Tuesday, 25 November 2014

What A Pain: Early Modern Migraine Treatments

It’s dark out and bit stormy, the barometer is fluctuating, the fluorescent lighting in your office is flickering, and your officemates’ voices are just grating on your nerves.  The smell of someone’s lunch is making nausea set in.  You’re irritable and your head is exploding in pain.

You have a migraine.

Migraines, according to the thoroughly trustworthy Wikipedia, affect roughly 15% of the population worldwide and costs billions of dollars in lost productivity and medical fees each year.

Migraine sufferers differ.  For some, the onset of a migraine can mean a week of uninterrupted pain, nausea, light and sound sensitivity.  For others, it’s a really big, annoying headache.  Modern treatments and pain management regimes range from surgery to popping a few pills to nasal sprays. 

For Lady Anne Conway (1631-1679), things were a bit more difficult.  Conway’s headaches were likely migraines.  She described them as a “violent fitt of the headache” that lasted for several days.[1]  Throughout her life, Conway sought the advice of different medical men including the mountebank faith healer Valentine Greatrakes, to respected physicians Thomas Willis, William Harvey, Theodore Turquet de Mayerne, and the son of Jan Baptist van Helmont.[2] 

An educated woman, Conway actively sought and researched new pain management methods, rejecting those outright she thought ineffectual and trying those she thought worthy.  Indeed, Conway even rejected a “elixer” her husband recommended and requested instead some of Robert Boyle’s “Ens Veneris,” having read of it in Boyle’s book on experimental philosophy.[3] 

Unfortunately, none of Conway’s efforts, nor those of her doctors, proved successful and she suffered from migraines till her death in 1679. 

The early moderns did not have ibuprofen or triptans.  So what did they use to combat migraines?

Most remedies seem to involve the physical placement of an ointment or plaister on the head.  The Widdows Treasure (1595) for example recommended this remedy for the migraine:

Take a handfull of Camomill, a handfull of Betony, a handfull of Veruaine leaues cleane picked, stamp them and seeth them in Ale woort, and when it hath sod, put thereunto a little Commin seed finely beaten, with a little pouder of Harts horne, three spoonfuls of vineger, the yolkes of two Egs and a little Saffron, stir them about, and lay a playster hot ouer all his forehead. It is an approued medicine for the Megrim.[4]

One would assume that the warmth of the plaister, at least, would certainly have provided some soothing relief.

Even tobacco was thought to cure migraines.
Other herbal remedies included decoctions of sassafras to the semi-magical wearing of St. John’s Wort that had been “gathered when the Sun is in Aries, and then presently dryed, and made into fine Powder, and worn about the Neck in a Silk Bag.”[5]

The so-called Aqua Hungarica or Queen of  Hungary’s Water was also thought efficacious.  Here, two pounds of fresh rosemary flowers were distilled in spirits.  The resulting rosemary flower water could be taken inwardly, applied to the affected part like an ointment, or in the case of migraines, “drawn up the nostrils.”[6]

Two pounds of fresh rosemary flowers is a lot of flowers.  It seems likely that this latter water would have been somewhat pricy to both make and purchase.

For those with even more money, the 1602 Diacatholicon Aureum recommended a powder of gold consumed in a posset.  The patient was to consume anywhere from two to five grains of the gold powder.  The gold, the author argued, was “good for al diseases” and would affect a cure through purgation.[7]

Not all early modern migraine treatments were so benign – if you would call strong purges benign! 

William Bullein, for example, recommended purging followed by bloodletting, very specifically, from the “middle veine of the forehead.”[8]

A veritable "How to Trepan" guide from Scultetus (1674)
It seems natural that as the site of the pain, surgeons would focus their craft specifically on the head.  Ambroise Paré, the eminent French surgeon, related that ancient authority suggested the surgeon:

"marke the Arteries which are behind the eares, then divide them in cutting to the very bone, and make a great incision the breadth of two fingers…the incision be made transverse, cutting or incising the length of two fingers."[9]

Paré, however, thought the incision to be too troublesome and  liable to cause further injury.  Instead, he recommended a more simple course – a single incision to open both “the Arteries behind the eares, and those of the Temples.”[10]
Last, in a case of jumping from the frying pan into the fire, some surgeons recommended trepanning to cure the migraine. 

Perhaps the most invasive of the early modern surgeries, trepanation involved boring a hole into the skull, without any anaesthetic, in order to release the pressure thought to cause migraines.

In 1656, Conway was so desperate to be rid of her constant head pain that she traveled to France to have the operation performed.[11]  
Conway was never trepanned and we’re not entirely sure why.  Various ideas include: she was talked out of the procedure by Henry More, her surgeon was unavailable, or her surgeons thought trepanation too dangerous given her health.

