The second of the 2014 season of presentations was a classic example of what WSHOMS does so well – it juxtaposes subjects that while coming under the broad definition of ‘history of medicine’ succeed in simultaneously fascinating, informing and astounding us.
The first presentation was by Julie Wakefield:
Healing Rituals in West Sussex in the 19th Century
Julie became interested in the history of medicine when a curator at the Museum of the Royal Pharmaceutical Society and she currently works at the Old Operating Theatre and Herb Garrett in London, where she researches Historic Herbalism and Folk Remedies. Indeed she is collecting tales and remembered experiences from the older generation along these lines, so if you could dig up any memories of what your grandparents used to treat their various ailments, please add them in the comments section and I will make sure they reach Julie.
Probably everyone present at this lecture was expecting to hear about some interesting details regarding sick room practices from the old days; poultices, leeches and bizarre contraptions to hold hernias in, but no, we learned about healing methods that were of an altogether different ilk, and very strange they were too!
During the middle Victorian period we West Sussex folk apparently approached illness and injury in ways entirely unrelated to theories of physiology, either the newer more scientific understandings or the ancient humoral sort. Perhaps the expense of seeking out a trained physician precluded serious efforts to resolve diseases (or previous experience with such doctors put people off taking that course of action), or maybe it was deeply held religious beliefs drove these actions, but either way the common people appear to have relied rather heavily on superstition and magic for relief of their ills. And some of these superstitions had obscure roots, and rather dodgy practitioners to boot.
The Reverend Thomas Firminger Thiselton-Dyer (1848 –1923) author of The Folklore Of Plants, gripped our speaker’s attention, and with good reason. In it he describes places and people, some by name, including which village they lived in and their occupation, and goes into some detail as to how they dealt with their various ailments, not only through the usual recourse to herbs or drugs of the wise woman, cunning folk or doctor’s devising but through the offices of quasi-religious purveyors of charms. These charms are pretty odd in general. We heard a couple of variations that went something like this: An old woman will murmur over the one to be healed “There came two angels from the north, they brought fire and frost; out fire in frost. In the name of the father, son and holy ghost”. The direction, number of angels and other details would differ but ending the charm with standard Christian liturgical tropes may have been a device aimed at defending the charmer from charges of heresy or witchcraft. Calling such a charm ‘a blessing’ was likewise a common practice.
One such old lady who offered charms is reported by a Mrs Latham of Storrington as a collector of simples and a maker of ointments and who specializes as a ‘charmer of wounds caused by thorns’. This old lady was taught a charm (full of Christian imagery) by a shepherd who said she could earn a little money from the use of it. This suggests that, like the cunning folk and wise women (both of which were lay physicians with various degrees of training and experience in the use of medicinal plants) who charged small sums for their ministrations and advise, but significantly less than the physicians, who were a far less common species. (As someone who does DIY around my home along with my husband I think I need to find someone like this old lady charmer as I get splinters as soon as I look at a piece of timber, and I reckon that counts as a thorn, don’t you?)
The combination of pagan and Christian terminology and imagery was very common in superstitious rituals. One that I found particularly rich was the one that was used by the head of the household in the treatment of whooping-cough. It starts in such a way as to bring you up short, thus… ‘Boil a donkey’ (see what I mean).. ‘Make a silk bag and put the hair from the donkey’s pelt, specifically from the area of the cross on its back, into the bag. Pin this bag on the patient and have them sit backwards on another donkey, a live one, and have it lead back and forth by someone for three days. This will cure the whooping-cough’. Interestingly, the live donkey was lent by the local vicar for this purpose, so it was not considered so pagan or antipathetic to her Christian beliefs as to make involvement impossible, as I suspect it would now. Clearly in 1870 or thereabouts, West Sussex was far more liberal and experimental than it is now. What we don’t hear about is what, if any, were the results of the use of charms and strange practices such as this. Three days sitting backwards on a donkey being lead back and forth for a patient with whooping-cough sounds rather bad for one’s health, I am sure you agree.
We also heard about Cleft Tree Magic which consisted of villagers cutting a tree down the middle in order to create a cleft in it and passing sick people through the gap a prescribed number of times, from east to west, or other specified directions, in order to heal ruptures (!). The number of passes was frequently nine, which must have made such processes into significant events, with ritualistic properties and all that this implies, including the belief that if the tree is cut down following this procedure, the patient for whom it was undertaken will die. The number 9 is not a number that appears in Christian traditions, but has roots in astrological principles, 9 being the number of Jupiter, and Jupiter being the Greater Benefic and therefore invoked for healing. Interestingly the symbol for medicine, the crossed capital letter R used in prescription writing, is a variation on the astrological glyph for the planet Jupiter. So when writing a prescription for a patient the physician, consciously or not, is calling upon the Jupiter/Jove to guide his choice of medicine.
