: Wellcome Library, London

 

Pharmacy sign, Credit: Wellcome Library, London

Unicorn horns were actually believed to come from the mythical creature and possess its symbolic purity and strength, though they were most often a narwhal tooth or powdered rhinoceros horn. The horns were commonly powdered and used in poison antidotes or as vessels to drink from before or after ingesting poison (Jackson, 97). Unicorn horns were also believed to have properties which allowed them to detect poison (Knight, 245). In addition to being thought to detect, prevent or cure the effects of poison, the horns were also thought to strengthen your heart, relieve headaches, resist the plague and pestilence, expel measles and small pox, and cure “falling sickness” in children (Brockbank, 3) all of which were reoccurring ailments in the early modern period.

 

Bezoar stones were solid masses from the intestines of goats, sheep or deer that were primarily believed to detect poisons but also, in some cases thought to provide a cure if small amounts of the stone were consumed. “Oriental” or “East” Bezoars, as St. John called for, were the most valuable type which came from a Persian wild goat (Jackson, 97). It was occasionally consumed, but more commonly mounted on a chain and dipped in to drinks to nullify the effects of poison if there was any (Jackson, 97). Queen Elizabeth I reportedly kept one “sett in golde hanging at a little Bracelett … The most parte of this stone being spent” indicating the Queen mounted and consumed her stone (Auble, 18).

Mounted Bezoar Stone, Credit: Wolfgang Sauber

The belief in the magical powers of the “bones” from a stag’s heart originates from a folk tale. The tale is that stags ate poisonous snakes by sniffing them out of holes and then after which they rushed to drink water. The “bones” in their heart were believed to be what protected the stags from being poisoned. The “bones” were actually caused by the degeneration of arteries into flat, oblong bone like objects. Powdering and consuming this “bone” was seen as a preventative measure to protect against the effects of poisoning (Jackson, 97).

Unicorn horn, bezoars and “bones” from a stag’s heart, were the key ingredients to the “Banisters Powder” in St. John’s recipe book. Because of the longstanding beliefs about these ingredients and their associations with poisoning detection, prevention and cures, this recipe was perhaps intended to cure or prevent poisoning. One can imagine the remedy would have been thought to be fool-proof against poison because it combined the powers of each of these ingredients. Although there was a movement away from magical remedies and cure-alls among physicians in the Early Modern period, belief in the curing power of magical objects was still present in the lives of home practitioners such as Johanna St. John. What we would consider scientifically impossible, they were only beginning to discover.

A strong belief in unexplainable phenomenon was common practice and popular beliefs are difficult to dispel, especially when they hold significant symbolic value. Just the other day the North Korean state media associated the discovery of a Unicorn Lair with their new young leader. It is hoped this association would strengthen the nation’s confidence in their young leader because of the symbolic meaning of the Unicorn and its ties to the state’s history. This example illustrates that a belief in the symbolic power of an object, like a Unicorn or its horn, bezoars, or “bones” from a stag’s heart can transcend both time and logic, persisting even when its truth is questionable.

Works Cited:

Auble, Cassandra. “The Cultural Significance of Precious Stones in Early Modern England.” Dissertations, Thesis, & Student Research, Department of History, University of Nebraska Paper 39 (2011).

Brockbank, William. “Sovereign Remedies: A Critical Depreciation of the 17th-Century London Pharmacopoeia.” Medical History 8.01 (1964): 1-14.

Jackson, William A. “Antidotes” Trends in Pharmacological Sciences 23.2 (2002): 96-98.

Knight, Katherine. “A Precious Medicine: Tradition and Magic in Some Seventeenth-Century Household Remedies” Folklore 113.2 (2002): 237-247.