All posts by Saskia Klerk

Post-doc research fellow at the Charité Institut für Geschichte der Medizin und Ethik in der Medizin (Berlin) attached to the ERC-funded project, “Ways of writing. How physicians know 1550-1950” since October 2014.

I have been developing the projects´ natural historical side. Accordingly, I focus on physicians´ interest in plants, minerals and animals. I am particularly interested in how their reading and writing practices generated knowledge and what these practices tell us about the social and cultural position of physicians.

I will remain with the project until October 2017.

Before I came to Berlin, I worked at the Utrecht University Institute for the History and Foundations of Science, led by Bert Theunissen. There I wrote my dissertation entitled: “Galen reconsidered. Studying drug properties and the foundations of medicine in the Dutch Republic (ca.1550-1700)”.

The Order of Things (2)

By Saskia Klerk, with Sietske Fransen.

Over a year ago, Sietske and I started our ongoing series on a Dutch recipe collection BPL 3603, kept in the Leiden UL. We have already learned much about the manuscript and its compiler from examining a number of entries. But, as Sietske showed in her most recent post, there is more to discover by turning our attentions to the organization of the manuscript as a whole.

We recognized a certain order to how the recipes were entered into the 70-folio volume. Especially the fact that a first set of pages (p. 1-76) is alphabetized and a second set (p. 77-122) isn´t, appears significant. Still, some anomalies remained a bit of a mystery to us. A closer look at the alphabetical organisation of the first part was a big eye opener.

We can be sure that, as Sietske has suggested, the recipes in the volume were transcribed from a collection of recipes kept in a notebook or on loose slips of papers, which then formed the basis for further collecting.[1] The recipes were initially ordered alphabetically, mostly according to the affliction they were supposed to cure.

The manuscript allocates only one page to the letter "E", marked on the top right corner.
The compiler allocated only one page to the letter “E”, marked on the top right corner.

To fit his recipes into the manuscript, the compiler took into account how much room he needed for each letter. The number of pages assigned varied from one half-filled page for afflictions starting with “E” (p. 11), to the seven full pages for the letter “O” (p. 32-38).

Crucially, he marked only the recto pages with a letter in alphabetical order and initially left the verso pages blank. In this way, the verso pages remained open for additions and their letter grouping could be assigned later, creating a flexible information organisation system. Additional recipes transcribed on the verso pages tended to start with or contain the letter on surrounding recto pages.

A variety of tobacco illustrated in Johannes Neander´s Tabacologia (Leiden 1622).

The letter T shows how this system worked. Two and a half recto pages were filled with cures for toothaches and loose teeth (p. 55, 57 and 59), leaving space on the last recto page for additional recipes. Two of their verso pages are assigned to cures for consumption and split nipples on the one hand and a discussion of the virtues of tobacco on the other (p. 58). Importantly, the one page in the manuscript that remains completely blank is a verso page (p. 60).

Many recipes were later added onto the initially blank pages. This arrangement meant that on the verso pages of part one, we find materials that the compiler came across after he designed the manuscript with the alphabetical organisation.

As Elaine Leong has pointed out here, arranging recipes within a basic, alphabetical organisation is not as straightforward as it might seem. Clearly, this was the experience of the compiler of BPL 3603.

Practicalities such as running out of space on a page, forced him to reconsider how he categorized recipes. For example, due to space constraints, he entered recipes for the same affliction under as many as three different letters. When the page on dysentery (Rode Loop p. 47) under R was full, the collector grouped further recipes under L with recipes for lame Limbs instead (p. 28) and also under the much broader defined “afflictions of the belly” in the B section, particularly with recipes against diarrhea and stomachache.

His efforts to organize his recipes provides a perspective on how decisions about appropriate treatment could be informed by the organization of medical knowledge on paper.

Seventeenth-century physicians tended to organise their knowledge around illnesses rather than recipes, in order to choose a treatment. Various complaints, loose teeth and joint pain for example, could be subsumed under one disease, scurvy, and treated with the same remedies. On the other hand, dysentery (Rode-loop) distinguished itself from diarrhea (Buick-loop) by the presence or absence of blood in the stool, and each required different treatments.

This manuscript reveals the different organizational options that this compiler´s focus on recipes presented him with. He considered the area or part of the body where an illness occurred, its different common names, the letter that a recipe contained or started with, its main ingredient or manner of preparation.

An unexpected result of choosing where to put a new recipe on paper, the compiler of our manuscript also created new relations between illnesses and treatments. Why not try a recipe for dysentery in case of diarrhea or stomachache? The creative arrangement of recipes by the compiler might have led to more such epistemic effects than we initially realized.

[1] The recipe collection of Constantijn Huygens (1596-1687), a prominent diplomate and poet, remains in the form of such untranscribed and unorganized notes and slips of paper, in the Dutch Royal Library: Mss. KB: KA 47.

