Pain and Hunger

What would you do if you had toothache, in a world of pre-modern dentistry? Those of us who have suffered a weekend of it can probably imagine (in the end) getting a friend to pull the tooth out with pliers. But what if the tooth was absessed? Or impacted? An impacted wisdom tooth growing sideways underneath the other ones? Can one imagine cutting into the gum – no X-rays to tell you where to cut, of course – and levering it out, very probably bit by bit? Anyone who has had this done under modern conditions will not like to think about such treatment under premodern conditions: but then, what was the alternative? Some of the root-rotted teeth found in archaeological excavations make one wonder whether it was possible to die just from pain. The thought casts a new light on the side-remark of Chaucer’s Northern student in the Reeve’s Tale: ‘Oure maunciple, I hope he will be deed, Swa werkes ay the wanges in his heed’ – I expect he’ll die, the teeth in his head hurt so continuously.

In such circumstances, fiction or fact – and one should add to them all the cases of compound fractures, slipped discs, trapped nerves and other currently painful but non-life-threatening ailments – anyone living before at least the 19th century would probably have thanked God, and paid hard cash, for the services of a really experienced tooth-drawer or bonesetter. Some people, it’s said, learnt to pull teeth out with their fingers alone. It must, or it ought to have been, a prized skill. But at this point the shadow of the medical profession falls over the whole speculation. For centuries if not millennia, if you couldn’t read, write or preferably talk Latin, you were a mere ‘empiric’; and the fact that you could pull teeth or set bones without inflicting appalling agony was beside the point. You were a mountebank, a charlatan, a quack. In Health for Sale Roy Porter studies, amusingly and alarmingly, the theory and practice of ‘fringe medicine’ up to the dawn of modern surgery and pharmacology. What was a ‘quack’? he asks. How could you tell one from a doctor, other than by demanding to see his degree?

The irony obviously is that it was not so easy, at least if you were interested in results. Joshua Ward (1685-1761) was widely regarded as a quack, and drawn as such by Hogarth, along with the Epsom bone-setter Sally Mapp, in The Company of Undertakers. But he put back George II’s dislocated thumb when the licensed physicians were all telling the King he had gout and was just going to have to put up with it. The third of Hogarth’s ‘undertakers’, John ‘Chevalier’ Taylor (1703-72), seems to have been an evident crook, who boasted of his success at seducing patients, talked what he called the ‘true Ciceronian’ (i.e. always ending every period with a verb), may have been the death of Bach and certainly did nothing for Handel. Still, he clearly removed a lot of cataracts; he had a steady hand and a sharp knife; there is something horrid in his own account of how he cured a noble lady of a drooping eyelid, she calling out while he operated, ‘You hurt me! you hurt me!’ he replying, ‘Remember lady, beauty! beauty!’; but it is hard to see that he was doing anything more than many a respectable but basically business-orientated plastic surgeon now.

The Surgeons’ Company and the College of Physicians did not like people like Ward or Taylor, but from a modern perspective there does not seem to be much consistency in their position. They (eventually) turned on the uroscopists or ‘pisse-prophets’ – when a cobbler’s wife brought Dr John Radcliffe a flask of her husband’s urine so he could diagnose the man’s ailments, he gave her a flask of his own so her husband could make him a pair of shoes – but they also turned on Mesmer, who had at least some idea of pain-relief. More generally, orthodox medicine in pre-modern times seems to have had all too little to offer other than a bedside manner and thumping doses of purgatives. The point emerges clearly from Gregory de Rocher’s translation of Laurent Joubert’s Popular Errors, of 1578, a ‘frantic attempt’, writes de Rocher, ‘at parrying the fierce blows to the power and prestige of physicians dealt by practical medicine’.

Joubert was attacking superstition. Thus he insists that it is not possible to tell whether a woman is pregnant from her urine – we now know that it is, but Joubert was thinking of something else. He dismisses quince marmalade for making your child quick-witted, putting your hand on your behind if you have sudden cravings during pregnancy (because that’s where the consequent birthmark will be), keeping cauls, and believing there are harpies in the bed-curtains. On the other hand, he is all for eating raisins to make your child sharp-sighted; agrees that old men can beget sons, but only if there is some other factor to make their old phlegmatic humours temporarily produce ‘a shot of hot and dry sperm’; and has a bizarrely prurient chapter (which indeed got him into trouble) on the detection of virginity. All round it would not be unfair to say that Joubert, like his profession at the time, had an elaborate and totally mistaken theory which was developed at the expense of any useful practice, and tempered only, in his case, by fairly frequent flashes of common sense. But how many unfortunate virgins were condemned to public disgrace by confident doctors, how many innocent son-bearing wives were viewed with intense suspicion by humour-conscious tittle-tattlers, one can only imagine: it is amazing how the sum of human misery could actually have been increased by the learned and well-intentioned.

