Pain in the 18th C

8/10/2019 Pain in the 18th C

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Smith/ An Account of an Unaccountable Distemper 459

Eighteenth-Century Studies, vol. 41, no. 4 (2008) Pp. 45980.

ANACCOUNTOFANUNACCOUNTABLE

DISTEMPER: THEEXPERIENCEOFPAININ

EARLYEIGHTEENTH-CENTURYENGLAND

ANDFRANCE

Lisa Wynne Smith

The abundance of artistic renderings of pain during the eighteenth centurysuggests it was a subject of great interest. In The Gout(1799), for example, JamesGillray (17571815) represented gout as an evil, sharp, and fiery devil biting intothe sufferers foot. Charles le Brun (161990) captured the differences between the

facial expressions of emotion, including acute and simple bodily pain. These im-ages evoke powerfully the early eighteenth-century inseparability between physicaland emotional suffering. Gillrays gout was the crippling fiend that could not beignored, while Le Bruns faces starkly revealed the connection of emotional andphysical pain. Representational art, however, was not the only means for depictingpain; eighteenth-century sufferers could be eloquent in their written descriptions oftheir afflictions, as revealed by letters written by patients to their physicians. Suchmedical consultation letters are a rich source for the history of the body. Usingcollections of French and English consultation letters dating from 1700 to 1740, Iwill consider two questions: what the overlap between mind and body meant forsufferers, and what it implied about the theory, practice, and experience of earlyeighteenth-century medicine.

Over the last twenty years, feminist theory and the history of the body haveindicated the importance of examining how bodies are experienced and gendered.1Debate also has flourished about whether or not early modern bodies were seen interms of one sex or two.2Notably, however, there has been little consideration ofthe body as a tangible element with real experiences; this article moves beyond adiscussion of the sexed body to consider the experience of pain.3The pervasiveness

Lisa Smithis an assistant professor at the University of Saskatchewan. In addition to complet-ing a monograph on early modern womens health care in England and France, she is currentlyresearching eighteenth-century mens health care and care-giving roles.


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Eighteenth-Century Studies 41 / 4462

several English physicians trained in France. As Matthew Ramsey has suggested,there were wider divergences in medical thought within countries than betweenthem.22Finally, the vocabulary of pain in both languages is remarkably similar,drawing on humoral theory.23The parallel pain descriptions raise the question ofwhat roles gender, national culture, shared medical culture, and social status playedin shaping bodily experience.24

It is useful to consider consultation letters in relation to illness narratives.Studies of chronic illness today have discussed the need for patients to understandtheir suffering within the context of their lives and to create illness narrativesoftenmore than oneto explain it.25Historians have also used this methodology to studydiaries, autobiographies, or literary accounts.26Illness narratives accounted for thecause of the diseasecatching cold, eating and drinking to excess, or omitting totreat a simple ailmentand were shaped within the context of the patients lives.Many sufferers formulated their narratives of becoming ill, being sick, and getting

better in terms of Gods correction of their moral and spiritual failings, but as manypossible stories existed as there were patients.27Narratives provided patients withthe opportunity to identify the meaning of their experiences. Eighteenth-centuryaccounts in diaries and autobiographies were constructedlike modern illnessnarrativesin hindsight, with patients interpreting initial events according to theirchanging needs.28

However, consultation letters cannot be interpreted in exactly the same wayas more personal sources.29Eighteenth-century physicians had neither the technol-ogy to look at the interior of living patients bodies nor much interest in hands-on

examinations, ensuring the centrality of patients stories.30Descriptions had to beas full as possible, especially in letters, so they could be as meaningful to the doctoras to the patient. The cultural script of embodiment (humoral theory) was mostaccessible to patients and best articulated their perceptions of real experiences.31Physicians then interpreted symptoms within a medical narrative of diagnosis,prognosis, and recovery.32However, the term illness narrative does not strictlyapply to many consultation letters, which might be better named pain narratives.Patients tended not to write about immediate problems, but about long-standingailments.33Some illness interpretation occurred in the letters, such as identifying a

cause or providing a medical history, but many letters lacked a storyline of treat-ments, direct cause, meaning, and progression from past to present. Instead, theybegan in the moment of pain, lacking an interpretation that functioned for bothphysician and patient.

EXPERIENCING THE HUMORAL BODY

In consultation letters, both English and French sufferers described painwith the same vocabulary, suggesting a shared experience primarily based onhumoral theory. Pilloud and Louis-Courvoisier have identified in Tissots patient

letters the occasional use of other models of the body, such as iatromechanismand nerves, although humoral ideas predominated. Humoral theory was flexible;by the eighteenth century, it went beyond balancing the four humors to consider,for example, blood quality and movement of internal fluids.34Amid debates aboutiatrochemistry, iatromechanism, and vitalism, patients prioritized the humoralbody.35Sloane and Geoffroy even treated their patients within a humoral frame-


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work, perhaps to make their advice more comprehensible.36This sharply contrastshistorians debates over one-sex or two-sex bodies, highlighting the importance ofthe humoral body on a daily basis. Moreover, despite Wayne Wilds assertion thatthe rise of new science rhetoric resulted in pre-1730 consultation letters con-taining little patient subjectivity, the language of pain in the Sloane and Geoffroyletters was extraordinarily descriptive and personal.37Humoralism fundamentallyshaped sufferers experience of their bodies, as revealed by descriptions of internalsensations and body/mind overlap.

English and French patients perceived the body in terms of motion: fluxions,rising and falling vapors, and stoppages. Although Alisha Rankin has suggestedthat bodily flows were distinct from humors, the humoral body was by its natureexpected to be constantly in a state of flux. Both Rankin and Duden, moreover, haveanalyzed womens descriptions of flows, but consultation letters indicate similarbodily experiences for both sexes.38For example, Mrs. Rider complained of a

fluctuation of wind in her bowels, one of the most common sorts of fluxes.39Themovement of a flux might be dangerous, depending on where it went, as HenryDowning experienced in 1726. He was subject to frequent catarrhe & deflux-ions of Rheum, such as sometimes in the night falling on my windpipe awake me& make me apprehend a danger of being suffocated.40There could be multiplefluxes simultaneously, as with one French man who had a copious and frequentstomach flux, as well as fluctions on the teeth and eyes for over thirty years. 41Vapors were a related internal movement; in 1724, Canon Aubriots rising vaporswoke him up several times a night.42Both implied a distinctly unpleasant physical

sensationnot just a theoretical movement within the body, but something widelyunderstood. Conversely, internal stoppages, or obstructions, could be perturbing.43For example, a French monk wrote in 1727 that he felt a blockage in the stomach,which he blamed for his hypochondria.44Patients were aware of constant move-ment within the body, which they expressed in terms of wind fluctuations, risingvapors, falling defluxions, and blocked stomachs. This reflected a model of thebody in which humors constantly moved, regardless of gender.