To break or not to break (Part 2): From Cairo to Dordrecht

By Saskia Klerk, with Sietske Fransen

In the eleventh chapter of his Steen-Stuck (Treatise on the Stone, 1637), Johan van Beverwijck related a story of an encounter in Dordrecht, the Dutch city where he was town physician. A man had shown him the pieces of stone that he said had been broken by the following recipe. Van Beverwijck tried it himself, but had not found the same results. Still, he noted, the pieces of stone that the “trustworthy man” showed him, would together make up a large stone.

Broken bladder stones from Des monstres et prodiges (1573) by Ambroise Paré (c. 1510– 1590). From the Lyon edition of 1664.
Broken bladder stones from Des monstres et prodiges (1573) by Ambroise Paré (c. 1510– 1590). From the Lyon edition of 1664.

Around 1677, the compiler of Ms BPL 3606 copied this passage, leaving out Van Bever-wijck´s skeptical remark. Apparently, he found the display of broken stones, a tactic we have encountered before, to be persuasive proof of the recipe´s effectiveness.

When Sietske and I started our blog series on this Dutch recipe collection, I did not expect most of my posts to be about “stone breaking” remedies such as this one. However, they turned out to have been of particular interest to its compiler. By pursuing this interest, Sietske and I have learned quite a bit about him and his world. For example, we now suspect that he lived in or near the province of Zeeland in the south-west of the Dutch Republic. We also confirmed Sietske´s earlier observation, that the compiler especially noted down remedies that where accompanied by favorable experiences. In my last post, I showed that the compiler of BPL 3606 used Steen-Stuck´s tables of contents to find the information he was looking for.

As I continued studying the manuscript, the question of why there are so many stone-breaking remedies in it became more pressing. In an earlier post, Seth LeJacq laid out the persuasive answer that patients’ fears of surgery led them to explore alternative therapies. Master Reijmers´ story has shown us that the compiler of BPL 3606 shared these fears and desires. Perhaps, this is also key to understanding why he included not only so many recipes for stone breaking remedies in his manuscript, but also three other sections from Steen-Stuck that are not recipes.

Before the recipe, as a “Nota”, the compiler copied a short section on how the stone should be returned to the bladder if it got stuck in the bladder´s neck. In his Treatise on the Stone, Van Beverwijck suggested surgical options to actually remove the stone from the body as well. The compiler copied the most curious of these, after the recipe, as another “Nota”.

Alpinus told of this procedure in Cap. XIV of the third book of De medicina Aegyptiorum (1591) under the title "To remove stones without an incision"
Alpinus described this procedure in Cap. XIV of the third book of De medicina Aegyptiorum (1591) under the title “To remove stones without an incision”

This particular option advised sufferers to blow into the   urethra with a little pipe. Thereby extending it far enough to be able to remove a stone no larger than an olive pit. Despite his interest in the cure, the compiler omits the original source of this procedure, Van Beverwijck´s teacher in Padua, Prosper Alpinus (1553-1617) and the Egyptians amongst whom Alpinus had resided.

The inclusion of treatments such as these  further confirms the compiler´s anxiety towards actually cutting the body. Moreover, I would argue this anxiety was a factor in the transmission of this custom from faraway Egypt to this Dutch recipe collection. Alpinus explicitly mentioned the non-cutting aspect of the procedure in the title of the chapter in which he described it. Van Beverwijck repeated this aspect in Steen-Stuck, before going on to describe cutting the body to remove the stone as a last resort.

Finally, in his exploration of alternative therapies the compiler also recorded knowledge that by 1677 was outmoded to many of his contemporaries.

Section from Van Beverwijck´s, Steen-Stuck (1649) Ch. 11, pt. 4
Section from Van Beverwijck´s, Steen-Stuck (1649) Ch. 11, pt. 4
The same section copied in BPL 3606
The same section copied in BPL 3606

Van Beverwijck named several materials that possessed a stone breaking power. Some of these (such as lime zest and laurel) worked by a manifest quality and others (such as ashes of scorpio and woodlice) by a hidden property. In his note-taking, the compiler was careful to separate these into two lists.

The distinction between manifest and hidden or occult qualities was characteristic of academic Galenic medicine familiar to Van Beverwijck. It was fundamental to explaining the properties of medical materials. Was the way a material worked in the body “manifest”, that is, was it caused by the primary qualities (hot, dry, cold and moist)? Or could this “operation” not be explained from these qualities and was it therefore “hidden”? While this important distinction had come to be questioned by the 1620s, as I described elsewhere[1], Van Beverwijck included it without comment. Accordingly, when the compiler copied out this section, all that mattered to him was that the physician asserted the healing properties of these materials.

