Friday, 13 June 2014

The Early Modern Kobayashi-Maru: Advertising Surgery in 17th Century England



How, precisely, does a surgical practitioner advertise?  The idea sits uncomfortably – a flashy ad, some neon lights, maybe Vince-the-ShamWow-guy?

Seventeenth century London handbills or advertisements are as fascinating as they are important.  Littered with cure-alls, promises of “no cure, no money,” and intriguing images, advertisements can also reveal which ailments required a patient to see a surgeon, and what kinds of treatments were available, and the advertising strategies used to convince a patient to see a surgical practitioner. 


Not a handbill - this is from the title page of Salvator Winter’s A Pretious Treasury (1649)
Upon reading the advertisements a pattern quickly emerges.  Venereal disease is, by far, the most frequently mentioned ailment mentioned.  Next, surgeons advertised their ability to treat ruptures, the stone, eye, ear and teeth maladies, inflammation, and cancers.  Skin ailments like harelips, leprosy or “scall’d heads” featured prominently alongside other visible outward manifestations of disease such as buboes, scabs, and “breakings-out all over the Body.”[1]  So called “oculists” who couched cataracts advertised frequently and made up a specialized group of surgical practitioners.  

Cornelius Tilburg treating a man’s eye complaint
It is impossible to judge the magnitude of disease outbreaks or the pervasiveness of certain ailments based on these advertisements.  Venereal disease was rampant throughout London and was represented as such by its frequent mention in handbills.  Skin diseases and the stone, also well represented, were the surgeons’ domain. 

Stomach ruptures or “broken bellies,” however, are likely overly represented in the advertisements.  John Schultius explained ruptures as when one’s “guts cannot be kept in.”[2]  Along with falling wombs and anal prolapses, gut ruptures represented one especially bizarre manifestation of the desire to keep everything and everyone in their proper place.  To this end, surgical practitioners offered manual operations while others offered trusses – contraptions meant to hold the gut (or anything else) in place.[3]


Anon. Ruptures cur[‘d] by Bartlett of 
Goodmans-[Fiel]ds, (1660?)
Surgical practitioners, it seemed, also had some difficulty convincing potential patients to undergo an invasive operation.  Like general health treatises discussed, many of these advertisements suggested internal remedies for surgical ailments. Both Mr. Elmy the operator and the unnamed surgeon who lived at Mr. Brett’s apothecary sold medicines to be taken inwardly.[4]  The latter, in fact, stressed that he provided “inoffensive Medicines, that a child of Twelve Months old, may receive the Benefit without the least Uneasiness.”[5] 

Gilbert Anderson, a self-proclaimed physician and former military surgeon also advertised his services.  Anderson highlighted his military service as evidence of his competence, using counterintuitively, his lack of experience with the challenging operation of amputation.  Instead, Anderson framed this lack of experience as a positive characteristic; it was evidence that he was not hasty to perform an invasive, painful, and radical operation when other easier, painless, and minor solutions were at hand.[6] 

As observed with Samuel Pepys, fears of being cut for the stone could delay the decision for years.  Some quacks preyed on those fears, emphasizing the “hazard of cutting, which often proves more fatal than the Disease,” to advertise their concoctions.[7]  For example, an unnamed German man offered a powder that cured both the stone and rickets while a man calling himself a physician offered “an infallible  Medicine” that dissolved bladder stones.[8] 

It is no surprise then that when Abraham Souburg advertised his services, he stressed that he was able to remove the stone without using an instrument (or more than one instrument), arguing that it was the use thereof that caused collateral damage to the area and made patients lame.[9]  He went further, writing that he would give “six hundred Rix Dollars,” to anyone who could produce a patient he had harmed by cutting for the stone.[10]  Even Tilburg offered inward medicines for the stone.[11]           

In comparison to those offering physick for surgical ailments, few offered solely their surgical skills for the same.  Simple surgical procedures such as bleeding or extracting teeth were likely the easiest operations to convince patients to undergo by virtue of their simplicity. 