Suffering had a flexible vocabulary, concurrently describing physical andemotional pains in ways that underscored the anxiety surrounding illness. This

emphasizes the extent to which body and mind were inseparable in the early eigh-teenth century;45pain involved ones whole being, both body and soul.46Patientsand their doctors often referred to emotional states as symptoms of disease. TheEnglish term uneasy, and the French incommoder (which in its adjectivalform means unwell and in its verb form, to bother), and oppression occurfrequently. In modern English, uneasy has a distinctly mental connotation, butoccurs ambiguously in early modern English, often with a physical emphasis. Forexample, Mary Butler, the Duchess of Ormonde, wrote about all the sorts of un-easyness that ever I had with vapors, including twitching when she fell asleep, withsudden awakening.47More unclear is Anne Hamiltons use of uneasy. In 1710,

she complained that most uneasy to me is the hot flashing, a discomfort duringthe day that became violent at night.48Similarly, Sarah Longs use of the word in173839 is complicated. Her uneasinesses referred to convulsive twitching inher head and sore eyes. She wrote that uneasinesss generally happen when I ammost inclined to sleep, & feel as if my scule were bent in, & my Eyes Draging out


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my Head; so that I am obligd to struggle a long time, before I can Recover mySelf again.49Here, uneasiness initially appeared physical, but later Sarah Longreferred to the great struggle to get back to normal; such a struggle over convulsivetwitching must have been as much mental as physical. Similar ambiguities emergewith the use of incommode. A frequent use of incommode emerged in theexample of Mr. Seret, who consulted Geoffroy (1729) about mes incommodits,headaches.50However, sometimes, as with an anonymous French woman, in-commode was ambiguous. Her constant stomach pain was very bothersome(fort incomode).51It is unclear, however, whether it was bothersome physicallyor emotionally, since the woman then described in detail the stomach pains thatworried her and how they never entirely left.

Oppression was commonly used in both England and France. Sometimesoppression was purely physical, without any emotional undercurrents. One Frenchwoman referred to its physical nature in 1714: I find myself troubled by this op-

pression of which I spoke. I am hardly oppressed when I am calm. It only occurswhen I am active or I climb the stairs.52Thus, oppression could describe internalobstructions. However, Ann Warners letter about her daughter (1724) containsexamples of the dual use of oppress. While her daughters spirits are so oprestyt she some times can hardly speak, she was also vastly oprest by wind.53Dr.

Jeffries discussed Mrs. Riders physical and emotional oppression: she complains ofa great oppression; sinking of spirits; [illeg.] apprehension of something she knowsnot what; a fluctuation of wind in her Bowells.54Jeffriess account emphasizesthat both doctor and patient perceived the ambiguity of Mrs. Riders oppression.

Importantly, even the emotional use of oppression evoked physical discomfort.Expressions used for physical pain can provide meaningful metaphors for onesemotional state,55but the ways in which words like oppression or incommodewere used by early modern sufferers indicate more than a metaphor. The overlap-ping emotional and physical meanings of these words reveal the close relationshipbetween physical and emotional suffering.56

In turn, words with more obvious emotional connotationsfrights,apprehensions, and heartsicknessdescribed pain. Often, these were purelyemotional response to ones illness or treatment. John Grandorge reported in

1725 that Thomas Tufton, the Earl of Thanet, apprehends yt any forcing things[remedies] will not do well, nor to continue these bathings.57John Hales (1706)attempted a prescribed poultice, but when his skin became inflamed, he stopped thepoultice, fearing twas dangerous.58But fright could be physical. Among her manyphysical problems, Lady Sondes was equally concerned about that ugly feelingin a fright, I did not know for what.59A French word related to apprehensionis inquitude (worry). In 1728, Gouet de Luygnee wrote for her father, whocomplained of insomnia, a fluction of the head, colic, and a worrying/naggingpain in the legs (inquietudes dans les jambes). In the same letter, however, sheexpressed her own worries about my fathers health (inquietudes sur la sante

de mon pere).60Inquitude, then, could be as much physical as emotional.Similarly, Sarah Long felt an obstruction in the vessels of her head, which ap-prehension reaches to my temples, and as I think likewise to my heart.61She didnot just fear the obstruction, but, as her use of apprehension as another nounfor pain indicates, her apprehension had become physical.


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Maux de coeur (heartsickness, heart pains, or, today, nausea) also haddual meanings. A French man who suffered from vertigo or vapors had a long listof symptoms: dizziness, sweating, headaches, loss of appetite, spots on his face,melancholy, and un mal de coeur fort.62In this context, it is not clear whether thesickness was predominantly physical or emotional. By contrast, a French Damessymptoms were primarily physical: light hysteric vapors, stomach problems, las-situde in the limbs, and maux de coeur.63This double usage emerges in GeorgeHepburns letter to Sloane:

His [Mr. Walpoles] countenance, a listless heavy disposition and a verygreat dejection of spirit, sufficiently denoted that both the solids and flu-ids were in great disorder. And, that ye Peculiar sensation of a sinking atthe heart (as it is calld) which is no doubt a Relascation about the upperorifice of the stomach.64

Here medical diagnosis combines with the patients perceptions, which appearplainlysinking at the heart. While it was a physical problem, the term alsoindicated an emotion when alongside symptoms like heavy disposition anddejection of spirit. Physical processes could reflect emotions, one reason whyphysicians advised keeping ones spirits up during illness. However, the use ofemotional words in place of pain nouns suggests that the experience of pain wasas much emotional as corporeal.

Extended pain descriptions evoked patients general moods. As Lucy Bend-ing has noted, the metaphors and analogies used throughout an account, rather

than specific words, most effectively transmit the overall idea of ones sufferings.65

For example, in a letter to Sloane (1708), Elizabeth Howland used hot and drywords ten times, describing her hart burning of great violence, a great heatand smarting in her mouth, and a flushing heat over her body. This, she believed,was because of a great sharpness and heat in [her] bloud that needed blood-let-ting; she had already taken milk and barley water to cool and sweeten her blood.66Her physical experience was intense internal heat, which she treated with coolingmeans. In contrast, a thirty-six-year-old French nun suffered cold symptoms. Dur-ing her period, she had violent oppressions accompanied occasionally by fever.For a day before, she sometimes also had a small stomach pain and coldness on

top of her head. Her breathing was difficult, a prodigious wheezing in the chestwith acrid and salty phlegm. The letter gives the sense of a pervasive heaviness thatkept increasing suddenly. Oppression appeared nine times, described variously asviolent, more violent than ever, and more intense.67She also used cold,wet terms for the illness, indicating its nature and her physical temperamentto her physician. Geoffroy diagnosed her as having a tendency to head colds andpleurisycold and wet humoral disorders.68

Patients who consulted Sloane and Geoffroy were fluent in the languageof pain; humoral theory offered a vocabulary and a store of metaphors that si-

multaneously expressed physical and emotional symptoms. Humoralism may havealso provided physicians with diagnostic possibilities, indicating important details:location, movement, pattern, intensity, emotional response, hotness or coldness,moistness or dryness, and sharpness or heaviness.69Although historians have tendedto see the doctorpatient encounter and the production of medical knowledge in


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terms of patient demand, they have overlooked the potential usefulness of humoraltheory in diagnosis.70Physicians such as Sloane and Geoffroy may have continuedto use humoralism in practice, despite their adherence to other theories, not onlybecause it allowed doctors and patients to speak the same language, but becauseit was effectiveand the newer theories lacked practical applications.