Here, the compiler´s fear of cutting the body thus resulted in a quite eclectic collection of materials, surgical techniques and a stone-breaking recipe, originating from as diverse places as Egypt and Dordrecht. Investigating his interest in alternative cures for bladder stones further, has also indicated the practical reasons behind the staying power of (parts of) Galenic medicine, despite its philosophical problems.

[1] Saskia Klerk, “The Trouble with Opium. Taste, Reason and Experience in Late Galenic Pharmacology with Special Regard to the University of Leiden (1575–1625),” Early Science and Medicine, vol. 19, issue 4 (2014): 287-316.

To break or not to break (part 1): Reading Van Beverwijck´s Steen-stuck

By Saskia Klerk, with Sietske Fransen

Johan van Beverwijck (1594-1647)
Portret of Johan van Beverwijck (1594-1647)

Johan van Beverwijck (1594-1647), who we introduced in our first post, was one of the most prominent medical authors of the Dutch seventeenth century. His Steen-stuck [Treatise on the Stone] (1637, 1649, 1656) was the first of his publications in which he proposed not only how to prevent a disease, but also how to cure it. The treatise was rather conventional in its structure however. Being a learned physician, Van Beverwijck discussed where in the body gravel and stones occured, their cause and signs or symptoms and prevention as well.

The compiler of our manuscript (BPL3603) was exclusively interested in chapter eleven, about both medicinal and surgical treatments.

Similar to his dealings with Van Helmont´s work on the plague, the compiler consulted a treatise about the particular affliction he was interested in. He copied five passages from Steen-Stuck into the manuscript, alongside his discussion of master Reijmers, which I examined previously.

As a “Nota” to Reijmers´ recipe, the compiler first copied a recipe that Van Beverwijck singled out amongst several compound medicines.

University Library Leiden, MS BPL3606, p. 121 (selection): first passage copied from Steen-stuck under the page heading "Tried remedies to break the stone".
University Library Leiden, MS BPL3606, p. 121 (selection): first passage copied from Steen-stuck under the page heading “Tried remedies to break the stone”.

The use of the word “Nota” signals that Van Bever-    wijck´s recipe functioned as a comment on Master Reijmers´ , as another example of a stone-breaking remedy. The compiler cited Van Beverwijck as its source, rather than “Dr. Quercetanus´ Pharmacop. Dogm.”, to which Van Beverwijck referred.

The compilers´ choice for this recipe as the first passage to copy from Steen-stuck, deserves further attention because it shows how he read Van Beverwijck´s treatise. The recipe wasn’t the first in the chapter and earlier passages in the source text are copied later in the manuscript.

The content description at the start of the chapter explains the compilers´ choice. The eleven chapter parts are numbered and named. They move from the lightest treatments to the severest: that is, from treatments that would make it easier for a stone to move out from the bladder naturally, to those requiring an operation to remove it. The compiler disregarded this structure and skipped to number six, “on compound medicines to break the stone“. This brought him straight to the recipe that he copied under the page headingTried remedies to break the stone. The content description thus helped him find what he was looking for, information about stone-breaking compounds.

Van Beverwijck had built in a structure by which Steen-stuck could be read from front to back, from the causes of stones to their cure. The content descriptions at the beginning of each chapter however, facilitated different ways of reading the treatise. From this manuscript, we can tell that the compiler used this navigation aid quite effectively.

After including the anecdote about the hare-catching boy in the manuscript, the compiler apparently returned to this chapter in Steen-stuck. His interest in stone-breaking remedies brought him to number four in the chapter, to “those <medicines> that break the stone”. From there, he read through the rest of the treatise and selected four more passages to copy into his manuscript. These selections I will cover in part two of this post.

Catch the Hare: Remedies for the Stone

By Saskia Klerk, with Sietske Fransen

In our previous post we have seen that the writer of BPL3603 was especially interested in Van Helmont´s Dageraed because of its recipes to which he added notes about personal experiences to prove efficacy. There I wondered if we would find the same practice in his selections from some of Van Beverwijck´s writings.  

The parts taken from Van Beverwijck can be found near the very end of the manuscript. They are not placed on their own, like the citations from Van Helmont, however. Instead, they are interspersed with copies from another source, a master Wilm Reijmers. It is the latter’s remedy for breaking the stone that appears to have renewed the writer´s interest in the subject of stone breaking remedies in general and in some of Van Beverwijck´s writings more specifically. He had already included remedies for bladder stones within the alphabetical scheme of the manuscript.

Reijmers sent his remedy in a letter to the writer of BPL3603. Reijmers declared that the remedy pulvarised the stone in the bladder of his patient and the grit was driven out through the urine. Apart from a complicated dosage and a twelve-day long treatment, the recipe also required a living hare. After a short additional passage taken from Van Beverwijck, the manuscript writer says: “I cannot resist to tell something memorable about these matters.”

