Wednesday, 23 April 2014

To Honour the Bard: "Send in the Surgeon"


The post’s title is a bit misleading, I admit.  You see, surgeons were never Shakespearean characters.  Todd Pettigrew has argued that was because “because the culturally available narratives surrounding the surgeon were, ideologically speaking, blurry and confused.”[1]  Fair enough, occupational boundaries did put the proverbial “gray area” to shame.

Surgery and surgeons do pop up on occasion in Shakespeare and in various other 17th century plays and prose fiction.  The narrative examples employed by these authors of fiction reflect the beliefs related to surgery and its practitioners.  If the cultural narratives and available literary representations were blurred and confused, it is simply because it is reflective of surgery’s growth in the period. 

The 17th century was one of transition and importance in the professionalization of surgery.  Both guild and individual practitioners sought epistemological legitimacy, and increased occupational and social credit by presenting themselves as similar to physicians.  Contemporary novels, plays, and ballads, can help us gauge how these attempts to increase social and professional credit were perceived by 17th century writers and their audience. 

The physician was a popular character; Thomas Berger and William Bradford’s index of characters in early modern drama lists 104 identified as doctors and a further 68 as physicians.[2] In contrast, they list only 35 plays that include surgeons as characters.[3]  The surgical practitioner in all of these texts was a minor character at best, named rarely, with few lines of speech. 

For a conference paper & thesis chapter I looked at a further 90 items of prose fiction and 30 ballads that revealed similar findings.  Surgery and its practitioners were referred to briefly and in passing; someone would send for the surgeon, he would examine and dress a wound, and promptly exit the scene.

Though the Bard never included surgeons as characters, we do get a sense of his  understanding of surgery/surgeons in both The Merchant of Venice and Macbeth. 

Surgeons treated wounds and were to be fetched immediately!
Portia: Have by some surgeon, Shylock,
on your charge, to stop his wounds,
lest he do bleed to death. 
The Merchant of Venice IV,i.
Captain: But I am faint. My gashes cry for help
Duncan: So well thy words became as thy wounds:
they smack of honour both—go get him surgeons.
Macbeth I,ii.
I find especially telling the portrayal of surgeons in Philip Massinger’s A Very Woman.  He portrays interprofessional (or interoccupational; surgery as a “profession” is much contested) cooperation where an unnamed doctor and two surgeons work together to successfully treat a wounded man.[4] 

This depiction is particularly interesting as it reveals Massinger’s understanding of the role of physicians and surgeons and he uses the moment to reinforce the subordination of surgery to physic. 

The doctor and surgeons disagree over a course of treatment for their wounded and melancholic patient Don Martino Cardenes: 

Doctor: He must take air.
1 Surgeon: Sir, under your correction,
The violence of motion may make
His wounds bleed fresh.
2 Surgeon: And he hath lost already
Too much blood, in my judgment.
Doctor: I allow that;
But to choak up his spirits in a dark room,
Is far more dangerous.  He comes; no questions.[5]

Though important to note, this disagreement is more significant than just a doctor overruling the judgments of two surgeons. 

Rather, the scene also reveals something of the professional boundaries Massinger thought important.  The surgeons’ expertise lay in the treatment of wounds and they are focused on his blood loss.  In contrast, the physician’s knowledge of medical theory meant that he approached the patient with a more holistic view of his wellbeing.  Both Martino’s mental and physical state could be treated with a change of environment; no doubt influenced by the Hippocratic writings universities deemed necessary reading for physicians. 
           
The doctor’s relationship with the two surgeons is an interesting one.  Though they work together, it is evident that he makes the therapeutic decisions and they act accordingly.  The physician hints at this when he praises their conduct – the surgeons did not use quack medicines, but followed the rules of Chiron and Aesculapius themselves.  As the second surgeon states “we were but his subordinate ministers, and did onely Follow your [the doctor’s] grave directions.”[6] 

The other characters thus heap their praise upon the doctor.  While the surgeons are offered 3000 crowns as a reward, “such petty sums” could not fully thank the doctor and he was offered his choice of the treasury and a castle or city of his choice to rule.[7] 

A noble and humble character, the doctor requests only that a “Colledge for Physitians may be With care and cost erected, in which no man May be admitted to a Fellowship, But such as by their vigilant studies shall Deserve a place there.”[8] 

One of the good doctor’s last actions in the play is to ensure the continued good name of physic and its rank at the top of the medical hierarchy.  In Massinger’s eyes, at least, the manual artist could not compare to the physician with his complex and learned theories.