MAKING SENSE OF PAIN

Despite the overall efficacy of humoral language, patients did not alwaysfeel that they successfully articulated their suffering. Elizabeth Howlands narrativecaptured the heat of her pain, but not its essence: I so little know how to tell youwhat I aile that I cant thinke you can make any thing of what I have writ.71Norcould an anonymous French woman fully communicate about her kidney pain.This she discussed last, as it was impossible to express (quil nest pas possible

dexprimer).72

Modern studies of pain have argued that there is a point at whichit becomes indescribable, but perhaps the act of writing about pain, as much aswhat they actually verbalized, was what helped sufferers.73Consultation lettersalso reveal the process of patients trying to understand their suffering.

These letters were functional communication between doctor and patient.A patient had to recount everything, since the doctor could not ask further ques-tions before responding. However, the process of letter writing itself might havebeen therapeutic, helping the patient to impose order and meaning on the chaosof sufferingor, as Elaine Scarry has termed it, to remake a world shattered bypain.74Work on Protestantism in Germany, Quakerism in England, and judicialtorture in France has shown the need in early modern Europe for confession inorder to set the world to rights. Telling the right story could balance the bodiesand minds of sufferers, healing both the individual and society.75Modern studiesof pain claim that it isolates sufferers, as others never fully comprehend their ex-perience, but eighteenth-century patients ability to describe pain may have elicitedunderstanding. 76Barbara Stafford has examined late eighteenth-century cartoonimages of pain in terms of Enlightenment ideas about sensitivity and the force ofthe imagination. She argues that caricatures of pain were intended to make viewersfeel the pain through their imagination.77

Letters could have played a similar role. In addition to gaining sympathyfrom friends and family, patients may have wanted to persuade the doctor of thetruth of their suffering. With doctors, however, it was not just a matter of gainingcommiseration; the more detailed the narrative, the more reliable it appeared. Therewas a tension between physicians need for patients stories, issues that could affectthe construction of patients stories, and physicians knowledge that patients couldexaggerate or be unreliable. While physicians could observe their patients physicallyduring ordinary consultations,78epistolary consultations relied solely on the story;there was a fine balance between recounting a good story that led to diagnosis and

one that was too good. As Roy Porter has noted, the patient had to be careful, sincea too-fluent talent in describing pain might be perceived as rhetoric or histrionics.79Consultation letters, however, suggest that patients were often struggling to identifytheir suffering rather than writing letters of great rhetoric.


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Many patients feared that undiagnosed pains threatened their lives.80Inter-nal movements were not always described in exclusively humoral terms, but weresometimes depicted as an independent force. For some, the movement of internalpain implied an integral assault on the sufferer by a living entity that had invadedthe body.81Mlle de Refuge had beating [batement] in the left ear and sometimesin the head (1729), while Mrs. Irwin wrote (1724) that when she laid her handon her stomach, it beats as if something were alive.82The violence and regularityof moving pain permeated the letter of the anonymous French woman. Flutter-ing and beating in her stomach came upon her frequently, almost constantly,waking her in the middle of the night. These were violent pains she reiterated fivetimes in the letter.83The frequently used imagery of torture highlights a sense ofphysical and emotional invasion. Torture was thought to work because of the closerelationship between body and soul; the truth of the soul could thus be forced outthrough physical pain.84Among many other problems, such as itchiness, vomiting,

night suffocations, insomnia, and trembling limbs, M de Guijon was particularlytormented by gout.85A languishing French man was unable to eat or sleep in1723 because of his bloody coughing and the prickings and violent rendingsin his chest.86Such descriptions implied an attack against body and mind, sug-gesting the extent to which patients dreaded the effects of an undefined pain upontheir entire lives.

Even defined illness could cause fear, if patients believed that it was untreat-able. A series of letters to Geoffroy presented sixty-year-old Mme de la Buretieresillness. She had first consulted Geoffroy in September 1724 and was still under-

going treatment in May 1725.87

The physical symptoms and her treatment werediscussed primarily by her local physician: vapors, swollen and red eyes, tremblingin the head and hands, and lack of appetite. The physician assured Geoffroy thatthe patient followed her prescribed regimen, which he summarized.88The physicalsymptoms, however, played relatively little role in the patients letters. Out of fourletters to Geoffroy, she detailed only once her symptoms and thrice her response tothe prescribed remedies.89Rather, she emphasized her fears about her illness. Forher, the dominant problems were the continual worry, sadness, and trembling.90By May, she had a frightening repugnance to taking milk, which was supposedto be the most effective remedy, and wondered if her catarrh was incurable (peutestre ce catarre en moy est incurable).91She told Geoffroy that he alone couldgive her consolation and hope for treatment, despairing when he did not respondquickly.92The physical nature of illness was less important to Mme de la Buretierethan the possibility that she could not be cured.

The particularly comprehensive cases of Lady Sondes and Mr. Pulleynprovide a useful comparison of two eighteenth-century patients attempts to under-stand their suffering. Unfortunately, when looking for extensive cases containingmultiple letters, a cultural comparison becomes more complicated. Although theletters contain excellent examples of pain descriptions for both countries, there

are fewer cases for France than for England of individuals experiences over time.English patients were more likely to write their own letters to an important physi-cian, whereas French patients frequently had their letters written by another medicalman or a friend of high social standing. For example, M de Guijon did not writeabout his gout, while his brother, Dr. Jullien, and Geoffroy did.93Also, patients


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rarely approached Geoffroy more than once,94but several of Sloanes patientswrote multiple times. Soeur Pecquet de Ste Victoire, who suffered from vomitingand stomachaches over six months (1730), is an important exception. However,possibly because her illness was obvious, her letters do not suggest difficulties withits interpretation; she only consulted Geoffroy about her course of treatment.95By contrast, the letters of Lady Sondes and Mr. Pulleyn reveal their attempts tolive with their suffering and to describe it. For them, the continual pain provokedanxiety about its role in their lives until it was interpreted medically.

Catherine Watson, widow of Edward, Viscount Sondes, wrote to Sloaneseveral times between 1722 and 1734.96Her illness (unspecified), she complained,had aged her: I am near forty years old & may by my Afflictions, & ill health beas old, & decayed, as if I was fifty or sixty.97She wrote:

the pain you have often heard me complain of, in my left side was very

bad & I shivered inwardly for two or three nights, but grew better again.I had a little cold, but that mended too. Only, especially in the morning,I felt a pain & fullness in the back part of my head. After I got up, itwould go off. But my hands & legs used to feel mighty full & I have hada soreness in my flesh. About this day seven-night, I thought my mouthlooked to be twitched when I spoke, & my underlip feels stiff & looksdrawn, & when I speak it some times feels that it does not move readily.My lord says he should not have perceived it if I had not told him, so itsnot much, I suppose. I was let Blood as I had been for such a complainttwo years ago, which ordered me, & I sent to Mr. Grahams for somepowders. I thought they cured me that you gave me, but still I am ill &my legs twitch, so much as is very troublesome to me. And I am so wearythat they are ready to sink under me, & I am so troubled with feeling, ina great fright, as one cant imagine &, especially, in bed. My heart toobeats extremely & I dont sleep so well as I used. I have frightful dreams& look very pale, & yellow. . . .98

Lady Sondess complaints varied, as she tried to understand an illness that did notimprove:

