By Joe Craig, Park Ranger
“About 1730, Pultney, later the Earl of Bat, lay for a long time at Lord Chetwynd’s house of Ingestre, in Staffordshire, sick very dangerously, of a pleuritic fever. This illness cost him an expence of 750 guineas for physicians…Dr. Hope, Dr. Swynsen, and other physicians from Stafford, Lichfield and Derby, were called in, and carried off about 250 guineas of the patient’s money, leaving the malady just where they found it. Dr. Friend went down post from London, with Mrs. Pultney, and received 300 guineas for the journey. Br. Boxholm went from oxford, and received 200 guineas. When these two physicians, who were Pultney’s particular friends, arrived, they found the case to be quite desperate, and gave him over, saying everything that had been done that could be done….”
Doctors and Patients; or Anecdotes of the Medical World and Curiosities of Medicine, by J. Timbs 1876
Tales of medicine in the early modern period often dwell upon its unpleasant aspects. Goodness knows they are legion, replete with enough blood, bile and barf to satiate even the worst gross-out desires of a pack of Cub Scouts.
The painful treatments are all too well known and documented. Indeed, Richard Wiseman’s Severall Chirugicall Treatises (1676) gave such graphic descriptions of injuries and the operations to heal them that it won the contemporary and colloquial name of “Wiseman’s Book of Martyrs”.
Although not as physically painful as the healer’s ministrations, the cost of medical care could be a trial for a patient’s fiscal well being. The anecdote above cost the Earl of Bat is probably extreme: 750 guineas would be almost £800 sterling which roughly translates out to almost $80,000 in money today. Even for a peer that is staggering amount, but what about regular people, “us that sells ale”? How could they afford medical care without rich man’s resources?
Insurance in the 18th Century was overwhelmingly structured for physical property: buildings, ships and the like. Lloyd’s Coffee House eventually morphed into Lloyd’s of London, a byword for reliable insurance. Some life insurance policies were developed, but the notion of having the impact of medical bills softened by an insurance scheme wasn’t in the cards.
The good news was that many practitioners created a “sliding scale” based upon the perceived ability of a patient to pay. Richer folks would be expected to shell out more than a poor labourer. Some practitioners even went so far as to devote one day a week (or month) to “the poor” when their diagnoses and treatment were for free; medicines might be distributed at a reduced cost.
In larger some cities charitable hospitals were opened, with very stringent criteria to be admitted and treated. Those “Sick and Lame POOR” admitted to the General Infirmary of the city of Salisbury in England often had to be recommended by one of the benefactors who’d ponied up money for its establishment. Others were admitted, of course, but there were priorities and limits to the capacity of the infirmary: a sick person might have to wait until there was an opening.
Legislation beginning in the Tudor era essentially made poverty to be the fault of the poor. Some pittance of charity was available to the “deserving” poor: if one was incapable of working, sick or starving, s/he would be the wards of their parish. Costs of incurred would be covered by the “ratables” of the parish, that is the property owners. Anyone who was to receive assistance jolly well needed to prove it, and woe betide a “sturdy beggar” (ancestor of the legendary “welfare queen”) who had the temerity or need to try and get some food or medical care.
Even if one was in need, assistance was given with an air of reluctance. After all, there is nothing so satisfying to a human to learn that something or someone is Somebody Else’s Problem. Whenever possible, the problem would be shunted to another parish as noted in a satirical piece:
“I was born in Shropshire; my father was a labourer, and died when I was five years old: so I was put upon the parish. As he had been a wandering sort of man, the parishioners were not able to tell to what parish I belonged, or where I was born; so they sent me to another parish, and that parish sent me to a third. I thought in my heart they kept sending me about so long that they would not let me be born in any parish at all; but at last, however, they fixed me….”
“Story of a Poor Disabled Veteran”
Dr. [Oliver] Goldsmith
The Wit’s Magazine, 1784
In theory, then, the-well-to-do could manage their own medical expenses and the poor would receive some benefit of charity, no matter how small. As in the present, it could be quite a trial for someone in the middle who would have to absorb the expenses. Worse for 18th Century sufferers there was no sick leave and therefore no income while sick or injured.
A young dyer’s apprentice in Southwark, England, Francis Newman, found himself unable to work beginning in August 1759. According to the account in the London Magazine it was because he had lost the use of his hands. At his shop the expended dyes were used by the nearby brass pin manufactory whose coils of brass wire were covered in an oxide scale. To remove the scale the coils would be placed in the expended dye baths and the dyer’s apprentices earned a few extra pence by taking the coils out and striking them on the ground to remove the scale.
