"Be temperate in wine, in eating, girls, and sloth, or the Gout will seize you and plague you both," Benjamin Franklin

Sitting centre-stage in the US 100$ bill is Benjamin Franklin, one of the most remarkable figures of his age. I say ‘sitting’ because the poor old blighter would frequently have had great difficulty standing in the latter years of his life – because of gout.

I sympathize, having just had a flare-up of the same excruciating illness. Tell friends that you have an arthritic condition and they are full of compassion and sympathy. Tell them you have gout and they collapse with mirth. The pain is the same! Yet the build-up of dagger-sharp uric acid crystals is not necessarily a symptom of rich living. There is conjecture that Franklin was prone to gout because of his early exposure to lead in the printing trade. Sure, he was partial to a drop of wine (well, maybe a couple of bottles a day!) but I can say from personal experience that I get gout yet never touch a drop of red wine. A rich diet? Not really, I am Mr Muesli-Man. For me it is taramasalata, or processed meats which trigger off an attack - and of course more and more modern foods use large amounts of preservatives and curing agents.

Franklin seemed aware of the causes but did nothing to alleviate them. He wrote a dialogue between himself and his tormentor Madam Gout, in which he pleads for mercy but Madam Gout refuses on the grounds that he has been indolent, and eaten and drunk too much throughout his life. 

Franklin in 1782 painted by Joseph Wright of Derby

In one conversation with a French lady he was told by her that the attacks were probably caused by too many sexual encounters when young. He replied that it could not be so because he did not get gout when he was a young man who enjoyed female company, and that the gout only started when these activities declined! Apparently he then propositioned the lady claiming that this would prove his point, but she emphatically declined his kind offer!

His attacks could last for many weeks. He took laudanum as a pain-killer but was probably unaware of the cause of the attacks - uric acid – although the substance had been identified by a Swedish scientist in 1775, which is about the time his attacks started. At that stage he was living in France but in 1785 he made the last of his visits to America. With him on his journey across the Atlantic he brought his angora cats, his grandsons, and upwards of two tons of luggage! He died in 1790 but spent those last five years studying and mapping the Gulf Stream – and working on the American constitution.

Apparently one of the items in his voluminous pile of luggage was the wild autumn-flowering crocus (also known as meadow saffron) or colchicum autumnnale  to give it its proper name. The plant is highly toxic (eat the leaves in your salad mistaking it for the somewhat similar looking wild garlic and you could be dead within the day). Indeed colchicum had been a well-known poison from the days of Ancient Greece and Rome, but Franklin is credited with having introduced the plant into the States. Why? Because it remains the one certain way of stopping the formation of uric acid crystals and is therefore the basis of the colchicine prescribed for me by my doctor.

   Colchicum autumnale or Meadow Saffron  courtesy of http://www.floralimages.co.uk/

But no blog on gout could end without a couple of Gillrays: in the first Gillray lampoons the idea, prevalent in the wealthier sections of the community, that alcohol was a cure-all (in this case for gout, digestive disorders and tuberculosis)

 'Punch cures the Gout, the Colic and the Tisick'    http://www.hsl.virginia.edu/

And in the second, our old friend The Gout is shown with painful accuracy as the devil, sinking its fangs into the swollen foot of the hapless victim!

 James Gillray,1799, courtesy of Wikipedia

I am firmly of the view that a blog should have regular articles about doctors who have had biscuits named after them. We have covered Dr Abernethy, and now it is the turn of Dr William Oliver of Bath, who was born in 1695 and died in 1764.

A Cornishman by birth he went to Pembroke College Cambridge to study medicine and then had a spell at Leyden before taking up residence in Bath. He quickly established himself as the doctor 'anyone who was anybody' wanted to consult.

As a result of his conduct and of his opinionated views he fell out with many of the other doctors in the city but this was not to stop him launching an appeal to found the Royal Mineral Water Hospital in 1738. When it was built he ruled the place as his own fiefdom until his retirement. He lived out his remaining days, suffering greatly from gout, until his death in 1764.

But what he is remembered for is a dry biscuit, which he developed for his patients to counter their over-rich diets ! Around 1750 he introduced the world to the 'Bath Oliver' biscuit, and shortly before his death confided the recipe to his coachman Atkins, giving him at the same time £100 in money and ten sacks of the finest wheat-flour. The fortunate recipient opened a shop at 13 Green Street, Bath, and soon acquired a large fortune. The ‘Bath Oliver’ is still a well known brand but is now the 'Fortts Bath Oliver', appreciated by connoisseurs as an accompaniment to cheese.