Are things absolutely different now? De Rocher compares Joubert’s physiology and modern psychopathology, with some conviction; in both cases the theory seems much easier to improve than the practice. But the more powerful comparisons lurk in Porter’s book, some stated, some not. Respectable medicine in former times, Porter points out, was very strongly ‘patient-centred’. If the patient was not satisfied he could always go to a quack, or to another physician, and large numbers of them evidently did, seeking desperately for cures which probably did not then exist. Nowadays, faced by better-organised procedures and vastly greater authority, ‘patients have become passive.’ Though one has to go on and complete the contrast by pointing out that one major reason why people now go to homeopaths, acupuncturists or reflexologists is that the latter usually listen a great deal harder than GPs. It is now the fringe which is ‘patient-centred’; and, making a still neater contrast, it is the GP who hands over the ‘secret nostrum’, or prescription, and assumes that the matter is closed, just as, once upon a time, did the vendors of Ward’s Drop, West’s Elixir, Godbold’s Vegetable Balsam, or indeed Beecham’s Pills. The archetypal mountebank used to be the man who sold you a bottle ful of mercury guaranteed to cure your VD, and vanished before the side-effects became obvious; while the respectable practioner hung around vainly trying, with an inadequate pharmacopoeia, to treat the whole man. Now the respectable practitioner hands you the analgesics, mutters that lots of people have low back pain, and hints there is a long queue still stuck in the waiting-room: the frustrated patient leaves and heads for the chiropractor, knowing that at least he will find there half an hour’s worth of attention.

So what is the difference between a quack and a doctor, other than fashion and a very real difference in modern resources? Possibly the answer is money: Porter’s book is full of cases of quacks who made fantastic amounts out of people’s credulity. There are people today charging £25 for 15-minute consultations, eight hours a day, at the end of which patients are told to eat a stone of grapes every week, or nothing but grilled oranges, presumably to rectify imbalances in their humours. Or the difference could be rhetorical style: ‘charlatan’ comes from the Italian ciarlare, ‘to chatter’, and the one consistent thing about Porter’s quacks is their remorseless self-advertising and puffery. The rhetoric has become more ‘organic’ and ‘holistic, but modern ‘fringers’, too, rely heavily on persuasion, in extreme cases close to mental domination or seduction. But perhaps the only answer (a very unsatisfying one) is sincerity. The true doctor at least thinks he knows why he is recommending his treatment. The quack is concerned only to collect the money and keep the patient’s eyes bandaged till he’s in the next county. Yet the difference, as said already, cannot have seemed a very significant one to the pre-modern patient with the aching tooth, the dislocated thumb, the rumbling appendix.

A third study in pre-modern health is Piero Camporesi’ s Bread of Dreams, to which Roy Porter contributes an introduction. Briefly, Porter says that Camporesi ‘possesses great shock value’, especially for ‘the stolid Anglo-Saxon reader’, and that this extends through understanding the past to understanding the present. This particular Anglo-Saxon reader finds all of that very hard to swallow. For Camporesi’s overall thesis is not only that the whole of Western Europe up to the 17th century was ‘an enormous house of dreams’, with a population permanently hallucinating from starvation, rotten meat, fungal growths and opium, but also that pre-industrial man was a kind of infantile hysteric, controlled by drug lords in just the same way that the CIA (or someone) ‘broke’ the Black Panthers by drugs, and the student movements of the Sixties were shattered by mysteriously available hallucinogens. This is an instance, one might think, of a plausible case becoming ever less plausible as corollaries are added to it, multiplying the odds against the whole thing rather than reinforcing the likelihood of any one bit. Nevertheless Camporesi has one vital point to make: and that is the importance in all pre-modern history of the great four-letter word – food.

Even worse than the impacted molar, perhaps, is dying with your hands full of grass, as so many must have done, surrounded in a way by evident food but unable to digest it without the insides of a cow. Camporesi records many desperate expedients. In Reggio in 1601 a peasant and his wife, unable to bear the sight of their children dying of starvation, locked them in the house and walked away. When the neighbours broke in two sons were dead and one was dying; he was trying to boil straw in the hope it would become edible. In such circumstances stretching what you had just in order to fill your belly, no matter how indigestibly, was a natural recourse. Langland records the ‘cutting’ of bread with beans and bran, but sees it as a sort of punishment: those who do not work profitably, ‘lat hem ete with hogges,’ let them sustain life ‘with houndes breed and horse breed’. But people cannot live off horse fodder, still less pig food; though many must have wished they could. An Italian expedient then (perhaps an English one too) was to mix other seeds and plants in with the wheat or the barley: acorns, dog-grass, lupins, pine-nuts, elm leaves, ‘panic grass’ (whatever that may be), vetch, sorghum, anything that would add bulk, that looked good, like hawthorn berries, and above all that was available for free. Among the commonest ‘additives’, Camporesi suggests, were items which not only stretched the diet but also deadened the pains in the belly: poppy, darnel or hemp.

