Category Archives: medical practitioners

How Best to Treat the Heat in 1793 Beijing

By Marta Hanson

Translating traditional Chinese medical terms into modern English forces one to consider dramatic changes in medicine over the past two centuries. Take, for example, the modern Chinese phrase fa re for “fever,” which literally means “to produce (fa) heat (re).” Although today it refers to elevated body temperature, traditionally it referred to the preternatural heat that patients experienced dispersed throughout their bodies and only sometimes referred to elevated skin temperature.[1] In fact, before the late 19th-century, the English term “fever” also contained multivalent meanings and multifarious patterns of excessive heat.[2] Fever in the sense of having a temperature above the 97.3 to 99.5 °F human range was not even defined in western medicine, nor a convenient clinical thermometer invented to measure it, until the late 1860s.[3] Although many of the febrile-related symptoms that fall under the Chinese disease concept “Hot diseases” (rebing) could fit under the biomedical umbrella of acute-infectious diseases, in classical Chinese medicine they were originally conceptualized as caused by climatic configurations of qi (i.e., vital energy/matter).[4]

The Yellow Emperor’s Inner Canon: Basic Questions (ca. 1st c. BCE) originally distinguished two types of Hot diseases related to different types of climatic qi. The first included an acute-onset febrile disorders caused by external pathogenic qi related to changing seasons or local weather. The second was a type of “Cold Damage” (shanghan) acquired in the winter but which went dormant until the heat of the spring or summer manifested it as excessive heat and internally impairing dryness. The first Inner-Canon definition that Hot diseases could be due to other types of pathogenic climatic qi also facilitated conceptualizing epidemics as due to pathogenic environmental qi unrelated to the winter cold or local climate.[5] Nonetheless, no matter the original cause when excessive heat was the result, it had to be expelled.

An interesting case of disagreement on how best to “treat the heat” occurred in Beijing during a febrile epidemic (wenyi) in the spring and summer of 1793. The Qing official, Ji Yun (1724–1805) unusually responded to this epidemic by comparing the success rate of three therapeutic drug strategies. The first, associated with Zhang Jiebin (1563-1640), resulted in 80–90% mortality. The second, promoted by Wu Youxing (1582?-1652), was no more effective. But a third formula created by the living doctor, Yu Lin (ca. late 18th cent.), had successfully cured the concubine of the Chief Minister of the Court of State Ceremonies, Feng Yingliu (1741–1801) with a strong gypsum-based formula.[6] Ji noted that those who witnessed this were shocked but those who followed his method ended up saving countless lives.[7]

The three competing cures in Ji’s short anecdote illustrate well how Cold and Heat were the main metaphors used to understand the cause of epidemics and legitimate drug choices for treating them. Zhang’s “warming and tonifying” (wenbu) tonics were based on what the Cold Damage Treatise (Shanghan lun, ca. 220 CE) recommended for treating Hot diseases (believed to have their origin in winter Cold manifested in the summer). These included warming herbs such as Cassia twig (guizhi) and Ephedra (mahuang) to release cold via the exterior and Aconite (fuzi) to warm the exterior and expel cold.  [See rebing entry to far left in Figure 1]

Medication chart from the Gold-Dusted Cold Damage [Treatise] (Shanghan diandian jin, completed 1341, date of this printing unknown). Image credit: Wellcome Collection.
 Wu’s “purgative” (gongxia) formulas contained Rhubarb root and rhizome (dahuang) to purge downward, and even Betel Nut (binglang) to expel pathogenic qi.  Wu termed this anomalous qi (yiqi), deviant qi (liqi), or pestilential qi (liqi) in his Treatise on Febrile Epidemics (Wenyi lun, 1642). [See figure 2] As He Bian has written on this blog, Chinese rhubarb had its heyday in the eighteenth century, yet not all physicians were in accord with its suitability during epidemics.

 

Rhubarb from Li Shizhen’s Systematic Materia Medica (Bencao Gangmu) printed in 1596.

The third author named in this story, Yu Lin, later became famous for his recipe titled: “Epidemic-Clearing and Toxin-Dispersing Beverage” (Qing wen bai du yin). [8]  The fourteen-ingredient recipe was based on a combination of the White Tiger Decoction (baihu tang) that cleared out heat on the exterior with two other formulas.[9]  Yu’s recipe, however, featured crude gypsum (i.e., the “White Tiger”) in quantities at least three times the other main ingredients (raw foxglove root, rhinoceros horn, and coptis root). This made it an extremely Cold formula, and potentially life-threatening for those who thought Cold was the underlying cause and so used Zhang’s formulas. For Yu, however, Gypsum’s cold-cooling quality cleared excessive heat accumulated in the stomach system. [Figure 3 depicts this heat-clearing function of gypsum at the center of the man’s chest).

