Tag Archives: Surgery

‘This one is good’: Recipes, Testing and Lay Practitioners in Early German Print

By Tillmann Taape

Title illustration from Brunschwig’s Small book of distillation. © Wellcome Images

Having recently finished my doctoral thesis on the printed works of Hieronymus Brunschwig, which have previously featured on the Recipes Blog (here and here), I am delighted to contribute to this series of posts on testing and trying (for an overview, see our re-posted summary of the Testing Drugs and Trying Cures conference). What better opportunity to share how it all came together, and reflect on the role of recipes and testing in the narrative.

Hieronymus Brunschwig (c.1450–c.1530), a surgeon and apothecary from Strasbourg, wrote the first printed books on surgery and distillation. In my thesis, Hieronymus Brunschwig and the Making of Vernacular Medical Knowledge in Early German Print, I read these uncommonly practical and technical books alongside records from the Strasbourg archives, about the craft guilds and medical practice. This allows us to make sense of Brunschwig’s practical vernacular medicine in relation to local intellectual trends, different forms of healing, the local milieu of guilds and artisans, and early German print culture.

Brunschwig’s first book was the Cirurgia of 1497, the first surgical manual in print. This, of course, was an opportunity to codify and re-define surgery. Brunschwig revives the medieval tradition of what Michael McVaugh has termed rational surgery (i.e. a learned as well as a practical art), to educate trainee surgeons and to present their discipline as a respectable and useful trade. Emphasising the need for skilled hands as well as a working knowledge of the human body, Brunschwig defends surgery on two fronts: against learned physicians’ rhetoric of superiority, and against other craftsmen’s deep-seated anxieties about occupations which were in contact with sick and dead bodies.

A surgeon treating an abdominal wound. Hieronymus Brunschwig, Dis ist das Buoch der Cirurgia (Strasbourg, 1497). © Wellcome Images.

The later books on distillation, published in 1500 and 1512, open up to a wider readership, including not only medical artisans such as surgeons or apothecaries, but also the ‘common man’ – a middling social layer of literate citizens, householders and other lay practitioners. This new kind of medical reader, as I have discussed in a previous post and elsewhere, is emblematised in the figure of the ‘striped layman’ which appears in numerous woodcut illustrations throughout Brunschwig’s works.

A conspicuously stripy student, from Brunschwig’s Cirurgia (1497). © Wellcome Images

Many of the recipes and instructions in the distillation books are adjusted for this type of reader. They start from scratch and are rich in technical details which are not found elsewhere in print or, to my knowledge, in manuscript. Although Brunschwig engages with complex ideas about the nature of matter and its manipulation, such as John of Rupescissa’s notion of a ‘quintessence’ in all things, he re-works them into manageable, pedestrian remedies. Rather than pursuing Rupescissa’s heavenly panacea, Brunschwig uses distillation to produce a type of middle-class quintessences: although earth-bound and imperfect, they were reliable and effective remedies in the hands of laypeople.

Detailed woodcut images of distillation apparatus and instructions for its use. Brunschwig, Liber de arte distillandi de simplicibus (Strasbourg, 1500). © Wellcome Images.

One overarching theme of my thesis is the artisan’s approach to understanding and manipulating nature. For a craftsman with no Latin, Brunschwig mined a surprising amount of knowledge from texts. But more importantly, I argue, he knew things through direct physical engagement with bodies, materials and technical processes. His books are full of instructions to probe wounds, check temperature by touch, inspect colour changes in the alembic, and smell or taste distilled remedies. His expertise was located as much in the body and its senses as in books.

Nonetheless, writing was a powerful tool for recording and communicating practical insights. From cautionary tales of exploding alembics to heroic accounts of successful cures, Brunschwig emphasises his own experience as a source of knowledge. The German term he uses for this type of knowledge, erfarung, is related to fahren, meaning ‘to travel’. In the early sixteenth century, it denoted a way of experiencing the world through one’s own senses, by moving through it or simply being in it in an active, attentive manner. Erfarung was compared, often unfavourably, to spiritual contemplation and introspection. Over time, however, doctors and students of nature such as Paracelsus came to see personal erfarung as the necessary labour of insight rather than a sinful distraction. The Book of Nature, they insisted, should be read with one’s feet. Brunschwig’s emphasis on his own and others’ erfarung was thus part of a larger vernacular culture of experiential knowledge, as well as learned debates about experientia which have often been the focus of historical accounts of a medical empiricism developing in the early modern period.

Recipes played a major part in Brunschwig’s codification of experiential medical knowledge. Some, as I have shown in a previous post, were presented in Latin pharmaceutical jargon likely unknown to laypeople. These recipes were closed to readers, who were meant to copy them out on a piece of paper and hand them to an apothecary who would manufacture the remedy according to his art and his experience. Although the great majority of recipes are in German, some of these are also presented as tried and tested, by Brunschwig himself or others, and do not call for ‘tweaking’ on the part of readers.

Other recipes, however, give alternative ingredients or leave the exact composition up to the practitioner’s judgment. Many recipes come without the author’s seal of approval, and their sheer number makes it seem unlikely that Brunschwig could have tested each one. Such ‘open’ recipes leave room for improvisation and testing. The ongoing work of erfarung runs on into readers’ own practice, and often spills out into the margins of Brunschwig’s printed books. In many surviving copies, early modern healers from different walks of life marked recipes with a magisterial probatum est, or a simple vernacular note such as ‘this one is good’.

In some of the earliest medical works in print, Brunschwig addresses a readership of lay healers and ‘common men’ which would come to represent a significant portion of the early German print market. Through his use of recipes embedded within a culture of erfarung, he involved his vernacular readers in a continued effort of empirical trying and testing.

Pursuing the themes of recipes and artisanal knowledge, I am delighted to be joining the Making and Knowing Project at Columbia University this summer, and look forward to sharing our work on making, testing, and trying, which has previously featured on this blog.

 

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.

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.