A fair representation of early modern surgeons and physicians do you think?  Let me know here or on Twitter - I'm @medhistorian. 

p.s. happy birthday Shakespeare!  Still awesome 450 years later.



[1] Todd H.J. Pettigrew, Shakespeare and the Practice of Physic: Medical Narratives on the Early Modern English Stage.  Newark: University of Delaware Press, 2007.
[2] Thomas Berger and William Bradford, An Index of Characters in English Printed Drama to the Restoration. Englewood, Colorado: Microcard Editions Books, 1975.
[3] Berger and Bradford, An Index of Characters in English Printed Drama to the Restoration.
[4] Philip Massinger, Three New Playes. London: Printed for Humphrey Moseley (1655), 46.
[5] Ibid., 46-47.
[6] Ibid., 22.
[7] Ibid., 22-23.
[8] Ibid., 82.

Monday, 21 April 2014

Dear Measles, Please Don't Come Back



I still remember getting my second dose of the measles, mumps, and rubella vaccine.  I was 10 years old, and convinced myself that a distraction, any distraction, would make the process of vaccination go faster.  So, with childhood logic I started reciting times tables in my head…while out loud saying “oww, owww, owwww” even though the needle wasn’t even close to my arm.

Needless to say, the distraction didn’t actually help.  I still remember how horrified I felt at the vision of the needle sticking out of/hanging from my arm as the startled (I don’t know why he was startled, actually) physician let go of the needle.  Ah well, I was vaccinated and managed to leave the office with a lot more candy than I was probably allowed to eat on a single day.[1]

Yeah.  How I ended up as an historian of medicine is, sometimes, a mystery even to me.

Anyway, childhood reminisces aside, did you know that measles is making something of a comeback?  Canada officially eradicated measles as a domestically spread disease in 1998. Yet, a recent notice by the Canadian Public Health Agency listed 5 provinces that had recent measles cases.  In British Columbia alone the number infected is nearing 400.  News media informs me that the outbreaks across Canada were sparked by unvaccinated and infected overseas travelers.

The Lancet MMR vaccination article debacle – that claimed the vaccine led to autism – certainly helped matters.[2]  More recently, due to recent measles outbreaks,  Canadian media has identified a few fringe religious groups that refuse vaccination.  And, of course, we have the ever-vociferous celebrity voice – Jenny McCarthy (of Playboy fame) being the most outspoken – discouraging parents from vaccinating their children.  There are, of course, also those who did not vaccinate because they did not feel it necessary with such low domestic infection numbers.

Measles before vaccinations, proper hygiene, and a solid understanding of infection was a terrifying thing indeed.  So terrifying, in fact, that the early modern people saw measles and smallpox as closely related, differentiating between the two diseases only by degree.[3]  James Cooke, a 17th century surgeon, wrote that the two ailments were: “contagious and killing many, are fitly referr’d to maligned and pestilential Feavers.  The first are pustules, coming to ripenesse.  The seconded are small tubercles with intense rednesse, like an erysipelas…both these are accompanied with a continual Feaver.”[4]

Beginning with a cough, runny nose, and itchy or red eyes, measles masquerades briefly as a common cold or allergy.  Then, fever sets in, followed by the infamous itchy red rash that covers the whole body.  Complications lead to pneumonia, encephalitis, and even death.

“The duke has been thought past all hopes of recovery from a fever that preceded his measles: and I am told, that, whilst the danger lasted, the king sat crying upon his bed the whole day; and that he came three or four times in a night to see him.” - Seymour, Frances Thynne, Duchess of Somerset from Countess of Pomfret (1723)
This woman has measles.
Little was known about the manner of infection or how to prevent it.  Indeed, the measles vaccine was created only 51 years ago in 1963.

There were a couple competing theories about how one contracted the disease:

Blame Your Mom

One popular 17th century belief lay the blame for measles squarely at one’s mother’s feet.  Anthony Westwood’s De Variolis & Morbillis (1656) argued that infected mother’s blood led to measles in children.  This was, of course, logically deducted as “among many thousands of men it is hard to find one, who once in his life hath not had these diseases.  But a disease common to all men, must needs depend upon some common cause; such as are the principles of Generation, viz. the Seed and Mothers Blood.”[5]

He continued, “from the Mothers Blood, with which the child is nourished in the womb; for therein be it never so pure, some impurities are found, which communicate their pollution to the parts of the child; and that pollution of the parts doth defile the masse of blood.”[6]  The foetus, however, did not contract measles in the womb or even upon birth.  Rather, these impurities stayed in the body, further corrupting and then putrefying, finally culminating in the disease.