 An advertisement from 1884, courtesy of the British Library

A wartime advert for Fortts Bath Oliver biscuits,

At this point I had endeavoured to add a post script about the wickedly good chocolate Bath Oliver (a favourite of both John Lennon and The Queen Mother) but posterous has decided to get the text VERY confused!

Wonderfully decadent!

1766 May 25^th died Frances my beloved sister in law of the smallpox. She had but recently visited us in London and on her return to Bourton fell ill and died in her 34^th Year.

So Richard recorded the death of Frances Snooke. Her death followed a poignant exchange of letters between Richard and his brother in law William Snooke. The Snookes, who lived in the Cotswolds, had been up to Town to stay with the Halls. On their return Frances was taken ill and there remains William’s letter to Richard commenting that Frances felt poorly during the journey back to Witney; that she was unable to come down to dinner, but had some bread in her wine and water; that she felt “feverish, with a weariness in her Limbs”. He suspected that she had caught a cold.

But the next day William writes “Oh my dear Brother and Sister – the cause of my dear Wife’s disorder too clearly appears to be the Small Pox - the doctor makes no doubt about it. Our Distress is inconceivable. Pray remember her in your Prayers.” Daily updates followed – the description of her constant vomiting, and of the pocks covering her face, chest, arms and legs.

May 21 – Through Divine Goodness my dear Wife slept last night very comfortably and is now pretty cheerful, though blind and greatly swell’d. The pock begins to fill and to run together in the face, where ‘twill be in One.

‘Tis really  a very awful distressing sight. She complains of her Throat, and the great soreness”.

More letters followed, and then:

“May 24 – Yesterday morning very early I sent to Tewkesbury for a Physician, (Dr Perrold) who has been very successful in the Small Pox. He came before dinner and stayed all night. A blister had been put on the Back…he ordered another last Night on the Arm”.

Sadly May 25^th brought a letter from a mutual acquaintance Mr Palmer:

“Dear friend I must acquaint you about twelve a clock last Night without any material alteration the Lord was pleased to take Dear Mrs Snooke to Himself. I doubt not these will be heavy tidings to good Mrs Hall and your self….Dear Mr Snooke is so much oppress’d but desires me to lett you know the interment is designed for Wensday evening. If you can come down to pay your last respects to your valuable sister ‘twill be very Agreeable to Mr Snooke tho distressing on so Mournfull an Occasion.”

For the next two hundred years the full exchange of letters was incomplete – because all that remained with the Hall family papers were the letters from William to Richard. Then, in the 1970’s, pure chance led to a meeting (in far off British Columbia!) between two strangers. By coincidence one turned out to be a descendant of William and the other a descendant of Richard. They discovered that each had kept the letters of the other’s ancestor. Photocopies were exchanged, completing a sad record of a devastating illness.

Richard records in his diary

“3rd October 1783 Dear Anna began to prepare for inoculation” – in other words his infant daughter was put on a special diet. 

“Wednesday October 13^th – This day poor little Anna her Cousins Martha and Eliza were inoculated for the Smallpox”.

Elsewhere he records that he paid Mr Hayward Two Guineas to perform the inoculation. 

Six days later “poor Anna began to fail” and “wife went to sleep at Mrs Snooke’s on Account of the poor Baby”. It is not clear whether this is for the sake of the baby, or so that Richard could get an undisturbed night’s sleep!

By 21^st October he notes

“The smallpox came out in poor Anna & Eliza” and thereafter Anna remained “very poorly – had between two and three hundred pustules” until Friday November 5^th “Through the goodness of God – my Wife and Anna returned from Mrs Snooke’s – the Dear Baby through great mercy finally recovered from Inoculation

The whole episode of the smallpox inoculation is a reminder of how “hit and miss” the variolation process was – after all, it was introducing a potentially fatal illness into a child in circumstances where it was impossible to predict the strength of the dose or likely reaction. The work of Dr Edward Jenner, a country doctor from Berkeley in Gloucester, was soon to transform matters, and in 1798 he published his “Inquiry into the causes and effects of the Variolae Vaccinae”explaining the link between cow pox and small pox, and noting that milkmaids who caught the former rarely went on to be afflicted with the latter.