David Perronet and Benjamin Willmote both advertised offered their services for both dental work and phlebotomy.  Cost may have also been a factor – in the latter case, Willmote charged only six pence for the service and Perronet suggested that it could cost six pence or a shilling.[12] 

The treasurer’s records of St. Thomas Hospital give some idea of cost; major operations, it seemed, had a standardized cost: for dismembering a limb, cutting for a rupture, and cutting for the stone, surgeons were paid three shillings and four pence.[13]  For dismembering a finger, William Perse received one shilling eight pence.[14] 

Venereal diseases were much more difficult and expensive to cure; one advertisement suggested ten shillings as sufficient payment for curing the pox and five shillings for gonorrhea.[15]  

John Russell’s advertisement depicting the surgical operations he was willing to perform
In contrast, when practitioners offered medicines for surgical ailments, the cost was generally lower.  James Wasse Senior advertised his Wasse’s Elixir, it was sold by the half pint for three shillings with printed directions.  The elixir promised to cure agues, gout, and convulsions and even dissolve an cure bladder and kidney stones.[16]  Mr. Elmy the operator offered a remedy for all head pains, eye diseases, and memory that shed the bad humours without surgery; for this he charged one shilling six pence for 10 pills or three shillings for 20 pills.[17]  Even Perronet, though he pulled teeth, admitted that this was an inconvenient solution and offered special ointments and elixirs for sore gums and rotted teeth that ranged in price from six pence to one shilling.[18] 

The generally lower cost coupled with the promise of a painless and easy cure was likely more appealing to patients than a regimen of cutting, excising, stitching, and dressing.  Even John Russell, whose advertisement boldly depicted patients undergoing manual operations, used the textual portion to advertise his cures by medicines, noting that he cured one woman’s breast cancer specifically “without cutting.”[19] 

In effect, popular treatises and surgical advertisements both presented the same message: surgery was a painful and dangerous option to be avoided when medicinal remedies could suffice.
 
Forget Kobayashi-Maru - let's talk about Pepys's dilemma.

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



[1] Anonymous. “A Secret Which Has Been Found” Wing S2351B; see also BL 551.a.32, 112.
[2] BL C112f9, 27.
[3] BL 551.a.32, 143 and Anon. Ruptures Curd by Bartlett of Goodmans Field.
[4] BL 551.a.32, 84 and 10.
[5] BL 551.a.32, 10.
[6] Gilbert Anderson, All Praise and Glory be Given to God Alone, London.
[7] BL 551.a.32, 122.
[8] BL 551.a.32, 25 and Anonymous, At the Sign of the Two Faces, London.
[9] BL 551.a.32, 140.
[10] Ibid.
[11] BL 551.a.32, 3.
[12] Benjamin Willmote, The Highly Approved English Deaf Curing Doctor, London and David Perronet, His Universal Dentifrice, London.
[13] LMA H01/ST/D/04/001.  Treasurer's Common Acquittance Books Containing signed receipts for payments made by the Treasurer, including salaries of staff. See especially Molins comment regarding the stone on 1 June, 1674 and Hollier for dismembering and the cutting of a rupture on 13 Aug, 1674 and 14 November, 1674 respectively.
[14] LMA H01/ST/D/04/001, 27 April, 1676.
[15] Anonymous, Glad Tidings To Unfortunate Venerial Patients, London.
[16] Anonymous, James Wasse Senior Citizen and Surgeon of London, London, 2-6.
[17] Elmy, At the Blew Ball, London.
[18] Perronet, His Universal Dentifrice, London.
[19] John Russell, John Russell, Professor of Physick and Oculist, London, 1-2.

5 comments:

  1. Furdell talks about the close links between printed advertisements of medicines and the actual selling of medicine, saying that "bookshops [were] the chief retail outlets for proprietary medicines in early modern England" (_Publishing and Medicine in Early Modern England_, University of Rochester Press, 2002, p. 131). Do you know whether early modern surgeons would have actually hung out in or near bookshops? I would welcome any insights into what kind of relationship might there have been (if any) between booksellers and surgeons!

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  2. Hi John, thanks for the the comment. In general, "regular" or Company surgical practitioners didn't advertise in this manner. My guess is that, like the physicians, they saw it as too unseemly. Not to mention, of course, that those surgeons were not supposed to be creating and selling their own medicines; they likely focused more on manual techniques. The "irregular" (as Margaret Pelling calls them) surgical practitioners, were more likely to also compound and sell internal medicines. These, like Elmy, Russell, and Perronet above, would advertise in both handbills and general health treatises that their medicines could be found with them or at places like booksellers and coffee shops. For the most part, the answer differs depending on how one delineates "surgeon" - this is why I use "surgical practitioner" in my own work. Hope that helps a bit!

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  3. OK, thanks. So there would have been a distinction between different grades of surgeons at this time? Presumably they would cater to different pockets? Interesting!

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  4. Surgical practitioners certainly make distinctions in their treatises - i.e. a physician practicing surgery vs. a legally practicing guild member vs. the bonesetter or bloodletter or barber "pretending" to be a surgeon etc. Legality wasn't the only issue, of course, College physicians and Company surgeons also wrote negatively about those practicing surgery with only ecclesiastical licenses.

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  5. Make sure all the fittings and fixtures are designed for accessibility as well as appearance.look these up

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