Either way, Conway’s surgeons went ahead with the less dangerous surgical option – they let blood from her jugular vein instead.[12]

Which migraine treatment would you have chosen?
Let me know what you think here or on Twitter – I’m @medhistorian.

[1] Conway, Viscountess Anne, 1631-1679, Letter from Anne Conway to Henry More, January 26, 1652?, in The Conway Letters: The Correspondence of Anne, Viscountess Conway, Henry More, and Their Friends, 1642-1684. Hutton, Sarah. Oxford, England: Clarendon Press, 1992, 592.
[2] Sarah Hutton, Anne Conway: A Woman Philosopher, Cambridge, CUP (2004), 120-123.
[3] Conway, 592. 
[4] The Widdowes Treasure. London: printed by I Roberts for Edward White (1595), f.A8r.
[5] John Durant, Art and Nature John Hand in Hand, London: printed for Sam Clark (1697), 7 and 9.
[6] William Salmon, Pharmacopoeia Bateana, London: printed for S. Smith and B. Ealford (1700).
[7] Diacatholicon Aureum. London: printed for John Flasker (1602), f.C1r.
[8] William Bullein, The Government of Health, London: printed by Valentine Sims (1595)/
[9] Ambroise Paré, The Workes of that Famous Chirurgion, London: printed by Thomas Coates and R. Young (1634), 37-38.
[10] Ibid., 39.
[11] Joe Moshenska, Feeling Pleasures: The Sense of Touch in Renaissance England, Oxford: OUP (2014), 226.
[12] Marilyn Ogilvie and Joy Harvey, The Biographical Dictionary of Women in Science, New York: Routledge (2000), 583.

Tuesday, 4 November 2014

"Death In The Pot!" Part II

It’s Panacea’s first blogiversary! 

About almost 15 months ago, as I sat with my husband and our friends, I declared that I was going to start a history of medicine blog that was going to be awesome.  I had no idea what I was going to write about, if I could write for a non-academic audience, or even what a blog platform was. 

What I did have was a Word doc with a long list of potential blog names and Twitter handles.  Honestly, they were all really bad.[1]

Then one day, as if by magic, a horrible açai berry juice infomercial played just as I was reading a 17th century advertisement for a “Herculean Antidote Against The Pox” – and everything else – that was truly “infallible.” 

It was kismet.  From then on, I was pretty insistent on “Panacea.” 

In the past year, Panacea has had roughly 40,000 visitors from Alaska to Zambia and all the places in between.  I’ve had comments and emails from teenagers doing high school projects to fellow academics and everything from hate mail to guest writing and speaking requests.[2]

It’s been fun and I hope you’ve enjoyed reading as much as I’ve enjoyed writing and tweeting.  I’ve met some truly wonderful people via Panacea and Twitter and look forward to what the next year will bring. 

For those who were curious, the most visited posts have been (in order): Surgeons At War, Drinking Bath Water, and Putting A Stopper In Death.

And now to Death In the Pot Part II:

As Part I revealed, 19th century food adulteration was a big deal for both popular press and scientists.  The press, scientists, and physicians alike stressed the harmful nature of the adulterants used in foods and campaigned for better legislation. 

For their efforts, however, scientists such as Fredrick Accum were soon faced with accusations of alarmism.  Indeed, Accum was harried out England by 1824 (only four years after A Treatise was published) and his work was “widely regarded as exaggerated.”[3]    
Such criticisms meant that scientists and physicians had to be more careful when discussing the subject. By mid-century, scientists and medical men – though still lobbying for increased legislation – curbed their gloomy and calamitous reports. 

This linguistic turn to more measured language, I think, played a great role in 1) returning some measure of authority to scientists and 2) popularizing science.

Indeed, the public thanked science, not politicians, when the 1875 Sale of Food and Drugs Act (SFDA) was introduced to regulate the retailing of adulterated goods.  The Act allowed “local authority officials to inspect and take samples for analysis from retail outlets” before it reached the consumer.[4] 

The Act was the culmination of decades of lobbying by scientists, popularizers, and the public alike: 

Thomas Wakley’s Lancet, for example, printed names of both adulterators and seller of pure merchandise.[5]  Partly because of the furor stirred up by the Lancet, an 1855 Select Committee of the House of Commons was appointed to examine the issue of food adulteration and recommend legislative changes to the Parliament.  Moreover, they recognized that science had a key role to play, and of the sixty professional witnesses called, fifty percent were physicians, surgeons, chemists or druggists.[6]

Science, not the law, was seen as authoritative in matters concerning food adulteration.  Treatises were frequently reviewed and recommended, and sections were reprinted frequently in the popular periodicals.  One author recommended that his wife and other “maters-familias,” curious about food adulteration, could find “enlightenment…in the Reports of the Analytical Sanitary Commission.”[7]  Indeed, though a scientific text, it was thought to “serve to assist the most unscientific reader in detecting the difference between the counterfeit and the genuine article.”[8]

Authors of these scientific works examined seemingly embraced the role given them by the public.  Indeed, in some cases, they could be accused of vigilantism in the way they sought out and attacked those guilty of adulteration. 