A more disturbing aspect of this sort of bizarre and unlikely approach to healing was described too, and involved being touched by the hand of a dead person, usually a felon or just someone who had died in an accident. Again, this was done in a ritualistic way such as the dead hand of a drowned boy applied in a stoking manner, nine times mark you, to a woman endeavoring to heal her goiter. One would think that she and all those observing this would pretty soon see that it made no difference to the goiter and therefore should not be considered a useful method of resolving such things, but no, corpses continued to hold all sorts of promise of healing to the living, unsavory as this undoubtedly was.
Although herbal preparations often had ritualistic masses or the Lord’s Prayer said over them (nine times of course) it didn’t actually make any difference to the efficacy of the herb, though might have appeared to, to the gullible peasant. The lesser celandine (Ranunculus ficaria) is very effective indeed in the treatment of haemorroids, as the folk name, pilewort, implies, but it is effective whether or not someone with priestly assumptions tries to manipulate another into thinking that he or she has endowed it with extra power of some kind. Indeed in my Home Herbal Range I include Pilewort Cream (in little 30g glass pots at £4 each) for precisely that nasty personal problem that for generations before you have utilised this herb, and I certainly don’t perform any incantations over it!
The St Peter’s Charm was discussed as a ‘cure’ and ‘preventative’ for toothache, and shows how charms were not only had through the words of those individuals claiming some sort of ‘gift’ but could be written down, described as a ‘prayer’, and still be efficacious. Even a photograph of the written prayer was believed to contain within it the power of a charm. Handy, eh?
The established church routinely merged itself with earlier pagan customs such as seasonal high points (Christmas blending itself into winter solstice feasts and Saturnalia for example) and in these powerful magical practices a similar tendency of incorporation occurred, such that all sorts of layers of the various cultures could emerge. For example we heard that the local vicar would sprinkle holy water onto the marital bed of a couple who were apparently infertile, along with blessed bread and salt for them to eat, and yet if the wafer/host was stolen and eaten by someone hoping for a surreptitious cure that was not known about by the whole village then a kind of curse befell them at the eating of the wafer and transubstantiation would happen in reverse, leading to the culprit choking on it, as choking on a piece of flesh! So the Church got in on this sort of belief system, utilizing the credulity of the masses in order to maintain some control them
Humans of all cultures were and are very, very susceptible to superstition, and religious rituals of any doctrine are still today clear conduits for this tendency. Thank you Julie for a talk that showed that the bonkosity of my species knows no bounds.
~ ~ ~ ~ ~ ~
The second presentation of the day was by Lt-Col Ngozi Dufty MRCP MCGI DTM&H RAMC and a very different subject it was:
Syphilis and War – the necessary requirement for an epidemic
The great physician William Ostler once said “He who knows syphilis knows medicine” from which I take it that once this disease had spread far and wide, virtually all forms of medicament, chemical, spell, charm and prayer were tried, so clinicians of all stripes, from the 1400s to the 1950s would have experimented with their whole armoury of treatments in trying, and failing, to cure it.
I will spare you some of the more ghastly images of ulcerated body parts, and deformed faces, because they were very unpleasant, as you can imagine.
The history of ‘the pox’ is still somewhat mysterious but in Europe seems to date from the late 15th century and was spread by sailors, prostitutes, armies, prostitutes, husbands and more prostitutes. The name given to this dreaded disease whenever it cropped up related to whoever was being blamed, ‘the Neapolitan disease’, ‘the French disease’, ‘Pox of Naples’, ‘the Spanish Pox’, ‘the Portugese disease’ ‘the Turkish disease’ and ‘the Christian disease’ but the theory that the Treponema species of spiral shaped bacterium may have originated in The Americas has gained traction. There is some evidence that a disease with similar bacterial origins was common in the pre Christopher Columbus era as the skeletons of young people from Florida and other parts of America show typical markings, and suggests that a non-sexually transmitted version of a Treponemal disease was the cause, like yaws, bejel or pinta. Once in Europe this bacterium may have evolved to the form we now know as syphilis, the sexually transmitted horror that brought down so many people. This is known euphemistically as The Columbian Exchange.
The Italian poet and physician Girolamo Fracastoro first used the term ‘syphilis’ in a poem written in Latin in 1530 which told of a Greek shepherd named Syphilus who led a revolt against the god of the sun and later suffered from this disease. The name stuck.
Throughout the 1500s the diabolical disfiguring disease raged across Europe and at various times and places the authorities closed the brothels surmising rightly that they had something to do with it. Female patients in these houses of ill repute (an apt term) could be hanged if they did not leave and go to hospitals, but unfortunately prostitution was driven underground by that strategy and the dissemination of Treponema pallidum continued unabated. Women, it seems were generally blamed for it.
The treatments that physicians, cunning folk, herbalists, apothecaries, doctors, barber surgeons and aspiring chemists alike applied to the unfortunates, of whom there were many, were frequently drastic. Mercury, the one about which we have the most knowledge, being a toxic metal to mammals, causes a major expelling reaction, with huge amounts of salivation and sweating and loss of teeth, and loss of mind. Barbara Griggs has a great chapter on this in her 1997 book on the history of herbal medicine ‘Green Pharmacy, covering this subject and the horrendous attempts to treat it. And of course some people appeared to recover following such treatments, leading to the persistent belief that such an approach was worth pursuing, even though it killed many of those who undertook it.