I am afraid to take Steel as its apt to fill me with strange fancies, & it al-ways did so, & I too often have a fever after it. And your Electuary withlong taking wont agree with me as it fills me with wind, with which I amin my Bowells, Stomach, & up to my Chin those Nerves much tormentedin a morning. In the Afternoon, I have Twitchings in my legs, & somenights when I go to bed, for I can never lay down at first before that Ris-ing in my Nerves comes up the Back part of my head, & gives me a painthere for some little time. Then it expands it self about my head & then Iam in fear that it should deprive me of my memory, or senceswhich tisa mercy I retain with such an illness. I do my business as I used to whenI am not laid up, but so low spirited that I was just speechless today, &have often been quite so. I take an Electuary of Dr Colbys . . . [obliter-

ated line] . . . My bowells, & those sort of fitts were very good, but stillmy nerves & head he has not so much regard too, or I fancy not. Indeed,I have not told him so much of my fears, as I have you, nor would notto anybody else because I as yet have not these misfortunes, only when Iam so low spirited in a morning. I am then stupid, & forgetful of what issometimes said, except it is business; but that, reading & writing, I thank


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God, I am able to do. I have still often a coldness in my head & if I goout catch sad colds, . . . for this old Castle, is all up, & down steps, & Ihave not strength to go up & down stairs. It gives me almost fits. . . .99

Lady Sondes repeatedly attempted to convey particular symptoms. On an-

other occasion, for example, she described the twitching in her legs as Knawing,while she had such a sort of Pain in her back and weaknesse in her hips. 100Most disturbingly, she was in constant pain, to the point of distraction, particularlywhen it came to concentrating on work. Her vocabulary suggests an illness sur-rounded by confusion, anxiety, and sadness: strange fancies, stupidity, forgetfulness,low spirits, bad dreams, troubles, frights. She particularly feared that pain wouldeventually cause memory loss. She also portrayed a body that had turned on itself,with twitching legs that might sink under her, stiff lips that would not move readily,and nerves that expanded. Even the treatment caused her suffering. She dislikedthe medicines, which engendered an ugly feeling in a fright, I did not know for

what, as well as general tingleing and drawing in her lip.101

When the worst of her symptoms passed, Lady Sondes declared, with thefirst letters, I write, one of thanks should be to you, for the great kindness & care,you have showed, for me, in my illness. Although she lacked that equalness, oftemper, & spirits, I used so happily to enjoy, she was finally able to get on withlife. She reported that when I am about Busiynesse, [I] find my self best & cando itt and had started to take the Air regularly.102Importantly, she also foundDr. Colbys interpretations of her illness acceptable. Early on, he diagnosed her asperfectly Hysterical,103but Lady Sondes later repeated to Sloaneapparently in

agreementColbys opinions about her poor circulation causing her disorder.104

Mr. Pulleyn also had trouble making sense of his distemper. By the timehe asked for Sloanes help, his illness had lasted for several years. He had soughtmedical attention previously, but received unsatisfactory explanations. His letterto Sloane reveals his anxieties:

I am attempting to give an account of an unaccountable distemper withwhich I have been miserably tormented for some years. I must call it apain, yet cannot describe it so, for its neither like the Gout nor Tooth-ach, nor such accute distempers, but a certain sort of shivering in my

blood & Limbs (as my Thighs & Hipps) & so in my Body. And at lastit lodges itself about my breast & stomach, & there afflicts me with adreadful Melancholy & such a Pain as I have described, & while it ison me it almost distracts me, but I cannot tell how further than I have,but I gladly would be dead during the time its upon me. Any change ofweather from fair to rain or the like almost makes me desperate, but howit goes off & comes on me I cannot tell but that it does so. But when &during the time for the better, I think myself perfectly well & in a mannerforget my Misery. But when it returns it pays me with a sorrowful Memo-randum (I pray God help you that have reason to describe it more fully).

When I am at the best my Water is yellowish, but when the fit is comingon its as Pale as Rock Water, & thus it will alter in almost a minutestime. And when for the better I part with a pretty quantity of windwhich I am almost sure is the origin of my distemper, which (as I am told)is the Hypochondria. But whether right or no I know not, & if I did I amno wiser how to keep myself, for I have not yet met with anybody that


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could tell me the nature of it, or that they even knew anybody that wascured of it. But that understanding Physician that does, & can relieve me,shall be liberally rewarded.105

Similar to Lady Sondes, pain was the recurring pattern in Mr. Pulleyns life. Over

several years, the pain occurred regularlywhen the weather changed. But his painwas like a returning invader, a strange shivering that lodge[d] itself inside andafflict[ed] him. When well, he could forget the suffering, but the onset of paincaused misery, torment, distraction, desperation, and melancholy. Even worse,nobody had helped by naming or treating the disease. The foundation of his firstletter is one of frustration: how does one give an account of an unaccountabledistemper? A subsequent letter, however, suggests that Mr. Pulleyn had happy re-sults from his consultation with Sloane.106By then Sloane had treated Mr. Pulleynsdisease for at least eight months, during which time Pulleyn followed Sloanesprescriptions, apparently faithfully. Although Pulleyn received a great deal of

advice from others, he promised Sloane that he would not do any thing withoutyour approbation, consigning my self wholly to your directions.

The process of understanding pain emerges in these letters. Lady Sondesand Pulleyn constructed the plot lines of their narratives in a circular fashion,suggesting the difficulty of living with, and writing about, undefined pain. Thiscircular form of discourse, used by many consultation letter writers, focuses onthe subjective and private and lacks a clear beginning, middle, or end. This stylehas been contrasted with an allegedly more masculine form of linear discoursethat focuses on facts and has a clear narrative progression.107However, such an

interpretation overlooks the uncertainty and incomprehension surrounding manypatients experience of illness, regardless of their gender. Sufferers with undiag-nosed illness lacked a clear role, neither that of their normal lives nor of a patientundergoing treatment. They did not know the extent of their illness, caught in aperpetual cycle of pain; circular discourse reflected more accurately the ongoingnature of their suffering.

In Lady Sondess first letter, she described her ailment, gave some details oftreatment, and further discussed her complaints. In the second letter, she explainedthe negative effects of her medicines, which merged into a discussion of her various

complaints and her attempts to carry on as usual. Next, she wrote about her relation-ship with Dr. Colby and finally considered her complaints again. Compared to LadySondess truly circular narratives that ended where they began, Mr. Pulleyns initialnarrative appears superficially linear: beginning, middle, and end. He described hispain and melancholy, analyzed his urinary habits, provided his previous diagnosis,and concluded with a plea for help. However, his description of the pain itself wascircular, reiterating how bad it was and how much he suffered.

As the circular nature of the narratives emphasized, the relentlessness ofpain wore both patients down emotionally. Lady Sondes was weary; Mr. Pulleyn

sometimes wished to be dead. To some extent, a circular narrative represents thefailure of ones language to express pain completely. While Lady Sondes describedher feeling of fright as something one cant emagin, the usual pain terms failedMr. Pulleyn altogether; he felt he must call what he suffered a pain yet can-not discribe it soe, pitying anyone who could better describe it. Lady Sondes


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too sometimes fell back on the simple use of the word pain (or alternatively,versions of fear) as all-encompassingsuch a sort of pain that could not bedescribed more. To explain their pain, the patients referred to its various physicaland emotional forms. Although Lady Sondes and Mr. Pulleyn believed that wordsfailed them, their circular narratives clearly represented their pain: inescapableand, sometimes, indescribable.

