Category Archives: Bodies

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.

Gumpowder? A strange little recipe for sensitive teeth…

If you go to your bathroom and check the ingredients in your well-known brand of sensitive toothpaste, you may well find that the recipe contains the active ingredient potassium nitrate. Also known as saltpetre or nitre, this naturally occurring mineral is found in foods as a preservative (e.g. corned beef), and used in fertilizer, cigarettes, blood pressure medicines and fireworks. Since medieval times it has formed one of the main ingredients in gunpowder, and it is this connection that has also given potassium nitrate a long association with teeth and gums.

Many of the seventeenth and eighteenth century recipe books in the Wellcome Library’s manuscripts include treatments for gunpowder burns, but some also proposed that gunpowder could be therapeutic. Katherine Jones, Lady Ranelagh (sister to the famous chemist Robert Boyle), recommended a ‘little gunpowder’ applied in a linen cloth to ease toothache. On one page of Anne Brumwich’s recipe book (Wellcome MS 160, p.83) we can find nine recipes for toothache remedies written in two different hands. One, ‘An aproved medecine for ye toothake’ (approved meant that it worked) required gunpowder, aniseed water and lint, mingled together to ‘make a litell thing’.

Once the sufferer had picked their tooth very clean, the recipe instructed them to push the preparation into the tooth, taking care not to allow any of the mixture down the throat.

A century later, in A Treatise on the Scurvy (1795) David Paterson introduced his fellow naval surgeons to a wonderful, and apparently unknown remedy for scurvy: during a voyage in 1784, he claimed, he had restored the health of eighty sick seamen not with lemon juice, fresh fruit or vegetables, but with the potassium nitrate extracted from the gunpowder in his ship’s stores. Paterson’s remedy was soon forgotten, until in 1828, a desperate surgeon named Charles Cameron, having used up all his supplies of lemon juice, remembered Paterson’s recipe. Cameron was stranded in the calms near the equator and he was faced with a ship’s hospital full of scorbutic convicts, less than half way through the voyage to Australia. He extracted the nitre from the powder, dissolved some of it in vinegar, and mixed some more with vinegar and lime juice. He also added a little sugar (to taste?!) The effects were ‘miraculous’.

For the Navy, if Cameron was right, this was a money-saving opportunity; nitre was cheap and did not decompose over time. In the following decades surgeons continued to experiment with different remedies for scurvy until, in 1840, the Admiralty decided to perform a large-scale experiment to determine once and for all the best scurvy remedy. Over the next four years the surgeons of sixty ships transporting fifteen thousand convict men from Britain and Ireland to Australia received crystallised citric acid, potassium nitrate, and lemon juice. Their instructions clearly forbade the surgeons from trying to cause scurvy during the voyage but if the disease did appear, the patients were to be divided into three groups, each group receiving one of the remedies. Of course, the surgeons often had their own ideas, and often altered, combined and varyed the doses according to their own personal favoured recipe. So, while Surgeon Deas mixed some nitre with lime juice and some with citric acid, and felt that both mixtures were useful, Alexander Bryson gave each group the remedies mixed in a glass of wine, water and sugar. After many of the convicts developed severe scurvy, Bryson finally decided that potassium nitrate was ‘objectionable’. The surgeons had come to very different conclusions about the value of potassium nitrate but the results of the experiment were clear; potassium nitrate was abandoned as useless, lemon juice was in for good.

In the mid 1970s, dental researchers – in laboratories this time, rather than on ships – began to report a strange occurrence: mixing potassium nitrate with toothpaste seemed to reduce dental sensitivity in sufferers.  More work confirmed the compound’s beneficial effects, but the scientists still admitted that they were unclear why it should work; being soluble, it seemed that it should simply dissolve in water and wash out of the teeth at first rinse.

Jump forward again to the present, and potassium nitrate is often used as the active ingredient in products for sensitive teeth. So we have come a long way in medical understanding since women like Anne Brumwich stuffed aching teeth with gunpowder soaked lint, or Victorian naval surgeons dosed their convicts with nitre in the certainty that it helped with scurvy, and yet nitre has proved persistent: these earlier ideas about potassium nitrate’s ability to reduce not only the pain of toothache, but the symptoms of scurvy – a disease so commonly experienced in the mouth and gums – are worth wondering about.

 

Katherine Foxhall is a Wellcome Postdoctoral Researcher in History at King’s College London. Currently working on a history of migraine, Katherine has worked in the past on the history of migrant health, maritime quarantine, and illnesses including scurvy, cholera and typhus. Her book, Health, Medicine and the Sea: Australian Voyages, c. 1815- 1860 has recently been published with Manchester University Press.

Green sickness, red plants

By Helen King

I’ve been interested for a long time in green sickness, a condition affecting girls at puberty that involved menstrual suppression, often along with some sort of dietary ‘blockage’. The remedies for it, over the 400 or so years that it was recognised as a disease, raise all sorts of problems. For example, in the 19th century it was seen as a form of anaemia, so iron was prescribed. In the 17th century, before that level of knowledge of blood existed, ‘steel filings’ were often part of the remedy, and iron is a constituent of steel. So, how did they know to use steel? Or was this nothing to do with the iron content, but instead about steel being imagined as ‘cutting through’ the blockages?

Langham’s text. From http://www.cardiff.ac.uk/insrv/libraries/scolar/digital/healthyreading.html . Copyright: Cardiff University, used with permission.

William Langham wrote ‘The Garden of Health’ in 1597. It was based on earlier recipe collections, and I came upon it when I was thinking about using recipes to tease out what exactly was supposed to be causing the symptoms – so, if the recipe involved plants that were clearly evacuative, then this could suggest that the cause of the disease was seen as a blockage. Langham arranged plants in simple alphabetical order, rather than arranging the material under the names of diseases; but, as part of his accessibility, he also gave a list of conditions with references to the different plant entries where the reader could find out more.

Langham gives a range of recipes for green sickness. One is packed full of ‘red’ plants –

‘seethe powder of the Keyes [i.e. the ash tree] with Betonie, red Sage, red Mynts, and Magerom [marjoram] in running water from a pottell [= 2 quarts] to a quart, and drink thereof a good draught with sugar warme morning and evening’

Elaine Hobby pointed out to me that this recipe also appears in 1677 in ‘The Accomplish’d Lady’s Delight’ by ‘T.P.’ (possibly Hannah Woolley), but with ‘red Fennel’ instead of ‘red Mynts’. There was a second edition of Langham in 1633, and maybe the author used this.
So what’s all this red about? Betony, sage and marjoram often appear together in later collections as a gentle sternutatory. Red sage and betony are used against bilious attacks. Ash keys feature today on ‘wild food’ sites with the warning that they are very bitter and need to be boiled several times before eating, but what was used here was the ripe seed, dried and then reduced to powder. The ash-powder is used elsewhere for the stone (by provoking urination), jaundice and dropsy.

So maybe there’s something here about getting rid of obstructions. But to me, all this redness suggests the colour of blood, and the use of running water also makes me think that this is aimed at restoring or establishing a normal menstrual flow. How do we balance the known effects of the plants chosen, with the symbolic power of red? Comments please!

Helen King is Professor of Classical Studies at the Open University, UK. Her book on green sickness is  The Disease of Virgins.