Apparently, Newman, being the master dyer’s nephew, was the apprentice who got the extra duty (and cash) more frequently than others. Also, it is apparent that he was doing this bare-handed.
The expended dyes were rather acidic, not enough to burn him, but sufficiently strong enough to dry out the skin: Newman tanned the hide of his hands: “…the cuticle of the palms of his hands, and the inside of his fingers was become of hard and rigid, that he was no longer capable of doing either this, or any other business….”
Newman then began to seek relief for his condition which included a visit to his family doctor who prescribed physic. This undoubtedly cleared his bowels, but did nothing for his hands. He then became “an out-patient at St. Thomas’s hospital, where he attended six weeks or two months, but without receiving any benefit….”
When this failed, Newman listened to non-medical advice and resorted to patent medicines: “Someone told him, his complaint was owing to the scurvy (to which he had been subject) and accordingly applied himself to several persons who advertise remedies for curing that distemper, and, among the rest, to Mr. Ward, of whom he had some pills [powerful purgatives containing antimony]…” This unofficial regimen came close to ending Newman’s life: “…once, by mistake, took two of them for a dose, which operated so violently, that every body in the family imagined he could not survive it….”
Newman had himself admitted as an “in patient” to the hospital, but even their tender ministrations did him no good. Finally in August 1760, “…a twelvemonth from the beginning of this disorder….”, Newman’s foreman contacted the apothecary Mr. Samuel Moore who described Newman’s hands as having “the exact appearance of parchment, full of chaps”. Moore prescribed an alkaline liniment which reduced the effects of the acidity of the dye bath and with emollients gradually softened the skin. He also ordered some physical therapy of flexing his hands once Newman could move his fingers again. It was another two months before Newman was able to return to his work.
Although not mentioned in the account, his treatment and the inability to work for over a year were costs probably borne by his family. As being related to the owner of a good-sized shop Newman and his kin was probably not in any major financial distress.
But supposing the patient was the sole support for a family or his condition was even more serious? What might have happened then? Another article in the same magazine paints a very bleak portrait of what might occur. An account of an “Unfortunate Person labouring under a Cancer, at length” makes for rather grim reading.
Discovering a cancerous growth in his mouth, he “applied to several of the most eminent surgeons, but they, seeing no probability of effecting a cure, declin’d undertaking it….”. Then he shuffled between several hospitals hoping for help: “He then obtained admittance as an out-patient of St. George’s hospital, where he attended three months without success; was soon after examined by the surgeons of St. Batholomew’s, who declared, They could be of no service to him; and after that admitted an in-patient in Guy’s, where he continued till discharg’d as incurable …”
The poor individual was considered a bit of a freak: “His case was then pronounced so extraordinary, and the preternatural distension of his cheek appeared so shocking to all who beheld it, that Mr. [Benjamin] Rackstrow desir’d leave to take his mask; and he was advised to engage him to make a bust, in order that a likeness might be preserved, which was executed with greater exactness.” The bust of the patient was then displayed among other wax figures of notables and oddities at Rackstrow’s museum on Fleet Street in London.
“Mr. Bullock, surgeon, in East-Smithfield” attempted to cure the sufferer. Unfortunately, it meant additional and excruciating suffering: “A large quantity of the distemper’d flesh has been extracted, and several splinters of his jaw and cheek bones, and an aperture has been made under his eye; by which means the cancer was reduced….”.
It hurts just thinking about it.
The surgeon did work to affect a cure, but the “Unfortunate Person” hadn’t worked in two years and was essentially reduced to begging: “Having been, at the time of putting himself under Mr. Bullock’s care, near two years totally disqualified for the practice of his trade, and having a large family (Seven in number, and neither [sic] of them capable of getting their living) he was reduced to the necessity of imploring assistance, by a few advertisements”
Genteel begging, but begging nonetheless:
“To the humane and benevolent; whose liberality has preserv’d him and his family from want for which he now returns the most sincere thanks, His speedy amendment, under this gentleman’s hand, inclining him to hope that the relief which had been so generously given, would prove sufficient to prevent his being further troublesome, he discontinued his advertisement; but has the mortification to find, that, as it increased again, he must therefore continue sometime longer incapable of business, he is obliged still to intrust the affluent to compassionate his unhappy case and his numerous and indigent family; for which, as well as for the favours already received, he will ever retain the utmost gratitude.”
Not only was the “Unfortunate Person” desperately unable to provide for himself and family, but the cancer was coming back. What became of the poor man is not further recorded, but it’s not hard to imagine the long, lingering effects of the sickness and the draining of his family’s resources.
One can only hope that the “Unfortunate Person’s” neighbors in his parish allowed him some relief.