Edward Jenner

History states that it was May 14^th 1796 before Dr Jenner extracted the cow pox "serum" from  a young milkmaid by the name of Sarah Nelmes. She had come to see him for treatment for cow pox, having sores on her hands. He experimented by injecting the serum into an eight-year old boy (James Phipps, the son of his gardener). The boy developed cow pox, and, in order to complete the experiment, Jenner then waited for two months before introducing small pox into the boy’s system. He failed to catch the highly infectious and often fatal disease – because, as Jenner surmised, he had developed an immunity. Poor James – the experiment had to be repeated on  subsequent occasions before Dr Jenner was satisfied that the immunity was permanent!

All this was ten or more years in the future. However an uncorroborated diary entry from one of Richard Hall’s children hints at earlier experiments – stating that Richard went to meet Dr Jenner in the 1780s, that Richard was introduced to a humble milk maid, “that the figure of the cross was cut upon their arms and that they were bound together until their blood did intermingle”, and that a week later the good doctor counted the blisters – “one hundred, a good reaction”. So it is quite possible that before experimenting with syringes Dr Jenner used a “person to person” inoculation - it was hardly likely to be effective for widespread use as one imagines that the humble milkmaid might have been somewhat less humble if she were asked to submit herself to being “mutilated” on more than one occasion!

Richard would have got on well with Edward Jenner – both of them were avid fossil collectors. Jenner was also a great observer of the natural world – spending years of research into the nest-raiding and egg-laying habits of cuckoos! He was the first person to establish that it was the fledgling chick (and not its parent) which ejected the other eggs from the nest – an observation which gained him admission as a Fellow of the Royal Society in 1789. He also carried out observations on angina as well as experimenting with hydrogen-filled balloons, launching one from the grounds of Berkeley Castle in September 1784 (just two years after the Mongolfier Brothers in France experimented with the first hot-air balloon).

But for his work on vaccination against smallpox Jenner deserves every accolade going – perhaps no one man has ever saved more lives. It wasn't all plain sailing though - many ridiculed the idea of treating human illnesses with animal diseases, their fears satirised  by this Gillray print:

Jenner died in 1823, at the age of 73. He was the founder of immunology and in describing the cowpox  'virus' (he invented the term) we can acknowledge him as the pioneer of the modern science of virology.

Since drafting this post I have come across  the excellent book 'Angel of Death' by Professor Gareth Wiliams, which tells the fascinating story of vaccination - and the opposition to it over the centuries.

                                                  Painted by Gervace Spencer (1715-1763).

Lady Mary´s husband  was at one stage the British Ambassador to Turkey. Setting aside her colourful personal life and her own  literary success (she seems to have crossed swords with almost all the writers of the Age) she was a remarkable woman and deserves to be remembered for her work in spreading the word about Ottoman smallpox inoculation.

This was an era before Jenner, who will be covered in Part Two. In the early 1720's a devastating outbreak of smallpox swept through England. Before that date Lady Mary had herself contracted the disease, which marred her famous good looks. Her own brother had died of the disease. In 1717 she had gone to live in Turkey with her husband, and stayed for two years. In the Ottoman Empire, she witnessed the practice of inoculation against smallpox called variolation (she called it engrafting) and wrote home about it. Variolation involved drawing off a small quantity of liquid from the smallpox blister of a person suffering from a mild dose of the disease, and then injecting it into a healthy patient. It was hoped that this would in turn give rise to a mild version of smallpox.

Lady Mary had her son variolated but when she returned to England and started advocating the procedure she was met with much hostility from the medical profession - too "foreign" and anyway, what did Lady Mary know of such matters, a mere woman?

Undeterred she persuaded Caroline, Princess of Wales to test the treatment. Seven prisoners awaiting execution were offered the chance to be pardoned in return for being variolated - all survived and eagerly accepted their freedom. A number of orphan children were "subjected" to inoculation, without harm, and it looked as though there was a real breakthrough when George Ist permitted two of his grandchildren to be treated. But there were also set-backs. There was no guarantee that the mild strain of virus would stay mild and a number of children died of smallpox as a direct result of the inoculation. Perhaps two or three in a hundred cases of inoculation were fatal - but that had to be seen in context of the fact that full blown smallpox, caught naturally, caused death in perhaps a third of all cases, as well as leaving survivors badly disfigured and often blinded. Slowly though, inoculation became known as a way to prevent smallpox.Lady Mary was a ruthless and determined campaigner. She died in 1762, aged 73.