The herbs Guaiacum officinalis (lignum vitae) and Smilax officinalis (sarsaparilla) were also used extensively in the treatment of syphilis throughout the 16th and 17th centuries and have some similar effects to mercury, though with none of the latter’s terrible toxicity. Both these herbs stimulate the body to expel pathogens, through internal warming, much as the production of a fever does (their diaphoretic effect). Fever evolved as a method of non-specific bodily defense which not only speeds up all cellular reactions but also alters the internal environment such that microbes are stressed by the raised temperature and are rendered more vulnerable to attack by the highly activated white blood cells. These days Medical Herbalists use these herbs to treat persistent inflammatory states, such as arthritis, as they stimulate blood flow, oxygenation, immunological activity and nourishment of the tissues of the joints etc and thus enable resolution of inflammatory vicious circle but for syphilis I doubt if their effects were sufficient to make much difference. Mercury brought about some of these effects through being a toxin, whereas the herbs brought about these effects through helping the system fight off toxins.
Interestingly, Guaiacum resin (it’s a tree) is still used in certain lab testing of urine or faeces as it changes colour in the presence of blood. So if you see on a lab report that a ‘gFOBT’ test has been performed you will know that the ‘g’ stands for Guaiacum in a faecal occult blood test. Smilax is still in use by Medical Herbalists and soft drinks manufacturers too.
Whatever the mechanism, therapeutic herbs and metals had a pretty meager or temporary effect on outcomes (other than the high cost in side effects suffered by those on the mercury of course) and syphilis continued to devour all classes of people across Europe and the rest of the world. In fact, according to the 20 minute video below (and I recommend watching it, it’s very good, made by an American Naval medicine centre in 1973) this disease has injured and killed more people than any other infectious disease in history!
Only in 1905 was the spirochete finally properly identified by Fritz Richard Schaudinn, a German zoologist, and Erich Hoffmann, a dermatologist, and a year later a test for it was developed, the Wasserman Reaction test (or WR for short) by a German bacteriologist, August Paul von Wassermann, who had worked with the great Robert Koch no less. This was later refined such that false positives were less common, though they are still possible, as certain auto-immune disorders can trigger the test to come out positive when no T. pallidum is present.
Our hero in this sorry tale, and we desperately need one, is Colonel L. W. Harrison who, in 1913, when VD was declared a National Emergency, transformed the approach to sexual health. By insisting on each patient having privacy and free treatment he, almost single-handedly, changed the face of this area of medicine, which can still be seen today in our free access GUM clinics. Harrison put a lot of effort into education of soldiers and had them issued with prophylactic packs with mercury in them. (I am not sure if this means he had condoms made laced with mercury compounds or something else). He also had a pathology lab set up so that testing could be efficiently performed and promptly acted upon. Soldiers were always the most vulnerable to sexually transmitted diseases, in all the wars from 1493 to the first world war and beyond. His work was done before the advent of penicillin in 1943, when various forms of mercury and arsenic, and the combination of the two, were still the mainstay of treatment, and unfortunately caused an appalling array of side effects, such as necrosis of the liver, but he was dogged in his attempts to minimize them.
Here is a letter in the British Journal of Venereal Disease January 1932 pages 48 – 55 from Col Harrison in which he disputes certain arsenic based syphilis treatments that another doctor had proposed. It is an altogether fascinating letter, especially the advice on page 52 to ensure that patients consume a diet high in fats and proteins rather than in carbohydrates. I really recommend that you read it, here:
Like our speaker Dr Dufty you too will become an admirer of this intelligent and dedicated man.
Prior to this man’s brilliant work we saw how health authorities, in their attempt to get to grips with venereal diseases in some countries put in place utterly stupid and counter productive practices. For example, in France prostitutes were lined up and checked for VD regularly using a speculum. But, unbelievably, the same speculum was used again and again, woman after woman!!! Words fail me…..
Once the sulphonomides and penicillin arrived on the scene in the 1940s treatment was revolutionized and a grip was got, at last, but not before all sorts of nasty experiments were done on unsuspecting people. Our speaker included the shocking and shameful experiment in Tuskegee, Alabama, which ran from 1932 to 1972 in which the US Public Health Service wanted to see what happened if syphilis was left to its natural progression. To find out they enrolled 600 poor black people, 400 of whom were found to have syphilis but were not informed of this diagnosis nor treated in any way but left to go on infecting others and developing late stage complications, and bringing about congenital syphilis in their children. You can read all about it here: http://en.wikipedia.org/wiki/Tuskegee_syphilis_experiment
The incidence of syphilis dropped between 1930 and 2010 but unfortunately has risen again. London, Brighton, Portsmouth and Manchester are all hot spots, suggesting that the present generation of young people has not had the fear of VD put in them, as perhaps was the case in the latter half of the 20th century. I hope this short blog post acts as a reminder that this disease has not gone away!
Here is that fab video I promised you: https://www.youtube.com/watch?v=qW3AJ9xPSWE