Okay, Maybe Not Mom’s Fault?

James Cooke restated the mother’s blood theory above.  He also, however, acknowledged that it was possible to contract the disease through what he termed “external” means.  By this, Cooke meant infection in a sense we can almost recognize today. 

As he wrote: “External causes are either contagion, as when a body so diseased, communicates the disease to another, call’d infection, or the aire from the influx of the planets or other causes, corrupting or disturbing the humours.”[7]

Gideon Harvey, in his A Treatise of the Small-Pox and Measles (1696), leaned toward Cooke’s infection theory.  Displaying logic a bit superior to Westwood, he questioned how a mother who had never had smallpox could infect their child with the disease.[8]  This idea simply did not make sense to Harvey who concluded that rather, “all are, or have been imbued with those impure, contagious Effluvia after their Birth, that have the power to produce the Small-pox or Measles.”[9]

So What?

The airborne infection theory did not immediately revolutionize how one thought about the measles.  While some thought that certain scents could help treat or prevent smallpox, the sheer infectious nature of the disease was not fully grasped.

Thomas Cocke, for example, recommended inhaling special vapours as “a great Antidote against the Plague, malignant Feavers, Small Pox, Measles, and all contagious Diseases, and of absolute use, not onely for sick People, but such also as live in the House, and tend them; or are necessiated to take their diseased Reekes, and dying Breaths.”[10]

Over 100 years later in 1767, Lady Coke, Mary Campbell noted that the Duchess of Northumberland felt little compunction in visiting her brother, one Mr. Howard, who was severely stricken with measles.  Indeed, Lady Coke ridiculed a Mrs. Pennant for fearing to come into contact with “anybody that came from a House where there was the measles.”  Coke wrote, “I laugh'd at her unreasonable fears, & assured her the measles cou'd not be carried.”[11]

From 1915. 4 kids in 1 bed, 2 with measles. The mother tells the district nurse that there is no risk of infection.
Howard, it seems, was told to keep to his bed and the prognosis was positive – he was strong enough to be bled for a third time.  Six days later, Lady Coke heard news that Mr. Howard was still doing better, then had a turn for the worse, then was bled and felt better again.

“I said to the Servant, ‘I hope there is no danger!’ he assured me none was apprehended.”

Mr. Howard died, due to the measles, at 8am the next morning.

Treatment

From Lady Coke’s memoirs, we can see that bloodletting was a tried and trusted treatment for measles – even when inefficacious!

Practitioners used generally a combination of dietetics and medicines to treat the ailment as well.  Westwood, for example, recommended eating things that were easy to digest to counteract the phlegmatic humours that caused the disease.  He suggested especially wheat and barley bread, lamb, partridge, larks, and pheasant while “moistening” the meat with the juice of sorrels.  While poultry seems to be the meat of the day, Westwood did, however, note that water-fowls were to be avoided.[12]

I leave you with a receipt to treat measles used in 17th and 18th century England.  Lady Allen's water made it into many early modern receipt books!
 
Lady Allen's water for small pox, fevers, and measles contains sage, rosemary, rue, wormwood, bettony, centaury, gentian root etc.  All easy to access herbal ingredients. Wellcome MS 160/63.

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


[1] The receptionist was very amused by my audible “owwws” and said that I managed to terrify the few children in the waiting room into begging their parents to not be vaccinated.  I was double their age and vaguely remembered feeling mortified (until there was chocolate in hand and we were in the car).
[2] The article by Andrew Wakefield was subsequently retracted. Lancet apologized and Wakefield was banned from practicing medicine.
[3] Likely due to al Rhazi’s A Treatise on the Small-pox and Measles (9-10th century).
[4] James Cooke, Supplementum Chirurgiae (1655), 260-261.
[5] Anthony Westwood, De Variolis & Morbillis (1656), 7-8.
[6] Ibid., 9.
[7] Cooke, 262.
[8] Gideon Harvey, A Treatise of the Small-pox and Measles (1696), 15.
[9] Ibid., 16-17.
[10] Thomas Cocke, Miscelanea Medica (1675).
[11] Coke, Lady Mary Campbell, 1726-1811, Diary of Lady Mary Campbell Coke, February, 1767, in The Letters and Journals of Lady Mary Coke, vol. 1. Edinburgh, Scotland: David Douglas, 1889, pp. 247.
[12] Westwood, 49.