In 1851, the Analytical Sanitary Commission received one of the highest compliments it could be paid - it was caricatured in Punch.  The often irreverent magazine praised the Commission, calling it the “Scientific Detective Police,” and stated that “if any of the knaves thus pilloried in the Lancet, abetted by a disreputable attorney and a dishonest barrister, endeavour to avenge themselves through the technicalities of the law, Punch hopes they will meet with twelve true men in the jury-box who will scout both them and their legal accomplices out of court.”[9]   

Though the Lancet was a radical, reforming periodical, one question still remains: why did the issue of food adulteration encourage such outrage and even mild vigilantism in the scientific sphere?

Reynold's Misc. May 1857
The answer, perhaps, lies in the recognition – made as early as Accum’s text – that some of the blame lay at science’s door.  Accum criticized the chemists who supplied drugs to brewers and grocers and stated that it was “lamentable that the extensive application of chemistry to the useful purposes of life, should have been perverted into an auxiliary to this nefarious traffic.”[10]  Cameron also made note of this relationship, stating that “as chemistry advanced, it unfolded new secrets… [and] at the same time gave a larger scope for the adulterators, and pointed out new sources for more effectually disguising any alteration in the article, and rendering the sophistication almost imperceptible.”[11]            

That chemistry, in particular, was at fault lends an interesting dimension to the issue.  Indeed, it seems that chemistry may have fallen out of favour and microscopy, instead, was the preferred method of detecting adulteration.  Chemistry may have been mistrusted because it was the method of adulteration or because it was thought inaccurate or unable to quantify adulteration. 

This was especially reflected in the popular texts that, as one stated, saw Hassall glorified and Accum forgotten.  Indeed, the author wrote that “the microscope alone is capable of detecting at one operation the nature and extent of the more harmless but general of…frauds.”[12]  Again, in Chamberss journal, one article stated that “chemistry was well known to be inadequate to the exact examination of the majority” of adulterants.[13] 

Perhaps this was also caused as a byproduct of the Lancet and Hassall’s publications.  Hassall mentioned frequently that his investigations were done with a microscope.  Indeed, he was “the first to exploit it systematically and quantitatively”[14] and illustrated his reports with woodcuts depicting the adulterants.

In general, though, it is evident that the food adulteration crisis had a positive effect on the way science was viewed by the public.  Reynold’s journal advocated the ownership of a microscope, stating that it was quickly becoming fashionable as well as practical.  Indeed, the article stated that “no better exercise could be found for the young microscopist than testing the eatables from the pantry” and that with some help from Hassall’s woodcuts, even the “dullest” would be able to readily identify adulterants.[15] 

Microscopes were being advertised for public use and specifically for detection of food adulteration.  One advertisement stated that the microscope would show “all kinds of Animalculae in water, circulation of the blood, &c &c., adulteration of food, milk, &c., and is just the microscope that every surgeon, dentist, schoolmaster, student, and working man should have.”[16] 

Though chemistry was criticized as less effective than microscopy, it too gained a some favorable public support.  One Illustrated Review article reviewed a new organic chemistry text for students.  In the review, the author noted that the work was very useful as “considering amongst other things, the work which the Adulteration of Food Act 1872 will give to the chemists we may expect a large demand for elementary manuals of this type.”[17] 

Once again, science was able to provide what the law could not: the popular texts saw it as the authority and the professional scientists embraced their role.  Throughout all this, it is evident that microscopy and chemistry, though more so the former, had earned the esteem of the people.  Moreover, they were encouraged and recommended as activities for the public. 

Though full of tragic tales, the epic of Victorian food adulteration ended with an aware – not to mention healthier – public.

Let me know what you think here or on Twitter – I’m @medhistorian.

