Understanding Sources: Glimpses of daily life in medical case histories

Our latest Postgraduate and Early Career Takeover is by Amie Bolissian. Amie is currently in the third year of her Wellcome-funded PhD at University of Reading, researching ‘The Aged Patient in Early Modern England, c.1570-1730’. Find her on Twitter at @AuntieAmie.

One ill-fated day, sometime around the middle of the seventeenth century, ‘an old servant to a person of honour’ was bitten on the back of his hand by a monkey. The surgeon called to treat the man, ‘forbad him wine’ to reduce inflammation. But the next morning the old man complained of a sleepless night, feeling ‘faint and sick’, and that ‘his Wound was the least of his ailment’. After his patient swooned, and claimed he ‘could not live without Wine’, the surgeon finally relented, and allowed him to return to drinking ‘as he pleased’. As it turned out, this entailed a ‘Quart’ of wine every morning but, soon after, the wound healed, and the patient was cured.1

[Detail of] A medicine vendor tying up his pet monkey. Etching by T. Major after D. Teniers II.. Credit: Wellcome Collection. Public Domain Mark

This story was just one of many medical case histories that Richard Wiseman, ex-civil war surgeon and personal practitioner to Charles II, included in his lengthy tome on surgery, published in 1676. He went on to explain that some heavy drinkers should never be forbidden wine and that with ‘Dunkerker’ sailors he could ‘scarce ever cure any of them without allowing them Wine’. Wiseman cited the saying ‘a Hair of the same Dog’, and admitted that his readers ‘may laugh’ at him for ‘pleading’ for these drinkers but, as he put it, ‘I hope you will consider I am a Water-drinker’.2 There is so much of historical interest to unpack in this short passage that it is hard to know where to begin. To start with: Whose monkey was it? And were monkey-inflicted wounds so common that this warranted no comment?

A one-legged hurdy gurdy player dressed in rags with his companion, an old woman dressed in rags reading from a song sheet. Engraving with etching by J. Matham after Adriaen Pietersz van de Venne. Wellcome Collection. Public Domain Mark

My particular interest in this case, as a researcher of old age and health, concerns the idea that it was dangerous for people with ingrained habits to change them suddenly, especially ‘aged’ people. Habits were believed to embed themselves deeply within weak, ageing bodies, and, even if these habits were considered unhealthy, it was thought potentially perilous to abandon them. Wiseman’s case history, and others from physicians, surgeons, and apothecaries have allowed me to see how these medical theories were applied in practice (or sometimes utterly disregarded), but my enthusiasm for this genre extends far beyond this function.

Case histories can provide useful insights into cultural attitudes, experiences, and monkey-related incidents, but have rarely been exploited for these details. Before blood-tests, scans, and other diagnostic techniques were available, the patient’s narrative of how and why they became sick was essential for the doctor to diagnose and treat them. While casebooks come in a variety of different forms, some more detailed than others, we can often find these stories, and information about a patient’s age, gender, or social status. So, let’s take a closer look at English language, medical casebooks as historical sources.

William Salmon, Select Physical and Surgical Observations. Credit: Wellcome Collection. Public Domain Mark

Firstly, where can they be found? Some practitioners, like Wiseman and Shakespeare’s son-in-law John Hall, had their case histories or ‘observations’ published in collections or medical treatises. Scanned images and transcriptions of these can be accessed at Early English Books Online. Handwritten manuscript casebooks have also survived, and are available to view at the British Library, Wellcome Collection, and Royal College of Physicians archives, among other locations. Most of these institutions allow you to photograph pages for free – which is useful, as doctors’ handwriting can be tricky to decipher in a hurry. Another amazing resource, and one useful for those unable to travel to archives, is The Casebooks Project. This is an online collection of over 70,000 case histories painstakingly compiled by a team of scholars, led by Professor Lauren Kassell, from the handwritten records of the Buckinghamshire astrological physician Richard Napier (1559-1634) and his colleagues. It includes non-medical as well as medical astrological consultations, and is easily searchable by keyword, gender, age, and patient query. Much of the text has already been transcribed, but there are also scans of each page, and useful palaeography tips.

The Casebooks Project Homepage, https://casebooks.lib.cam.ac.uk, accessed 28th June 2021

Yes, but what are the limitations of medical casebooks? Like all genres of sources, there are some caveats.

  1. Almost all of the casebooks that survive were written by men. Women were forbidden from attending university and qualifying as M.D.s, but we know that many practiced as midwives, lay practitioners, surgeons, and apothecaries. Despite women providing a large share of treatment between 1550 and 1750, medical case histories by women are relatively rare.
  2. Case histories only tell one side of the story. They were written by the practitioner, so the voices and opinions of the patients and their relations are obviously mediated. This is second-hand testimony, and the author’s interpretation was unlikely to be impartial.
  3. Quantitative conclusions should be approached with caution. Published collections were selected and edited, so they are not necessarily representative of a doctor’s entire practice. Likewise, seemingly unedited handwritten records might not give us a wholly accurate picture, as the doctors’ reputation (as a fertility specialist, for example) may have encouraged a certain type of clientele.

Nevertheless, casebooks can be very revealing of everyday habits, and attitudes and responses to pain, illness, and disability. They can, also, offer rare and precious glimpses of care-work absent from other sources – especially that provided by servants. Let me conclude with two tantalising examples.

Anon. Sickbed, etching, c.17th century, Wikimedia commons

In one case, Wiseman describes how he spent ‘days’ showing a 60-year-old man’s servants ‘how to reduce and dress’ a painful swelling. Here, we see a surgeon training servants in specialist medical care, and the ageing patient trusting them to perform it. In another case, we read of a 60-year-old gentleman suffering from a sore on his back during a plague year. Wiseman adds that none in the household suspected plague, even though ‘the Servants that washed his Linen brake out in Blanes [sores] on their Hands and Arms as far as they were in the Soap-suds’. What material historian Susan North has called the historical ‘unmentionables’ of cleaning and washing are often invisible in published discourse and life-writings. This rare insight prompts exciting questions around understandings of contagion and touch, and the experience of servants working in households with sick members. You never know what laundry and monkey treasures you might unearth in casebooks.3

Further Reading

Kassell, Lauren, ‘Casebooks in early modern England: medicine, astrology, and written records’, Bulletin of the history of medicine, 88/4 (2014), 595-625.

Pomata, Gianna, ‘The Medical Case Narrative: Distant Reading of an Epistemic Genre’, Literature and Medicine, 32/1 (2014), 1-23.

Duden, Barbara, The Woman Beneath the Skin: A Doctor’s Patients in Eighteenth-century Germany,  (1998).

Mann, Sophie, ‘Physic and divinity: the case of Dr John Downes M.D. (1627-1694)’, The Seventeenth Century, 31/4 (2016), 451-70.

Footnotes

1. Richard Wiseman, Severall chirurgicall treatises, (London: 1676), 346

2. Wiseman, Severall chirurgicall treatises, 347.

3. Wiseman, Severall chirurgicall treatises, 54, 221; Susan North, Sweet and Clean?: Bodies and Clothes in Early Modern England,  (Oxford, 2020), 20.

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