Depiction for White Tiger Decoction in Illustrations and Explanation of the Major Formulas of the Cold Damage Treatise (Shanghan lun dafang tu jie, 1833). Image credit: Wellcome Collection.

Expelling pathogenic Cold qi and warming the interior with aconite and cassia twigs, purging pestilential qi through the bowls with rhubarb, and clearing out the pathogenic Heat from the stomach with gypsum were thus all therapeutic strategies at play during the 1793 epidemic in the capital. The first framed the cause of the epidemic in latent winter cold that had to be dispersed. The second saw it as externally contracted pestilential qi that needed to be purged. Finally, the third considered it excessive heat that had to be cleared. Despite these major differences all three approaches nonetheless treated the febrile symptoms subsumed under fa re or, in the modern term, “fevers” as something that drugs could manage by adjusting the internal balance of Hot and Cold.

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Translations for Figures 1 and 3

Figure 1: From right to left are listed three disease concepts – Cold Damage, Wind Damage, and Hot Diseases. Their commonly used formulas are written below. The six formulas listed under rebing are from right going down and then to left going down: With sweat cassia twig decoction (han guizhi tang), Cassia twig and gypsum decoction (guizhi jia shigao), Cassia twig decoction together with gypsum, anemarrhena, cohosh, and ephedra (guizhi jia shigao zhimu sheng[ma] ma[huang], Without sweat ephedra decoction (wuhan mahuang tang), Evening produced (i.e., heat) gardenia, cohosh, and ephedra decoction (wan fa zhizi sheng[ma] ma[huang]), and Cassia twig decoction with ephedra and gypsum (guizhitang jia mahuang shigao).

Figure 3: From the right to left across the top is written. 1) “The assistant [drug] Amemarrhena (zhima) disperses dryness [and] produces jin [fluids].” 2) the space below the chin reads “protects the lungs.” 3) and to the left is written “licorice (gancao) harmonizes the stomach and rice (gengmi) assists the stomach qi.” 4) The 5-character phrases on either side of the oblong circle together state the therapeutic strategy “[When] the pathogenic [qi] has already changed into Fire, then clear, cool, and make it disperse.5)  In the long oval at the center of the body, the phrase instructs: “When it [i.e., the Fire} enters the stomach, use gypsum.”

[1] Nathan Sivin, Traditional Medicine in Contemporary China, Science, Medicine, & Technology in East Asia 2 (Ann Arbor: The University of Michigan Center for Chinese Studies, 1987), xxiv-xxv, 86, 108.

[2] Christopher Hamlin, More Than Hot: A Short History of Fever, Johns Hopkins Biographies of Disease (Baltimore: John Hopkins University Press, 2014).

[3] J.M.S. Pearce, “A brief history of the clinical thermometer,” QJM: An International Journal of Medicine 95.4 (1 April 2002): 251-52. Thomas Clifford Allbutt (1836-1925) invented the 6-inch thermometer that was first able to record a temperature in 5 minutes in 1866 and in 1868 Carl Wunderlich, using a foot-long thermometer put in the axilla (i.e., armpit), established the normal range from 36.3 to 37.5 °C or 97.3 to 99.5 °F.

[4] Shigehisa Kuriyama, “Epidemics, Weather, and Contagion in Traditional Chinese Medicine,” in Lawrence I. Conrad and Dominik Wujastyk, eds., Contagion: Perspectives from Pre-Modern Societies, (Aldershot, Hampshire: Ashgate Publishing Limited, 2000), 3-22.

[5] Marta Hanson, Speaking of Epidemics in Chinese Medicine: Disease and the geographic imagination in late imperial China (London: Routledge, 2011), 16-17.

[6] Gypsum is monoclinic calcium sulfate. See discussion of this episode in Hanson, Speaking of Epidemics, 2011, 126-27.

[7] Ji Yun 紀昀, Yuewei caotang biji 閱微草堂筆記(Jottings from Yuewei Hall), printed 1800. Repr. Shanghai: Shanghai guji chubanshe, 1980. Passage in juan 18, jotting #24, 458-9. Online access https://ctext.org/library.pl?if=gb&file=36038&page=45&remap=gb

[8] Jian Min Wen and Garry Seifert, translators, Warm Disease Theory, Wēn bing xúe (Brookline, Mass.: Paradigm Publications, 2000), 141.