The ongoing nature of pain for both patients continued, in part, becausethe meanings of their illnesses were unclear. Without an adequate explanation fortheir suffering, both kept rewriting their narratives. Most importantly, previousphysicians had not successfully interpreted the sufferers bodily pains; when patientsdisagreed with a diagnosis, they were unlikely to trust a physicians proposed treat-ment. Diagnosing diseases as hysteria or hypochondria was particularly trouble-some. Such diseases were difficult to treat and would constrain the patients life fora long time, but they could also imply moral judgmentthese were the diseases of

the sedentary, the effeminate, and the weak.108

Lady Sondes was an active woman who prized her ability to think clearly,go about her business, take exercise, and walk around her own home. One of herworries, she stressed, was that her illness was making her old before her timefiftywas generally considered the start of old age, but still a time of relative activityand vigor. But for the unwell, it could also be the start of ones progress into anincreasingly weak and passive role.109Hysteria could thus be a double-prongeddiagnosis for Lady Sondes; a disease of the overly delicate, it might even resultin a prematurely enfeebled old age. Perhaps unsurprisingly, she rejected Colbys

initial diagnosis, advice, and treatments, finding them to be disagreeable and evenfrightening. She also refused to share her fears with Colby, only feeling able to trustSloane. Clearly, communication had broken down between Colby and his patient,resulting in an inability to construct a joint narrative that explained her illness andto start appropriate treatment.110Only when he diagnosed her as having a blooddisorder, a controllable problem that did not require a major life change, did shemake peace with her illness. In the meantime, Lady Sondess letters to Sloane allowedher to begin to recreate her body and illness. It was not an immediate process, asshown by her thirteen letters in which the same themes and descriptions reoccur.111

Lady Sondes repeatedly wrote her illness to help Sloane, Colby, and herself find ameaning for her pain.

For Mr. Pulleyn, previous attempts to explain his suffering were unsuc-cessful. Although he had been diagnosed as having hypochondria, no one couldexplain the nature of his illness; he was frustrated with its elusiveness and thefailure of doctors to help him. Just knowing the nature of his illness would allowMr. Pulleyn to master his own disorder, or how to keep my selfe, as he put it.112As it was, the best framework that he had was that his pains worsened when theweather changed, but how it goes off & comes on me I cannot tell. Equallyworrying, no one he consulted had known a patient who had been cured of thedisorder. Desperately, Mr. Pulleyn promised that any understanding physicianwho helped him would be liberally rewarded. Until then, the story of his illnesswas incomplete; an unsatisfactory diagnosis rendered him unable to make senseof and live with his pain.


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through humoralism, which was flexible enough to allow the coexistence of othermedical ideas and expressive enough to describe simultaneously emotional andphysical symptoms. Humoralism also suggests an alternative way for historians tostudy the body, moving to a consideration of the lived body. In particular, justas pain descriptions in England and France were similar, men and women experi-enced the humoral body alike; they had similar physical sensations, described interms of internal fluxes and stoppages, and overlaps between body and mind. Forsufferers, pain was as much an emotional experience as a physical one; the bodyin pain, moreover, was essentially a humoral oneat least until diagnosis. Whenpatients suffered, particularly from an undiagnosed illness, the gendered bodywas peripheral to their experience. Indeed, even when diagnosed with gendereddiseases, like hysteria or hypochondria, the sufferers might consider it irrelevant;both Lady Sondes and Mr. Pulleyn rejected the initial diagnoses, which did notmesh with their own self-images.

By shifting their focus away from sexed bodies, historians can considermore deeply the specific functions of gender in embodiment, as well as the role ofgender in medical treatment. Continued study of the history of bodily experiencecan offer us many other insights into the creation of self-identity, such as whenand how gender was important, the influence of social status, and ones sense ofplace within the world and community. Certainly, given our modern obsessionwith health, intelligence, and behavior being inscribed genetically, it may even beimperative to look at experiences of people in the past to recall that we are notsimply the sum of our parts, but are also shaped by culture and society. Eighteenth-

century sufferers have much to offer us, with their evocative descriptions of painand illness that were shaped by humoral theory. Just as the viewer sees the barefoot upon the cushion in Gillrays caricature or the naked expressions of Le Brunsfaces, the reader of pain narratives catches an intimate glimpse of sufferers mostvulnerable moments: afraid, anxious, and alone.

NOTES

I am extremely grateful to Catherine Crawford, Rachel Rich, Cathy McClive, Warren Johnston, JuliaSimon, and the anonymous referees for their insightful comments on the many drafts of this article.

Funding for my research towards this article was provided by the Social Sciences and HumanitiesResearch Council of Canada.

1. For example, Judith Butler, Bodies That Matter: On the Discursive Limits of Sex(New York:Routledge, 1993); Moira Gatens, Imaginary Bodies: Ethics, Power and Corporality(London: Routledge,1996); Emily Martin, The Woman in the Body: A Cultural Analysis of Reproduction(Buckingham:Open Univ. Press, 1989); Evelyne Berriot-Salvadore, Un Corps, Un Destin: La Femme dans la Mdecinede la Rennaisance(Paris: H. Champion diteur, 1993).

2. Thomas Laqueur, Making Sex: Body and Gender from the Greeks to Freud(Cambridge: HarvardUniv. Press, 1990); Michael Stolberg, A Woman Down to Her Bones: The Anatomy of Sexual Differ-ence in the Sixteenth and Early Seventeenth Centuries, Isis94 (2003): 27499; Thomas Laqueur, Sexin the Flesh, Isis94 (2003): 3006; Londa Schiebinger, Skelettestreit, Isis94 (2003): 30713.

3. Roy Porter, Barely Touching: A Social Perspective on Mind and Body, in The Language ofPsyche, ed. G. S. Rousseau (Berkeley: Univ. of California Press, 1990), 80; Lyndal Roper, Oedipus andthe Devil: Witchcraft, Sexuality and Religion in Early Modern Europe(London: Routledge, 1994),1718; Caroline Bynum, Why All the Fuss about the Body? A Medievalists Perspective, CriticalInquiry22, no. 1 (1995): 133; Kathleen Canning, The Body as Method? Reflections on the Place ofthe Body in Gender History, Gender & History11 (1999): 499513.


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4. Lisa Forman Cody, Birthing the Nation: Sex, Science, and the Conception of Eighteenth-CenturyBritons(Oxford: Oxford Univ. Press, 2005); Londa Schiebinger, The Mind Has No Sex?: Women inthe Origins of Modern Science(Cambridge: Harvard Univ. Press, 1989); Anne Vila, Enlightenment andPathology: Sensibility in the Literature and Medicine of Eighteenth-Century France(Baltimore: JohnsHopkins Univ. Press, 1998).

5. Laqueur, Making Sex; Laqueur, Sex in the Flesh. 6. Laura Gowing has examined legal records, while Wendy Churchill has explored medical practice.Gowing, Domestic Dangers: Women, Words, and Sex in Early Modern London(Oxford: ClarendonPress, 1996), 7; Churchill, The Medical Practice of the Sexed Body: Women, Men, and Disease inBritain, circa 16001740, Social History of Medicine18 (2005): 322.