Wednesday, 9 April 2014

For All Men Once to Die

Morbid isn't it?

I’m sure many of you have heard that early modern peoples had a rather blasé approach to their own death, viewing it only as shuffling off this mortal coil and into heaven?  Or the myth that the early modern English (especially) were not attached to their children?[1] 

With a high percentage of infant deaths, inclement weather exacerbating already poor nutrition, epidemic disease, and largely ineffective medical treatment, the people of early modern England were certainly aware of 1) their own mortality 2) the mortality of their family and friends.

This awareness did not mean, however, that the early modern English were desensitized to death.  Indeed, like today, there were those who feared or dreaded death, planned for their own demise, mourned the death of loved ones, and memorialized them.

In this world, nothing can be said to be certain, except death and taxes.- Ben Franklin

Fearing Death

Religious belief permeated early modern England.  It shaped how you thought, spoke, dealt with others, and even how you cooked (stir that pot for 10 pater nosters!).  And, of course, it helped shape how you thought about death.

For many, death was a release from the sufferings of life and the beginning of a new, perfect, and suffering-free life in heaven.  For those who lived a life dedicated to their faith, death did not have to feared and, in fact, could be a welcome reprieve.

As Ralph Josselin, a 17th century clergyman, wrote, death was "a separation of soul and body from each other that they may more closely enjoy the communion of Jesus Christ: a wicked mans death is a departing from God, a separating of soul and body from God for ever."[2]
 
Similar religious arguments abounded.  Nicholas Byfield’s 1619 work, for example, promised in its very title that it provided The Cure of the Feare of Death.  Fearing death, he argued, was akin to an “ordinarie disease” and could be cured by recognizing that life on earth was frequently quite miserable and that to fear death was a distinctly unchristian behaviour.  As he wrote “it is the love of some sin, and delight in it, that makes a man afraid to dye” and that “it is an easie thing to bee willing to dye, when our hearts are cleansed of the love of this world.”[3]



Planning for One’s Demise

In a similar vein, Byfield suggested that setting one’s house in order was a key part of preparing to die, dying properly, and ridding oneself of the fear of death.  He argued that it was “most preposterous course for men to leave the making of their Wils to their sicknesse.”  Instead, it was something to be completed early and in great detail so to settle “worldly affaires, and according to their means, provide for their wife and children.”

I’ve stumbled across the wills of numerous surgical practitioners heading out to sea that help to underscore the necessity of will creation:

Here, John Harris’s will was written “considering the many dangers and uncertainty of this present life being outward bound on a voyage to sea” and left everything to his friend Stephen Capp.





Similarly, John Roberts’s will here states: “considering the perrills and dangers of the seas and other uncertaintyes of this transitory life Soe for avoiding controversies after my decease make publish and declare this my last will and testament.”



Accepting Death? Grief

Scholars such as Philippe Ariès and Lawrence Stone have commented that this heightened awareness of the inevitable – and often sudden or early – death meant colder interpersonal relations, even with family.  Here we see that wasn’t necessarily true. 

It is a very human inclination to ask “why me?” when something negative happens.  In terms of health, Ralph Josselin’s answer to the question – according to Alan Macfarlane – was one “conditioned to submission and acceptance.”[4]  Despite this resigned attitude, Josselin still questioned the illnesses and deaths of his friends. 

When his friend Mrs. Mary passed away, Josselin wrote that he was “perplexed in the dealings of the Lord so sadly with [them].”[5]  At one funeral sermon, Josselin noted that he “lost his ‘greife and trouble much in the pulpitt’” and upon the burial of his 10 day old daughter “kist her lips last, & carefully laid up that body, the soule being with Jesus.”[6]  Josselin’s acceptance of his child’s death and belief that she was in heaven was still accompanied by emotional outpouring and displays of grief.

Lady Ann Conway, likewise, was accepting of her illness that almost led to death, writing “it hath pleased God to raise me from that desperate sicknesse (which in all probability should have given a perfect release to all my sufferings).”  In the same letter we see juxtaposed her acceptance of personal illness and her grief at the loss of her child.  Perhaps needless to say, her outpouring of emotion at the latter was immense.