Hence the theory of a population more or less permanently drugged or at least accustomed from birth – like Victorian children on their opium-based Godfrey’s Cordial – to a kind of ‘symbiosis’ with powerful sedatives. Camporesi certainly makes his point, noting the common Italian dialectical names for this kind of bread, discussing pane alloiato,‘darnel bread’ or ‘dazed bread’, as well as pane alloppiato, ‘poppy bread’ or ‘opiate bread’, and bringing forward a wealth of material from the underclass culture. Still, one conclusion one can draw from his material is that none of these expedients really worked. The starving classes were still tormented by delusions that somewhere – if they could but find it – there was a herb that protected you from hunger, the lipice root which you only had to put in your mouth to feel satiated, the Avicenna pills or globuli contra famem, which contained such luxurious ingredients that if you had them you obviously couldn’t be in a famine, the herb of the Odyssey which banishes all care and sorrow. Behind all these perhaps lie such plants as ‘rustic’ or ‘laughing celery’: if you eat it you die with a smile, or at least a rictus, on your face. It is pathetic that the drive to eat anything at all could have spread such delusions. But it hardly supports the thesis of a herbally-sophisticated public.

Camporesi also tries too evidently to make his readers’ flesh creep, when the bare facts of famine are probably quite adequate in themselves. He collects stories of baby-eating; speculates on real origins for the European stereotype of the Polyphemus or cannibalistic ogre; remarks with lurid statistical interest: ‘We shall never know how many tons of human flesh have been consumed in the modern era.’ No doubt we never shall, and – without taking sides in recent correspondence – it hardly seems to matter in the long term. Cannibalism can never be anything but a temporary expedient because human beings need to eat so much to put on a pound of meat! It’s always cheaper as a business to eat your victim’s food than to eat your victim. The true tragedy Camporesi is looking at is one of overcrowding, and protein followed by calorie starvation. His grip on ‘tough existential reality’ is welcome; and yet the real drama may come in those computerised statistical studies he affects to despise, which show so clearly that so many deniers on the price of wheat meant so may dead, like it or not, human ingenuity notwithstanding, and regardless of which particular individuals the dead happened to be.

Statistics, indeed, are at the base of Mary Matossian’s part-complementary, part-competing thesis in Poisons of the Past. Matossian thinks like Camporesi that food adulteration was a normal part of daily life in all premodern eras: but her main target is the Claviceps purpurea fungus known as ergot, which grows wild in many grasses but is especially likely to infect rye. Ergot produces alkaloids very similar to LSD; its growth is critically dependent on wet springs and summers; among its ill-effects is a very pronounced decline in fertility. From these facts Matossian deduces a number of possibilities: it may have been mycotoxin infection rather than straight Malthusian pressure which kept the European population stable for so long. Ergot poisoning may also have created both the maleficia, the possessions and epidemics of which witches were routinely accused, and the hallucinations which gave the accusers their ‘evidence’. Maybe the French Revolution itself was triggered (not caused) by the ‘Great Fear’ of the peasants in 1789, a mass panic which came on after a cold, wet spring among a population largely too poor to afford wheat.

Matossian’s work benefits very much (pace Camporesi) from the use of statistics, especially Russian ones – for in Russia ergotism continued on a large scale well into this century. But it shows also how far statistics can or cannot take you. It looks as if cold springs led to demographic dips, but there could be other reasons for that besides mycotoxin infection – malnutrition, for example. Witch accusations do appear in rye areas like Aberdeen and Salem, and include symptoms diagnosable as food poisoning – but there was clearly a learnt element in witch trials which might have come from anywhere. The rye/wheat boundaries in England particularly (see Matossian’s comments on Essex and Norfolk) are just not defined enough to provide a clear correlation between ‘fits’ and eating rye; and on occasion her statistics seem vulnerable to transmission error (Norway in January is said to be the second warmest country in Europe). Matossian’s thesis is probably, overall, right. But it could have done with a touch of the vivid detail of Camporesi – as indeed he could have done with more than a touch of Matossian’s pragmatic probing. At least both make us aware of the paradoxical quality of bread: staff of life, but also opiate of the masses, and all too often, sceptre of death.

Pain and hunger: they ought to be looked at more often and with less evasion. Yet there does not seem, in the end, to be a lot to say about them. ‘Pain is extremely hard to shake off,’ says the Old English maxim. One of the Durham Proverbs, in an early Wellerism, remarks: “ ‘Let him have you who’ll call for you” – said he who saw Hunger going out of town.’ It is hard to do more, now, than sympathise.