7. Karen Harvey, The Substance of Sexual Difference: Change and Persistence in Representationsof the Body in Eighteenth-Century England, Gender and History14 (2002): 20223.

8. Karen Harvey, The Century of Sex? Gender, Bodies, and Sexuality in the Long EighteenthCentury, The Historical Journal45 (2002): 914.

9. Barbara Duden, Woman Beneath the Skin: A Doctors Patients in Eighteenth-Century Germany,trans. Thomas Dunlap (Cambridge: Harvard Univ. Press, 1991). See also Ulinka Rublack, Fluxes: theEarly Modern Body and the Emotions, History Workshop Journal53 (2002): 116; Malcolm Nicol-son, The Metastatic Theory of Pathogenesis and the Professional Interests of the Eighteenth-CenturyPhysician, Medical History, 32 (1988): 277300; Alisha Rankin, Duchess, Heal Thyself: Elisabeth ofRochlitz and the Patients Perspective in Early Modern Germany, Bulletin of the History of Medicine82 (2008): 109-144.

10. Men were also thought to lactate and menstruate (Duden, Woman Beneath, 11219). See alsoGianna Pomata and John Beusterien on male menstruation and Cathy McClive on the timing of flows.Pomata, Menstruating Men: Similarity and Differences of the Sexes in Early Modern Medicine, inGeneration and Degeneration: Tropes of Reproduction in Literature and History from Antiquity to Early

Modern Europe, ed. Valeria Finnuci and Kevin Brownlee (Durham: Duke Univ. Press, 2001); Beusterien,Jewish Male Menstruation in Seventeenth-Century Spain, Bulletin of the History of Medicine73(1999): 44756; and McClive, Bleeding Flowers and Waning Moons: A History of Menstruation inFrance, c. 14951761 (Ph.D. thesis, University of Warwick, 2004).

11. See, for example, Martin, Woman in the Body; Patricia Crawford and Sara Mendelson, Womenin Early Modern England 15501720(Oxford: Clarendon Press, 1998), 1830; Gail Kern Paster,TheBody Embarassed: Drama and the Disciplines of Shame in Early Modern England(Ithaca: CornellUniv. Press, 1993).

12. Linda Pollock, Childbearing and Female Bonding in Early Modern England, Social History22 (1997): 306. See also Laura Gowing, Common Bodies: Women, Touch and Power in Seventeenth-Century England(New Haven: Yale Univ. Press, 2003).

13. Michael Roper, Slipping Out of View: Subjectivity and Emotion in Gender History, HistoryWorkshop Journal59 (2005): 5772.

14. For similar criticisms, see Fay Bound, Writing the Self?: Love and Letter in England, c. 1660c.1760, Literature and History11 (2002): 119; Joanna Bourke, Fear and Anxiety: Writing aboutEmotion in Modern History, History Workshop Journal55 (2003): 11133.

15. Sverine Pilloud and Micheline Louis-Courvoisier, The Intimate Experience of the Body in theEighteenth Century: Between Interiority and Exteriority, Medical History47 (2003): 45172.

16. Joanna Bourke makes a similar argument for modern history. See Linda Pollock, Anger and theNegotiation of Relationships in Early Modern England, The Historical Journal47 (2004): 56790;Lucy Bending, The Representation of Bodily Pain in Late Nineteenth-Century English Culture(Oxford:Clarendon Press, 2000), 8990; Gail Kern Paster, Humoring the Body: Emotions and the ShakespeareanStage(Chicago: Univ. of Chicago Press, 2004); Bourke, Fear and Anxiety.

17. However, neither study focuses on bodily experience in the patients present: Antonie Luyendijk-Elshout focuses on the medical treatments for fear; David Gentilcore extensively considers illness nar-ratives, but they are remembrances of past long-term ailments that were cured miraculously. Pilloud


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and Louis-Courvoisier briefly touch on the mind/body connection, but do not explore it in any depth.See Luyendijk-Elshout, Of Masks and Mills: The Enlightened Doctor and His Frightened Patient, inRousseau,Languages of Psyche; Gentilcore, The Fear of Disease and the Disease of Fear, in Fear inEarly Modern Society, ed. William Naphy and Penny Roberts (Manchester: Manchester Univ. Press,1997); and Pilloud and Louis-Courvoisier, Intimate Experience, 47172.

18. Sharon Howard, Imagining the Pain and Peril of Seventeenth-Century Childbirth, Social His-tory of Medicine16 (2003): 36782; Lucinda McCray Beier, Sufferers & Healers: The Experience ofIllness in Seventeenth-Century England(London: Routledge and Kegan Paul, 1987); Raymond A. Ansel-ment, The Wantt of Health: An Early Eighteenth-Century Self-Portrait of Sickness, Literature andMedicine15 (1996): 22543; Elizabeth Cook, Epistolary Bodies: Gender and Genre in the EighteenthCentury(Stanford: Stanford Univ. Press, 1996); Patricia Crawford, The Construction and Experienceof Maternity in Seventeenth-Century England, in Women as Mothers in Pre-Industrial England: Es-says in Memory of Dorothy McLaren, ed. Valerie Fildes (London: Routledge, 1990); Rebecca Earle,ed., Epistolary Selves: Letters and Letter-Writers, 16001945(Aldershot: Ashgate, 1999).

19. tienne-Franois Geoffroy, MSS 52415245, Bibliothque Interuniversitaire de Mdecine (Paris)(hereafter BIUM); Sir Hans Sloane, MSS 4034, 40364069, 40754079, British Library (London)

(hereafter BL). Consultation by letter with Sloane cost a guinea, while at least one patient paid Geoffroytwelve livres, about half Sloanes fee. Physicians in both countries charged their patients on a slidingscale according to their finances. See Sir Gavin de Beer, Sir Hans Sloane and the British Museum(Lon-don: Published for the Trustees of the Museum by Oxford Univ. Press, 1953), 53; BIUM MS 5241, ff.4546, Marquis de Brichauteau to Geoffroy, 10 June 1729; Laurence Brockliss and Colin Jones, TheMedical World of Early Modern France(Oxford: Clarendon Press, 1997), 324, 541, 545.

20. Franois Loux and Philippe Richard found many proverbs suggesting that illness was a luxuryreserved for the wealthy, but Patrick Kiley suggests that French aristocrats considered expressions ofpain as unrefined. Franois Loux and Philippe Richard, Sagesses du Corps: la Sant et la Maladie dansles Proverbes Franais(Paris: G.-P. Maisonneuve et Larose, 1978), 15152 ; Patrick D. Kiley, MakingSense of Pain: Reading the Sensible Body of Late Eighteenth and Early Nineteenth-Century France

(Ph.D. thesis, Purdue University, 2000).21. Matthew Ramsey and Colin Jones have argued that English medicine was not entirely liberal

and free market, while French medicine was not necessarily tightly controlled by monopolies or thestate. Matthew Ramsey, Le Mdecin, le Peuple, ltat: La Question du Monopole Professionnel, inLa Mdecine des Lumires: Tout Autour de Tissot, ed. Vincent Barras and Micheline Louis-Courvoisier(Geneva: Georg diteur, 2001), 2740; Colin Jones, The Great Chain of Buying: Medical Advertise-ments, the Bourgeois Public Sphere, and the Origins of the French Revolution, American HistoricalReview101 (1996): 1340.