Goeree was a Northeasterly island of the Province of Zeeland, shown here on a cutout from a map of the Republic of the Seven United Netherlands (1664-1665), from the 'Grooten Atlas; oft, Werelt-beschryving; in welke 't aertryck de zee en de hemel wordt vertoont en beschreven' by Joan Blaeu. Middelburg is shown in red in the bottom left corner, Rotterdam and Dordrecht in the upper right. Courtesy of the National Maritime Museum in Amsterdam.
Goeree was a southwestern island of the Province of Holland, shown here on a cutout from a map of the Republic of the Seven United Netherlands (1664-1665), from the ‘Grooten Atlas; oft, Werelt-beschryving; in welke ‘t aertryck de zee en de hemel wordt vertoont en beschreven’ by Joan Blaeu. Middelburg is shown in red in the bottom left corner, Rotterdam and Dordrecht in the upper right. Courtesy of the National Maritime Museum in Amsterdam.

What follows is an account of events as told by master Reijmers, and confirmed by a burgomaster of Goeree, a Mr. Klimmert.

Two children were suffering greatly from the stone and the local stonecutter Sasbout had been called in.[1] After visiting the children he declared both had quite a large stone in the bladder and there was nothing else to do but to remove them by cutting. One of the children came from a rich farmer’s family. He was operated for the stone and died shortly afterwards. The parents of the other child were poor, and were therefore asking to gather the money for the treatment from church gifts. The church masters, however, didn´t think it advisable to hand over the money, fearing what had happened to the other child.

At this point Reijmers got involved. He said he could easily break the stone inside the body, that is, if a living hare could be provided. It wasn’t hare season though.

Copper engraving by Marcus Gerards (1521-1590) to the fable of the hare and frogs as told by Jean de La Fontaine (1621-1695) and translated by poet and playwright Joost van den Vondel (1587-1679) in Vorstelijcke warande der dieren (Amsterdam 1617, 1730).
Copper engraving by Marcus Gerards (1521-1590) to the fable The Hares and the Frogs as told by Jean de La Fontaine (1621-1695) and translated by poet and playwright Joost van den Vondel (1587-1679) in Vorstelijcke warande der dieren (Amsterdam 1617, 1730).

The next thing we are told is that the boy himself, still greatly pained by the stone, came across a hare caught up in the bushes behind his fathers´ house. In a great struggle, that attracted the attention of neighbours and injured the child himself, the child managed to get hold of it and bring it to his parents. They told master Reijmers what happened, and he cured the child as described above. Reijmers explained that when put together, the grit from the child´s urine (which was collected in a blue cloth) would have made a stone the size of a small chicken egg. 

The author of BPL3603 went on to add that Reijmers successfully treated several others in this way afterwards, to great wonder of the operator (this most likely referred to Sasbout). It is clear that the compiler of BPL3603 shared master Reijmers´ and Sasbout´s wonder at the incident on Goeree. While Reijmers wondered at how the hare was caught, and Sasbout wondered at how Reijmers remedy was successful, the compiler ended his account by praising God. “God alone is the glory, that has giving natural things such power and the people its use,” he wrote. 

I think we can learn several things from this anecdote.

Stone found in the bladder of Thomas Adams, late 17th century. Royal Society Classified Papers, vol. 14i, document 22. Reproduced by permission.
Stone found in the bladder of Thomas Adams, late 17th century. Royal Society Classified Papers, vol. 14i, document 22. Reproduced by permission.

Firstly, on a social-historical level, we saw how poor families could make an appeal to the church for financing medical care. As lay people in medical issues, the council weighted the costs and risks of the operation, both financial and social. Secondly, undergoing an operation for the stone was expensive and something more readily undertaken by the wealthy. However, it was not safer. In this story, the poor child was better off. Finally, the main function of the anecdote was to show that the remedy was effective, similarly to the way the author used Van Helmont to prove the efficacy of remedies for the plague.

Realising this, I began to notice that the pattern in how the writer of BPL3603 processed the medical knowledge he came into contact with, repeated itself in what he selected to copy from Van Beverwijck. My next post will be dedicated to these choices, while Sietske will first investigate more recipes by Van Helmont. Is that another case in which a recipe was personally passed on to the compiler of BPL3603?

 

[1] Two famous stonecutters by the name of Sasbout were active in the area around this time and are mentioned in contemporary sources. The Jakobus Sasbout who was operator in Middelburg and Jacobus Sasbout Souburg, operator in Dordrecht, might have been the same person, especially since Souburg is a village near Middelburg. A.J. van der Aa., Biographisch woordenboek der Nederlanden (Haarlem: J.J. van Brederode, 1852-1878) part 17-1, 133.