One of the young boys variolated was a certain Master Edward Jenner. Starved for two days (to weaken any natural resistance) he was confined in a hot fetid room with a number of other boys before being variolated. Perhaps the experience was enough to stimulate his interest in the disease, which led him years later to discover vaccination (based upon cow-pox serum).

But to Lady Mary goes the initial praise. Anyone reading the pitiful (and still harrowing) account of the onset of the disease in my book The Journal of a Georgian Gentleman, detailing day by day the spread of the pocks across the face of Richard's sister-in-law, will understand why smallpox was such a dreaded disease. She died in agony after just a few days. Terrible.  No wonder Richard was constantly diarising outbreaks of the disease - and no wonder he had all his family inoculated against it.

Richard's first wife was pregnant on fourteen occasions. In total four children were born and one of them died within days. Of the ten other pregnancies, Richard does not distinguish between the still-born and the miscarried - he simply recorded the fact, and commented that "the Lord is good to my Wife". One wonders if his wife had such a relaxed view ...

Richard wrote down this method of preventing a Miscarriage in about 1764 at a time when his wife was still in her thirties and hence of child bearing age. He notes that it was given by his friend Mrs Stringer:

1 Pint of Oak bark water

1 pint of spirit of Clarey

1 pint of best,Font, wine

1 pint of Mountain

2 pennyworth of Carraways

2 pennyworth of saffron

Mix these alltogether, and take a quarter of a Pint at 11 o'Clock every morning - and the same Quantity the last thing at night. The spirit of Clarey to be had at Mr Godfreys Chymist, in Southampton Street.

'Mountain' was shorthand for Mountain Wine i.e. wine from Portugal. Basically the recipe was for a couple of pints of wine, soaked with a few spices, and watered down a bit and flavoured with Spirit of Clarey.

All I can say is that Mrs Hall's own example suggests that this preventative concoction was not really effective!

And what was in Spirit of Clarey? Well I did find this advertisement on the web:

 I suppose I had best give credit for this quackery, so here it  is:  http://spiritofhealing.com/EssentialOils/77.html

(I say quackery but for alI know it may work marvellously as an aphrodisiac;it's just tht I am not advocating it for avoiding miscarriages....)

Richard obviously liked to be able to decipher his prescriptions. Mind you, he kept them for years and many of them have survived to this day. They mostly relate to his “nervous disposition” and stomach disorders.

I had forgotten that a ‘scruple’ was an extremely small measure  i.e. one twenty fourth part of an ounce (or twenty grains).

Cupping, as shown on Gwyneth Paltrow´s back when she attended a New York fim premiere in 2004, has been around for many hundreds of years. While the treatment may cause unpleasant looking blisters and skin discolouration these effects are short lived. It is thought that the cupping procedure helps reduce stress and pain. The person doing the cupping places small heated  glass bowls - in this case across the back - and the heat causes a vacuum leading to the skin swelling.It apparently leads to increased blood flow and all sorts of beneficial results.

The picture appeared on the BBC website using an image supplied by LFI (sorry, I cannot identify where credit is due any more than that).

While modern sceptics may dismiss it as an alternative medicine without proven results the fact remains that it has been popular for centuries, way before Richard notes it in his diary for 7th December 1768 where he records:

"Cupped at the Bagnio Newgate Street, 3/6d" 

Richard would needed to have known which bagnios were respectable. In theory they were simply  hot-water baths open to the public but in practice the term was often a euphemism for a brothel! Choose the wrong bagnio and you might catch something rather worse than blisters!

18th Century medicine seems to have relished causing blisters, and then piercing them "to remove toxins". On one occasion Richard had toothache and the doctor inserted a small dried pea behind his ear (as one does). After a day or two the side of Richard´s head would no doubt have swollen with the irritation; the pea was removed; the fluid drained and hey presto the toothache was expected to have disappeared!

In practice I suspect that Richard felt such a huge relief at no longer having the irritant behind his ear that he completely forgot about his other aches and pains...

If you are interested in other quack remedies and treatments do have a look at the Journal of a Georgian Gentleman - see my website at http://mikerendell.com 

 And if you are in the UK and are too mean to buy it - ask the Library if they will get it for you!

Among the papers listed in Richard Hall´s inventory of items at One London Bridge was a second edition of Dr Buchan´s Domestic Medicine. I still have the book. Buchan was a remarkable man in many ways, and his book had an astonishing success, being reprinted over 22 times and being hugely influential both in the UK and the United States, where it was published in both New York and Philadelphia.