22. Ramsey, Le Mdecin. Georges S. Rousseau suggests that hysteria was understood differentlyin European countries by the end of the eighteenth century: A Strange Pathology: Hysteria in theEarly Modern World, in Hysteria Beyond Freud, ed. Sander Gilman et al. (Berkeley: Univ. of California

Press, 1993), 91186.

23. The language is also similar to that of Johann Storchs and S. A. Tissots patients. See Duden,Woman Beneath; Pilloud and Louis-Courvoisier, Intimate Experience.

24. Western pain descriptions today overlap significantly. The McGill-Melzack Pain Questionnaire,developed in Canada, evaluates pain through vocabulary that appears to hold up cross-culturally, as aDutch study demonstrates. See Robbert-Jan Verkes, Willem Van der Kloot and John Van der Merj, ThePerceived Structure of 176 Pain Descriptive Words, Pain38 (1989): 21929. Medical studies suggestthat men and women physically process pain and pain relief differently, reducing pain to a matter ofphysical systems rather than social and cultural differences. Cf. Jane Bradbury, Why Do Men andWomen Feel and React to Pain Differently? The Lancet361, no. 9374 (June 14, 2003): 205253.

25. Arthur Kleinman, The Illness Narratives: Suffering, Healing & the Human Condition(NewYork: Basic Books, 1988), 4951; Harold Schweizer, To Give Suffering a Language, Literature andMedicine14 (1995): 21021; Marni Jackson, Pain: The Science and Culture of Why We Hurt(London:Bloomsbury, 2003); David Morris, The Culture of Pain(Berkeley: Univ. of California Press, 1991).

26 . Ernelle Fife, Agendas, Gender, and Audience: The Discourse of Eighteenth-Century Illness Nar-ratives (Ph.D. dissertation, Georgia State University, 1995); Morris, Culture of Pain; Roy Porter and


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Dorothy Porter, In Sickness and in Health: The British Experience 16501850(London: Fourth Estate,1988); Schweizer, To Give Suffering a Language; Sarah Skwire, Women, Writers and Sufferers: AnneConway and An Collins, Literature and Medicine18 (1999), 123.

27. Porter and Porter, In Sickness and in Health, ch. 6.

28. Howard Brody, Stories of Sickness(New Haven: Yale Univ. Press, 1987), 6, 15; Kleinman, IllnessNarratives, 4950.

29. On consultation letters, see Laurence Brockliss, Consultation by Letter in Early Eighteenth-Century Paris: The Medical Practice of tienne-Franois Geoffroy, in French Medical Culture in theNineteenth Century, ed. Ann La Berge and Mordechai Feingold (Amsterdam: Rodopi, 1994), 79117;Brockliss, Quatre Mdecins Francophones et la Rpublique des Lettres du XVIIIe Sicle: Boissier deSauvages, Villars, Calvet et Tissot, in Barras and Louis-Courvoisier, Lumires, 15169; MichelineLouis-Courvoisier, Le Malade et Son Mdecin: le Cadre de la Relation Thrapeutique dans la DeuximeMoiti du XVIIIe Sicle, Canadian Bulletin for the History of Medicine18 (2001): 27796; MichelineLouis-Courvoisier and Sverine Pilloud, Consulting by Letter in the Eighteenth Century: Mediatingthe Patients View? in Cultural Approaches to the History of Medicine: Mediating Medicine in EarlyModern and Modern Europe, ed. Willem de Blcourt and Cornelie Usborne (Houndmills: PalgraveMacmillan, 2004), 7188; Guenter Risse, Doctor William Cullen, Physician, Edinburgh: A Con-sultation Practice in the Eighteenth Century, Bulletin of the History of Medicine48 (1974), 33851;Frdric Sardet, Consulter Tissot: Hypothse de Lecture, in Barras and Louis-Courvoisier, Lumires,5566.

30. Roy Porter, The Rise of Physical Examination, in Medicine and the Five Senses, ed. WilliamBynum and Roy Porter (Cambridge: Cambridge Univ. Press, 1993); Stanley Reiser, Medicine and theReign of Technology (Cambridge: Cambridge Univ. Press, 1978), 122. Touch, however, may havehappened more often than we assume, as Cathy McClive recently argued in Looking and Touchingin French Legal Medicine, 15001800 (paper presented at the American Association for the Historyof Medicine Conference, Montreal, 3 May 2007).

31. Duden and Paster suggest that premodern language correlated with physical and emotional reality:see Duden, Woman Beneath, 3638, 8790; Paster, Humoring the Body. Language became medicalizedin the mid-eighteenth century: see Fissell, Patients, Power and the Poor, ch. 8; Nicolas Jewson, TheDisappearance of the Sick Man from Medical Cosmology, Sociology10 (1976): 22544.

32. Howard Brody, My Story is Broken; Can You Help Me Fix It? Medical Ethics and the JointConstruction of Narrative, Literature and Medicine13 (1994): 7992.

33. Generally, physicians took a week to reply. Letters to Geoffroy and his replies were usually dated.Sloanes response time can be estimated based on patients subsequent letters.

34. Blockages can also be seen in iatromechanism, and blood quality in iatrochemistry. See RoselyneRey, The History of Pain, trans. Louise Wallace, J. A. Cadden, and S. W. Cadden (Paris: La Dcouverte,

1993), 103; Pilloud and Louis-Courvoisier, Intimate Experience, 46063.35. On French and other European trends, see Luyendijk-Elshout, Of Masks and Mills, 20512;

Roselyne Rey, Vitalism, Disease and Society, in Medicine in the Enlightenment, ed. Roy Porter(Amsterdam: Rodopi, 1995), 27488; Elizabeth A. Williams, A Cultural History of Medical Vitalismin Enlightenment Montpellier(Aldershot: Ashgate, 2003); Vila, Enlightenment and Pathology.

36. Sloane was trained by the iatromechanist Thomas Sydenham, while Geoffroy was an iatrochem-ist. Most of Geoffroys replies exist; although very few of Sloanes do, patients letters sometimes referto his previous treatment. On shared medical language, see Nicolas Jewson, Medical Knowledge andthe Patronage System in Eighteenth-Century England, Sociology9 (1974), 36985. Wayne Wild hasalso noted the continuance of old-fashioned treatments in medical practice by physicians who espousednew ideas: Medicine-by-Post: The Changing Voice of Illness in Eighteenth-Century British ConsultationLetters and Literature(Amsterdam: Rodopi, 2006).

37. Using different collections of consultation letters, Wild argues that a rhetoric of sensibility andsubjectivity entered English consultation letters from the 1730s. For eighteenth-century France, Kileyargues that modern patients have a more extensive vocabulary, as well as more suffering. (Wild, Medi-cine-by-Post, 61100; Kiley, Making Sense, 2425, 6872.)


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38. Duden, Woman Beneath; Rankin, Duchess, 12933.

39. BL Sl. MS 4075, f. 286, Dr. Chistopher Jeffries to Sloane, n.d.

40. BL Sl. MS 4075, f. 73, Henry Downing to Sloane, 19 July 1726.

41. BIUM MS 5244, f. 85, n.a. to Geoffroy and Hequet, 10 July 1729: fluxions sur les dents et sur

les yeux, flux de ventre frequent et copieux.