[1] My husband even had to explain that “Sam’s History of Medicine Blog” was awful, as was “@themedhistorian,” “@panacea_histmed,” and “@medhist_sam.”  Even @ssandassie was vetoed.
[2] Not to mention ALL the spam.
[3] John Postgate, Lethal Lozenges and Tainted Tea: A Biography of John Postgate (1820-1881), Warwickshire: Brewin Books (2001), 23.
[4] Michael French and Jim Phillips, Cheated not Poisoned?: Food Regulation in the United Kingdom, 1875-1938, Manchester: Manchester University Press (2000), 36-37.
[5] Ibid., 194-195.
[6] “The Adulteration of Food and Drugs,” Fraser’s Magazine (June, 1870), 719.
[7] F.U.R. “Theobroma: A Chapter on Chocolate,” St. James’s Magazine n.s. 7 (April 1871), 635.
[8] ”Adulterations Detected,” Critic 16,383 (March 1857), 127.
[9] “The Lancet’s Detective Force,” Punch, 20 (Feb. 1851), 65.
[10] Accum, 4 and 12.
[11] Mitchell, Treatise on the Falsifications of Food  London (1855), vi.
[12] Andrew Wynter, “Article V: Food, and its Adulterations,” Quarterly Review 96,192 (March 1855), 461.
[13] “The English Thugs,” Chambers’s, 273.
[14] Postgate, 27.
[15] “Adulterations Detected,” Reynold’s Miscellany of Romance, General Literature, Science, and Art 18,464 (May 1857), 283.
[16] “Advertisement,” The London Review of Politics, Society, Literature, Art, and Science 17, 423 (Aug. 1868), 187.
[17] “Organic Chemistry: Adapted for Students in the Science and Art Departments,” Illustrated Review 6,81 (July 1873), 46.

Wednesday, 29 October 2014

"Death In The Pot!" Part I

“There is death in the pot!”[1]  The book of 2 Kings records that this was proclaimed, by several prophets, in response to the poisonous stew served to them.  The warning allowed Elisha to add flour to the stew, and so doing, remove the harmful effects rendered by poisonous gourds.[2] 

This dire warning was reprinted boldly, in capital letters, on the front cover of chemist Fredrick Accum’s 1820 book A Treatise on Adulterations of Food, and Culinary Poisons.  

Accum's book cover.  Isn't it gorgeous?
As those who know me have discovered, I love food.  It’s no surprise, really, that I was so captivated by Accum’s graphic book cover, frontispiece, and words.  As an MA student many, many years ago, I even found myself nodding along to statements such as: “of all the frauds practiced by mercenary dealers, there is none more reprehensible, and at the same time more prevalent, than the sophistication of the various articles of food.”[3] 

Food adulteration, he wrote, was an “unprincipled and nefarious practice.”[4]
Accum's sense of drama was amazing.

Today we worry about consuming GMO corn, artificial foods, antibiotic and/or hormone-filled meat while fondly trying to recall the golden years when food was real food. 

In 19th century England, they were – more or less – trying to recall those days too.  Londoners, you see, were purchasing and consuming foods contaminated with everything from alum to opium to Prussian blue dye.  Indeed, food adulteration during the Victorian era was fraught with fraud, deaths, cover ups, and scandal and many accounts read like mystery or detective novels.

By mid-century there were a plethora of popular and scientific texts that warned the public about the harmful nature of the foods they were consuming.  Both the popular and professional texts indicted the law for its ineffectiveness and castigated the men who knowingly sold adulterated food.

This included such things as adding chemicals to foodstuffs to make colours more vibrant or to make textures lighter, and even adding cheaper substances to foodstuffs without alerting the customer.

Public patterns of consumption played a very, very important role in increasing food adulteration.  For example, tea coloured with Prussian blue, a mixture of ferric ferrocyanide, lime sulphate and turmeric, was prized for its appearance.[5]  Not only that, but adulterated beer was preferred by workmen to pure beer!  The workmen found that the adulterants – hallucinogens and other narcotics – provided effects that the unadulterated drink could never match.[6]

George Dodd, in his 1856 treatise The Food of London, mentioned repeatedly that the public was partially at fault.  The love of aesthetically pleasing foods, he believed, prompted merchants to adulterate products so that it would be both appetizing and affordable.  This practice was surprisingly widespread. 

Bread, for example, was adulterated with alum so that it appeared white.  Copper was added to pickles so that it appeared green.[7]  Dodd reprinted the text of a Times article which stated that “anatto is used only in the cheese destined for London; that it’s use is a mere conventionalism, like that of very white bread.”  In response, he concluded that “our absurd taste for richly tinted cheese thus tempts men to adulterate.”[8] 

He blamed adulteration not only on “absurd” city tastes, but on a “love of cheapness” as well.[9]  Londoners were far more willing to purchase goods that were impossibly inexpensive.  Thus, articles such as milk and coffee were mixed with cheaper substances – water and chicory respectively – to allow and encourage the London consumer to purchase them.