His masterpiece was more than just the 18^th Century equivalent of the Readers Digest Book of Home Medicine – it was a ground-breaker in many ways. He had been born in Scotland in the same year Richard was born - 1729. It had been intended that the young Buchan would go into the Church but his interests were inclined elsewhere  and he graduated in medicine from Edinburgh University. After a spell in Sheffield he returned to Edinburgh in 1766 and spent a number of years in one of the poorest areas in the country, and was confronted with the ignorance about basic hygiene and cleanliness which he could see was causing pain, suffering and premature death. Indeed he was so upset at seeing that half of all children were dying before their teens, largely through unhygienic conditions, that he determined to end the mystique which went with the job of being a doctor, and encourage the public to understand the importance of hygiene in order to prevent illness. This was revolutionary – until then most treatises were a mixture of witchcraft and mumbo-jumbo. Rather like the Magic Circle trying to guard the secrets of the magician´s trade, the medical profession frowned on such openness. But in 1769 Buchan published the first edition of his Domestic Medicine and it became a runaway success with the public. The book cost six shillings and the 19 editions published in his lifetime sold 80,000 copies. The work was translated into many European languages including Russian French and Spanish.

We may find the advice somewhat rudimentary but Buchan was working at a time when washing was a rare occurrence. After all, Richard Hall´s own diaries record that he only bathed once every three months. Any lesser interval and he states that ´he resumed his bath´ as if it was part of a single process.

What Buchan was trying to do was to point out that hygiene was something that the public could embrace as a form of self-help. He also called for the provision of pure water supplies, publicly cleaned streets, and advocated the benefits of fresh air. Exercise and a good diet were also a part of his campaign. We may not think of his ideas as revolutionary – but they were at the time. Look at some of his quotations from the Domestic Medicine.

 "The want of cleanliness is a fault which admits of no excuse."

 "Diseases of the skin are chiefly owing to want of cleanliness."

 "Nothing can be more preposterous than a mother who thinks it beneath her to take care of her own child, or is so ignorant as not to know what is proper to be done for it."

 "Few things prove destructive to children than confined or un- wholesome air."

 "Sufficient exercise will make up for several defects in nursing; and it is absolutely necessary to the health, growth and strength of children."

 "The clothing of infants is so simple a matter, that it is surprising how any person should err in it; yet many children lose their lives and others are deformed by inattention to this particular."

 "A child never continues to cry long without some cause, which might always be discovered by proper attention."

 "Allowing children to continue long wet is another pernicious custom of indolent nurses."

He even appears to have recognized the problems of inherited diseases, with the advice  "A person labouring under any incurable malady ought not to marry."  

Buchan´s book is divided up into chapters for different types of ailment, and contains guidelines on what treatments should be given. He explains, for instance with broken limbs, the diet and regime to be followed by the patient. He lists how to make  poultices and plasters; infusions and ointments; what herbs should be applied, and so on. And if we dismiss them as being unscientific we are to miss the point – he was encouraging people to understand about illness from his admittedly 18^th century viewpoint so that people could help themselves.

 Did the book´s success make him rich? Apparently not, since according to one story he sold the copyright to his publisher for £700 pounds, only to see the publisher  recoup as much every  single year from sales!

Quoting from an interesting article by Dr. Adam G. N. Moore, writing for the Boston Medical Library

  “ In 1778 Dr Buchan moved to London where he gained a considerable practice. He was known for his convivial and social habits, one of which was to frequent the Chapter Coffee House, a haunt of authors and the publishing trade. Full of anecdote, of agreeable manners, benevolent and compassionate, he was unsuited to make or keep a fortune, for a tale of woe always drew tears from his eyes and money from his pocket. It’s little wonder that the Doctor, by then a handsome and genial white-haired Tory, often served as moderator for the "Wet Paper Club". This band of early morning paper readers assembled daily at the "Chapter", as it was familiarly known, to discuss the news of the day. The men, as they all were, grabbed the papers as soon as they were delivered, still wet from the printing process, before the coffee house waiters could dry them.” 

Buchan died in 1805 and was buried in Westminster  Abbey. Intriguingly three years later when the  mutineers from the Bounty were discovered on Pitcairn Island it was found that they  had kept a copy of Buchan´s book with them, wrapped in sail cloth.

 Helpfully the book has now been digitized. One such site containing the work can be found at http://americanrevolution.org/medicine.html