[9] White Tiger Decoction is used to treat an illness pattern with great heat, thirst, and sweating and a surging and large pulse. For analysis of the logic of the formula see Craig Mitchel, Feng Ye, Nigel Wiseman, Shang Han Lun: On Cold Damage: Translations & Commentaries (Brookline, Mass.: Paradigm Publications, 1999), 316-24

Tales From the Archives: A Recipe for Disaster: How Not to Distill Turpentine

In September 2018, The Recipes Project will be six years old. There’s been a lot of blogging on this platform, and we are so grateful to all our wonderful contributors. But with so much material on the site, it’s easy for earlier pieces to be forgotten. So, the editors have decided that, once a month, we’ll pull something out of the archives to share with our readers anew.

This month, I have chosen a piece written by Tillamann Taape. In this post, first published in July 2013, Tillmann writes vividly about alchemical disasters. Heat, unsurprisingly, comes into play. Enjoy!

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By Tillmann Taape

When sifting through early modern alchemical recipes, I am often struck by their inherent dangers which would make modern-day health and safety officers pull their hair out. Renaissance practitioners were remarkably unfazed by temperatures high enough to melt glass and metal, and they frequently recommended heating volatile and flammable liquid in sealed glass vessels which, by their own admission, had a tendency to crack if not handled with the utmost care. Surely these exploits must have gone wrong a lot of the time, resulting in burnt fingers or a faceful of boiling alcohol?

If we look at the stereotype of the alchemist in contemporary satirical literature, it seems that accidents came with the job. In his Ship of Fools (1494), German humanist and satirist Sebastian Brant echoes themes from medieval poetry in his depiction of the alchemist: a greedy and reckless fool whose dangerous and fruitless exploits leave him scarred, financially ruined and even blind. [1] As a source of historical information, satirical genres should of course be taken with a generous pinch of salt. It is significant to note, though, that early modern people saw alchemy as a potentially dangerous thing to do, even in times long before anything like today’s health and safety standards.

More direct evidence of alchemical disasters is, unfortunately, fairly rare. I would of course be delighted to be persuaded otherwise by readers of this blog, but to me it seems that while adepts of alchemy frequently wrote down instructions which sound like they might well blow up, they were frustratingly silent on whether this actually happened. I was quite thrilled, therefore, when I finally stumbled upon a first-hand account of an alchemical disaster: exploding stills, knocked-out practitioners and all. In his 700-page tome entitled Liber de arte distillandi de compositis or Large book of distillation, first published in 1512, my favourite surgeon-apothecary Hieronymus Brunschwig (introduced here and here) includes the following cautionary tale.

Brunschwig was distilling turpentine to separate the watery fraction from the valuable oil, and when nearly all of the water had come out, he was interrupted.

 I was called away to a patient, so the oil went into the water, and when I came back, a layer of oil was sitting on top of the water. I didn’t have the sense to simply decant off the oil, so I poured the lot into a new flask and thought I’d just extract the water by distillation. But I was called away again, and in the meantime the water evaporated from the oil, and some of it condensed on the side of the flask and dripped back into the oil, which rose inside the flask with a great tumult, and fumes erupted from the flask, blowing off the alembic. [2]

 A lot to handle: picture of a still from Brunschwig’s Large book of distillation. © Wellcome Images

A lot to handle: picture of a still from Brunschwig’s Large book of distillation.
© Wellcome Images

Things got worse when Brunschwig came back late at night and went to investigate the accident, telling his servant to bring along a light:

When the light arrived, the fumes touched it, and fire burst forth all around, and in the blink of an eye went out again, nevertheless burning off mine and my servant’s hair, clothes and eyebrows. We fell to the ground and did not know where we were, but before long we got up again and fetched a closed lantern so the same thing would not happen again, and threw ashes in the furnace to smother the fire. [2]

And this, dear readers of the Large book of distillation, is how you do NOT distill turpentine! Once the initial excitement about this truly adventurous tale had worn off, I realised that, to the historian, there was more to this anecdote than merely the satisfying confirmation that some procedures which look so precarious on paper did indeed go up in fire and smoke. In his description of this extraordinary incident, Brunschwig also reveals a number of interesting details about his everyday life and work. We get a glimpse of what it meant for an early modern practitioner to have multiple vocations. Juggling his alchemical activities with his duties as an apothecary and surgeon, it seems that Brunschwig could be called away to the aid of a patient at a moment’s notice, even at night. We also learn that he had at least one servant, and we can surmise that he did his distillations in an enclosed workshop, since a buildup of explosive fumes would be unlikely in the open air. Perhaps most importantly of all, this anecdote provides strong evidence that Brunschwig was actively performing many of the procedures he describes in his works, rather than just copying and compiling them for publication.