Most of the popular and scientific works decried this love of inexpensive and seemingly fancy goods.  They labeled food adulteration in legal terms, simply calling it cheating or fraud.  This language was most often used by the popular press, who was outraged particularly by the monetary losses of the consumer, more specifically, the already poor consumer.[10]  As an 1851 article stated succinctly, “if a person asks for oatmeal and pays for oatmeal, he has a right to expect oatmeal.”[11] 

Health, too, was a major concern.  First, Londoners lost nutrients due to food substitutions and second, were made to eat and drink poisonous or unhealthy substances in their food. 

In the case of the oatmeal, for example, the most common adulterant, barley, was not only substantially cheaper than oatmeal, but it possessed significantly less nutritive properties.[12] 

Likewise, another journal likened the mixing of water with milk to “committing murder by pinpricks” and “starvation administered in small doses.”[13]  More specifically, the author stated that adulterated milk did not provide the nutrients required for healthy life, thus “enfeebling the young, pinching the underfed, and stinting the sustenance allowed to the sick and aged.”[14]  Adulterating milk, in effect, preyed primarily on those most helpless in society.

Wealth, however, did not mean exemption from the dangers of impure or tainted food.

Not even chocolate was exempt.
An 1856 article in Chambers’s Journal of Popular Literature, Science and Arts contrasted a culinary day in the life of a wealthy family and a poor, labouring family.  It found that both the rich and poor suffered greatly from the adulterations of foodstuffs.  

The poor Delver family, for example, purchased brown bread adulterated with “potatoes, bone-ashes, and clay,” while the wealthy Smith’s family purchased fine, white bread that was adulterated with alum, “Indian-corn, rice, gypsum, plaster of Paris, and chalk.”[15]  While the wealthy fared poorly, because the adulterants used to make fine white bread were far more harmful to one’s health, the poor suffered because they lost valuable nutrients in the meager meals they could afford.

Fredrick Accum was one of the first scientists to speak out against food adulteration. He cited the use of lead as causing “terrible diseases” and that “wine adulterated with the minutest quantity of it, becomes a slow poison.”[16]  The scientists writing on the topic decades later followed in his footsteps and were quick to point out the poisonous nature of the foods being consumed. 

Charles Cameron, a physician, stated that “several of the substances used in food sophistication are far from being harmless in their effects.”[17]  The eminent Dr. Hassall, for example, brought to attention that both invalids and children suffered early deaths due to adulteration. 

Everyone, he wrote – no matter how healthy one felt – was susceptible to harm as “the fact must be borne in mind that some of the metallic poisons used are what are called cumulative.”[18] 

Tune in on November 4th for Panacea’s 1st blogiversary and the second installation of Death in the Pot.  We’ll look at how investigations of food adulteration inevitably furthered the cause of science by demonstrating to the public that science had beneficial – and practical – applications.

Let me know what you think here or on Twitter – I’m @medhistorian.

[1] 2 Kings 4:40, NIV.
[2] 2 Kings 4:38-41.
[3] Fredrick Accum, A Treatise on Adulterations of Food, and Culinary Poisons, London (1820), 5.
[4] Ibid.
[5] F. B. Smith, People’s Health 1830-1910, New York, N.Y.: Holmes and Meier Publishers, Inc., (1979), 210.
[6] Ibid., 211. 
[7] Fredrick Accum, A Treatise on Adulterations of Food, and Culinary Poisons, London (1820), 308.
[8] George Dodd, The Food of London, reprint of 1856 edition, New York, N.Y.: Arno Press Inc. (1976), 311.
[9] Ibid., 419.
[10] See: “Tricks of Trade,” Chambers’s Journal of Popular Literature, Science and Arts 510 (Oct. 1863), 238; “Milk,” All the Year Round 13,306 (March 1865), 128; “Facts and Scraps,” Ragged School Union Magazine (Nov. 1873), 263.
[11] “Oatmeal and its Adulterations,” Reynold’s Miscellany of Romance, General Literature, Science, and Art 7,164 (Aug. 1851), 88.
[12] Ibid.
[13] “Milk,” All the Year Round, 128.
[14] Ibid.
[15] “The Poor Man at Market,” Chambers’s Journal of Popular Literature, Science and Arts 128 (June 1856), 373.
[16] Ibid., 107.
[17] Charles Cameron, Lectures on the Preservation of Health, London: Cassell, Petter, and Galpin (1868), 97.
[18] Arthur Hassall, Food: Its Adulterations and the Methods for Their Detection, London: Longmans, Green, and Co. (1876),  837.