Remedies, Surgery and Domestic Medicine

Editors’ note: This post provides a sneak peek of Seth LeJacq’s fascinating article, “The Bounds of Domestic Healing: Medical Recipes, Storytelling and Surgery in Early Modern England“, which recently appeared in the Social History of Medicine. You should go read the whole article! An early version of the article was awarded the 2010 Roy Porter Student Essay Prize by the Society for the Social History of Medicine. The essay prize is a wonderful opportunity for undergraduate and postgraduate students to submit unpublished, original essays. Congratulations, Seth!

By Seth LeJacq

I began poking around in the manuscript recipe collections in the New York Public Library’s Whitney Cookery Collection during my summer research a few years ago, and I was struck by the wide array of ailments different recipes addressed. I was particularly surprised to find many remedies for surgical complaints, and that some recipes also included stories about the efficacy of remedies claiming that they had succeeded when sufferers were “given over” by doctors or had allowed them to avoid invasive surgical interventions.

Dropsy - St John
Johanna St John’s recipe book, Wellcome MS 4338, fol. 49r. Credit: Wellcome Library, London.

Another [for the dropsy]. Eat an handfull of Raisins and a crust of bread or a sea Bisquit in the morning, and drink not till noon, and then eat a peice of bread when you drink this cured Mrs Hearing who was to have been tapp’d.

These simple instructions in the Johanna St John collection, for instance, were said to have “cured” dropsy sufferer “Mrs Hearing, who was to have been tapp’d.” That is, by using this recipe she was saved from having to undergo surgery to drain fluid from her body. I discussed similar sorts of recipes claiming to help avoid breast surgeries in an earlier post. These sorts of recipes show that domestic healers thought they might need to be able to deal with serious surgical complaints. They also show that they were interested in finding alternatives to unpleasant and dangerous surgical therapies.

Even when recipes did not explicitly bill themselves as medicinal alternatives to surgery, collectors may have seen them as implicitly offering such alternatives. Medicinal remedies for bladder stones and cataracts, for instance, would allow sufferers to avoid being cut.

One question I’d still like to answer is whether people may have seen other sorts of recipes in this way. Take childbirth-related recipes. There are many recipes to help with delivery in stillbirth, for instance, such as this recipe, also from the Johanna St. John collection.

Johanna St John’s recipe book, Wellcome MS 4338, fol. 211r. Source: Wellcome Library.
Johanna St John’s recipe book, Wellcome MS 4338, fol. 211r. Credit: Wellcome Library, London.

To bring forth a Dead Child or Afterberth.

mugwort root or herbe wch is then most in strength boyle it in water tender stamp it fine put to it a little wheat chissel boyle it a little againe put it in a linnin Bag Lay it to the Bottom of her Belly as hott as she can suffer it.

Again, this is a fairly simple recipe that helps in a difficult and dangerous situation. What is interesting about recipes like this one is that surgeons claimed that they should be the ones to perform these deliveries. Lay collectors gathered a lot of medical knowledge belonging to the realm of midwives or surgeons. These recipes may be able to teach us more about the relationship between patients and these medical practitioners.

In fact, many recipes are intended to help people address medical complaints that surgeons treated. Early modern surgeons healed injuries and ailments on the exterior of the body, and they worked on keeping the body in good working order and aesthetically pleasing. Thus they could do a wide range of work, from setting broken bones, bleeding, and lancing boils, to cleaning teeth and beautifying the face. All of this was surgical work, and much of it is also found in various recipes circulating among collectors who didn’t work as medical practitioners. We even find recipes for serious surgical problems — fistulas or gangrene, for instance. Recipes of these sorts are common enough that it’s clear that many collectors wanted to (or felt they might need to) deal with problems that surgeons claimed as their own.

Surgeons were well aware that patients found some of their therapies unpleasant and consequently sought out alternatives, including domestic medicine. They sometimes even admitted that this impulse, and the practices of domestic healers, might have something to teach surgeons.

Equestrian portrait of Charles I and title page of the second edition of the Surgeon’s Mate (1639). Woodall’s is the center portrait at the bottom. Source: Wellcome Images.
Equestrian portrait of Charles I and title page of the second edition of The Surgeon’s Mate (1639). Woodall’s is the center portrait at the bottom. Credit: Wellcome Library, London.

Take the arguments for surgical reform in the published works of John Woodall (1570-1643). Woodall was an influential member of the Barber-Surgeons’ Company, the first Surgeon General of the East India Company, and an important surgical author. His Surgions Mate (first edition 1617) went into multiple editions over a half-century. It was the foundational English text on sea surgery, but also had a broad influence among readers of all sorts.

A recipe from Woodall. (See the paper for similar examples). Lady Ayscough collection, Wellcome MS 1026, fol. 46r. Source: Wellcome Library.
A recipe from Woodall. (See the paper for similar examples). Lady Ayscough collection, Wellcome MS 1026, fol. 46r. Credit: Wellcome Library, London.

Woodall remains best known for his writings on scurvy (he was an early citrus booster!), but his works also present a critique of surgical education and practice. He argued that surgeons were sometimes too violent in cutting. He held that aggressive interventions did not allow patients to benefit from the healing power of nature. Woodall used the example of gentle female domestic healers as a model of practice that would allow nature to help. He wasn’t against cutting by any means — he was known for developing a tool to drill into the skull (just see the image below), and was an expert in amputation.

Surgical tools, including Woodall’s trefine. From the 1655 edition of The Surgeon’s Mate. Source: Wellcome Library.
Surgical tools, including Woodall’s trefine. From the 1655 edition of The Surgeon’s Mate. Credit: Wellcome Library, London.

He was, however, receptive to criticisms of surgical practice, and very sensitive to patients’ fears of surgery and desires for alternative therapies. His work provides clear evidence that those fears and desires, which led people to collect the sorts of recipes we looked at above, had an influence on surgeons.

It’s easy to sympathise with patients’ fears of being cut; surgery was painful and potentially quite dangerous. Patients were clearly not content to simply suffer or submit to operations. Recipe books show that collectors wanted options when it came to serious surgical problems.

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.