Anecdotes like these, then, are more than just an entertaining read and a well-earned reward for ploughing through hundreds of pages of Brunschwig’s Alsatian dialect with its erratic spelling. Descriptions of extraordinary events also grant us a glimpse into the reality of practicing alchemy, and into practitioners’ everyday life.

[1] On the stereotypes and changing ‘personae’ of early modern alchemists, see Tara Nummedal,  Alchemy and Authority in the Holy Roman Empire. Chicago: University of Chicago Press, 2007, Ch. 2.

[2] Brunschwig, Hieronymus. Liber de arte distillandi de compositis […]. Strasbourg: Grüninger, 1512.

 

“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.

Teaching a Perfect Knowledge in the Arts and Sciences: Robert Dossie’s chemical, pharmaceutical, and artistic handbooks

Front page to a 1796 reprint of Dossie’s Handmaid

By Marieke Hendriksen

Robert Dossie (1717-1777) was and English apothecary, experimental chemist, and writer. Within just three years, he published three very successful handbooks: The elaboratory laid open (1758) on chemistry and pharmacy for ‘all practitioners of medicine’, Theory and practice of chirurgical pharmacy (1761) for surgeons, and The handmaid to the arts (1758), which taught ‘a perfect knowledge of the Materia Pictoriae’ such as painting, gilding, and japanning. Gibbs (1951, 1953) has written a short overview of Dossie’s life and work, with a focus on his role in the Society of the Arts, but paid no attention to the cohesion of his seemingly divergent work.

Lowengard (2006) has briefly noted that Dossie used a form typical for books about materia medica for his book on the arts, grouping the contents according to techniques employed as well as by the media to which they might be applied, yet his work has never been thoroughly analyzed. Did Dossie indeed transmit a way of structuring and presenting practical knowledge in text from one realm to another? Recipe collections and how-to books before the eighteenth century were often a mixture of medicinal and artisanal recipes and instructions, and the boundaries between medicine, chemistry, and the preparation and application of artist’s materials often so fluid as to be almost non-existent.

Moreover, some earlier printed books on painting and dying techniques did employ the format of a systematic discussion of materials and their preparations, followed by their application, for example Willem Goeree’s 1760 Verlichterie-kunde  What was novel about Dossie’s Handmaid of the Arts though was the combination of this way of presenting practical artisanal knowledge, his attempt to be encyclopaedic in his collection – listing the uses of the same base materials in the production of various artistic and decorative objects, and his very intentional use of the term ‘Materia Pictoriae’.

Rubia tinctorium (madder), one of the many plants that was both materia medica and materia pictoria

The latter appears to have been an attempt to subtly elevate the status of the visual and decorative arts by paralleling the materia pictoriae to the materia medica. Finally, the intended audience gives us more insight in how Dossie understood his own work. From the preface of the book, it appears that Dossie did not so much aim at the people creating visual and decorative objects, but at the professional preparers of artist’s materials, of whom he wrote: “a much greater share of knowledge in natural history, experimental philosophy, and chymistry, is required to the understanding the nature of the simples [sic], and principles of the composition, in a speculative light, than is consistent with the study of other subjects more immediately necessary to an artist.” (p. vii-viii)

In eighteenth-century England, high street chemists and druggists were evolving from preparers and sellers of chemical substances to compounders, stockists, and sellers of drugs and dispensers of medical advice, and it is in this light that Dossie’ work and his division between materia medica and materia pictorial must be seen. Did Dossie intentionally and successfully adapt and implement formats and language traditionally used in one field (medicine) for the organization and transmission of practical knowledge in text to others (chemistry and the arts)? To me it appears that in his mind, materia medica and materia pictoriae were both branches on the tree of chemistry, and that his corpus, which we now tend to see as divergent, was actually a cohesive body of work to him and his contemporaries.

 

Dupré, Sven, ed. Laboratories of Art : Alchemy and Art Technology from Antiquity to the 18th Century. Archimedes 37. Cham [u.a.]: Springer, 2014.

Gibbs, F.W. “Robert Dossie (1717–77) A Further Bibliographical Note.” Annals of Science 9, no. 2 (1953): 191–93.

Gibbs, F.W.  “Robert Dossie (1717–1777) and the Society of Arts.” Annals of Science 7, no. 2 (1951): 149–72.

Lowengard, Sarah. The Creation of Color in Eighteenth-Century Europe. Columbia University Press, 2006. http://www.gutenberg-e.org/lowengard/C_Chap05.html.

Worling, Peter M. ‘Pharmacy in the Early Modern World, 1617 to 1841 AD’, in Making Medicines: A Brief History of Pharmacy and Pharmaceuticals, ed. by Stuart Anderson (London: Pharmaceutical Press, 2005), pp. 57–76.