As she wrote, “I tell you it hath extorted from me a griefe proportionable to so great a losse. Neither am I yet able so well to overcome it as might beseeme one whose present constitution promising no later respite from the same fate consequently therefore ought not to be so much affected with such injoyments of this world.”

Elizabeth Robinson Montagu wrote similarly about the death of her child in 1744:  “I am well enough as to health of body, but God knows, the sickness of the soul is far worse; however, as so many good friends interest themselves for me, I am glad I am not ill. I know it is my duty to be resigned and to submit; many, far more deserving than I am, have been as unfortunate [in losing a child].”

Mourning  

The parents above felt intense grief at the death of their children and were willing and able to express their emotion to family and family.  Another common thread between them, interestingly, is the desire to not grieve too much.

Montagu, for example, noted that she was taking steps to come to terms with her loss with the help of family and friends.  She hoped that the grief would fade with time, read as a distraction, and was supported by her sister.  Perhaps, most important, she noted that her husband, “Poor Mr. Montagu shews me an example of patience and fortitude, and endeavours to comfort me, though undoubtedly he feels as much sorrow as I can do, for he loved his child as much as ever parent could do.”


Not mourning too much seems to have been a popular topic on which to write.  Edward Bury, in his 1693 work Death Improv’d, and Immoderate Sorrow for Deceased Friends and Relations Reprov’d wrote that grief was natural, lawful, and one’s duty.  Indeed, not grieving was “an Heathinish sin!”[7]  In the same way, grief that “disables us for our present Duty in our general or particular Calling” was also “doubtless” sin.[8]  One’s focus, he wrote, should be on the duty toward the living and the one’s own soul – there was little one could do for the dead.

Probably not an appropriate time or place to make this observation, but doesn't Bury look like someone's terrible artistic rendition of Severus Snape?
Celebration

Last, I’d like to turn to the valorization and celebration of the dead.  Dying well was important.  As Keith Thomas noted, “it was a source of happiness…to be able to leave behind ‘an honourable fame’ which would live in the memory of men when our bodies had turned to dust” and that “in the literary culture…it was commonplace to regard posthumous remembrance as the ultimate fulfillment of human life.”[9]

Indeed, funerary elegies epitomize this sort of posthumous valorization as the deceased person is transformed into the epitome of virtue or a truly unattainable ideal.[10] 

The anonymous tale of Susanna Bickes, a 14 year old girl who died of the plague in 1664, epitomizes this sort of inclination.  The author described Bickes’s last days, emphasizing her maturity in the face of death and, especially, her spiritual strength as evidenced by her many prayers and religious exhortations to those around her.[11]

In another, dedicated to the memory of Thomas Heneage, the author laments Heneage’s passing and the impartiality of death.   



His epitaph?

Here lies interr’d under this fatall stone, A world of men epitomis’d in one.



Let me know what you think here or on twitter. I'm @medhistorian.


[1] Much of this stems from the work of Philippe Ariès, Centuries of Childhood, London: Jonathan Cape, 1962 &Lawrence Stone, The Family, Sex and Marriage in England, 1500-1800, Harmondsworth, Middlesex: Penguin Books, 1979.
[2] Alan Macfarlane, The Family Life of Ralph Josselin, N.Y.: WW. Norton & Company (1970), 222.
[3] Nicholas Byfield, The Cure of the Feare of Death, London: printed by G. Purslowe for R. Rounthwaite 1619.
[4] Macfarlane, 172.
[5] Ibid.
[6] Ibid., 100.
[7] Edward Bury, Death Improv’d, London: Thomas Parkhurtst (1693), 7.
[8] Ibid., 9.
[9] Keith Thomas, The Ends of Life, Oxford: Oxford University Press (2009), 236.
[10] See: Andrea Brady, “‘Without weld, gard, or embroidery,’: A Funeral Elegy for Cicely Ridgeway, Countess of Londonderry,” Huntington Library Quarterly 72,3 (2009), 373-395  ß is particularly interesting as Ridgeway’s rejection of some feminine ideals are extolled/commented upon; Lucinda Becker, “The Absent Body: Representations of Dying Early Modern Women in A Selection of Seventeenth-Century Diaries,” Women’s Writing, 8 (2001), p. 251-262.
[11] Anon. An Edifieing Wonder, London: 1666.