42. BIUM MS 5245, f. 5, Aubriot, Chanoine de Boulogne sur Mer, to Sloane, 30 January 1724:aussitot une vapeur seleve qui mevaille [sic] en surtant, en mecriant. Quand je me porte bien celamaniere aussi ce qui mempeche de dormir, car cela meveille souvent trois a quatre fois par nuict.

43. BIUM MS 5242, f. 297, n.a., 14 June 1730. The male patient had a fever caused by his grandeset fortes obstructions.

44. BIUM MS 5242, f. 42, n.a., 8 August 1727: Embarras quil sent a lEstomach.

45. This linguistic overlap has been largely lost in modern England. See Horacio Fabrega and StephenTyma, Culture, Language and the Shaping of Illness,Journal of Psychosomatic Research20 (1976):

335; Dorothee Sturkenboom Historicizing the Gender of Emotions: Changing Perceptions in DutchEnlightenment Thought,Journal of Social History34 (2000): 5576; John Mullan, Sentiment andSociability: The Language of Feeling in the Eighteenth Century(Oxford: Clarendon Press, 1988).

46. Rey, Pain, 3; Duden, Woman Beneath, 87.

47. BL Sl. MS 4076, f. 189, Mary Butler to Sloane, n.d. [d. 1733].

48. BL Sl. MS 4042, f. 174, Anne Hamilton to Sloane, 4 September 1710.

49. BL Sl. MS 4076, f. 36, Sarah Long to Sloane, 8 January 173839.

50. BIUM MS 5245, f. 80, Mr. Seret to Geoffroy, 29 January 1729.

51. BIUM MS 5245, f. 221, n.a. to Mme Fouqau (?), n.d. Je sentis une douleur dans lestomach quipour netre pas continuel ne laisse pas que detre fort incomode. See notes 72 and 83.

52. BIUM MS 5241, f. 76, n.a. to Geoffroy, 26 December 1714: je me trouve incomode de cetteoppression dont jay parl je ne suis point dutout oppresse quand je suis tranquil il faut pour lestre quejagisse ou que je monte une escalier.

53. BL Sl. MS 4077, f. 216, Ann Warner to Sloane, 5 September 1724.

54. BL Sl. MS 4075, f. 286, Dr. Chistopher Jeffries to Sloane, n.d.

55. Fabrega and Tyma, Shaping of Illness, 335.

56. The relationship between body and soul, physical reflex and true suffering, was hotly discussed

by several early modern scholars. Descartes, for example, believed that pain required a judgment bythe soul. See Rey, Pain, 7782. Several modern studies have pointed out how chronic pain affects everypart of a persons life: Morris, Culture of Pain; Jackson, Pain; Kleinman, Illness Narratives; C. RichardChapman and Jonathan Gavrin, Suffering: The Contribution of Persistent Pain, The Lancet353, no.9171 (June 26, 1999): 223338.

57. BL Sl. MS 4075, f. 187, John Grandorge (Chaplain) to Sloane, 16 April 1725.

58. BL Sl. MS 4075, f. 201, John Hales to Sloane, 14 June 1706.

59. BL Sl. MS 4061, f. 306, C. Watson to Sloane, n.d.

60. BIUM MS 5241, f. 236, Gouet de Luygnee to Geoffroy, 26 May 1728.

61. BL Sl. MS 4076, f. 36, Sarah Long to Sloane, 8 January 173839. 62. BIUM MS 5241, f. 5, n.a., n.d.

63. Hysteria was a disorder of the emotions and body, although G. S. Rousseau (A Strange Pa-thology) argues that eighteenth-century hysteria was increasingly physical. BIUM MS 5241, f. 145,n.a., n.d.; Mullan, Sentiment and Sociability, ch. 5; Elizabeth A. Williams, Hysteria and the CourtPhysician in Enlightenment France, Eighteenth-Century Studies35 (2002): 24755.


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64. BL Sl. MS 4075, f. 218, Dr. George Hepburn to Sloane, 5 January 1721. It is not clear whetherthe patient is Horatio (1st Baron Walpole of Wolterton) or the Rt. Hon. Sir Robert Walpole (1st Earlof Orford).

65. Bending, Bodily Pain, 1047.

66. BL Sl. MS 4041, f. 245, Elizabeth Howland to Sloane, 22 November 1708. Although this de-scription was not strictly humoral, it was based on the humoral foundation of hot and cold qualities.

67. BIUM MS 5244, f. 74, n.a, n.d. Apres la saigne du pied ses opressions luy vinrent plus viol-lentes et plus long tems quelle ne les avoit jamais eu.

68. BIUM MS 5244, ff. 7576, Geoffroy to Unknown, n.d.

69. The McGill-Melzack Pain Questionnaire also attempts to identify these aspects of pain.

70. Jewson, Medical Knowledge; Roy Porter, The Body and the Mind, the Doctor and the Patient:Negotiating Hysteria, Gilman et al., Hysteria Beyond Freud, 22566.

71. BL Sl. MS 4041, f. 245, Elizabeth Howland to Sloane, 22 November 1708.

72. BIUM MS 5245, f. 221, n.a. to Mme Fouqau (?), n.d. See also notes 51 and 83.

73. See Elaine Scarry, Body in Pain: The Making and Unmaking of the World(New York: OxfordUniv. Press, 1985). Pain may be more difficult for modern patients to express. Gilles Trimaille, forexample, has discussed the confiscation of the measurement and determination of pain by modernmedical and legal experts: LExpertise Mdico-Lgale: Confiscation et Traduction de la Douleur, inLa Douleur et le Droit, ed. Bernard Durand, Jean Poirier, and Jean-Pierre Royer (Paris: Presses Uni-versitaires de France, 1997).

74. Eighteenth-century physician George Cheyne, who also had an extensive consultation-by-letterpractice, believed that letters were therapeutic (Wild, Medicine-by-Post, 113). See also Louise DeSalvo,Writing as a Way of Healing: How Telling Stories Transforms Our Lives(Boston: Beacon Press, 2000);

Mary-Jo DelVecchio Good, Paul Brodwin, Byron Good et al., Pain as Human Experience: An Anthro-pological Perspective(Berkeley: Univ. of California Press, 1992); Scarry, Body in Pain; Jackson, Pain;Kleinman, Illness Narratives; Morris, Culture of Pain; Michael Roper, Splitting in Unsent Letters:Writing as a Social Practice and Psychological Activity, Social History26 (2001): 31839; Rousseau,A Strange Pathology, 9495.

75. Pilloud and Louis-Courvoisier suggest that bodies and their passions needed to be open to theoutside world (Intimate Experience, 472). See also Rublack, Fluxes; George S. Rousseau, Inge-nious Pain: Fiction, History, Biography, and the Miraculous Eighteenth Century, Eighteenth-CenturyLife25, no. 2 (2001): 4762; Lisa Silverman, Tortured Subjects: Pain, Truth, and the Body in EarlyModern France(Chicago: Univ. of Chicago Press, 2001).

76. Bending argues that the assumption that pain lacks language overlooks sufferers experiences

(Bodily Pain, 11014). See also Scarry, Body in Pain, 161 f.; Porter, Expressing yourself Ill: The Lan-guage of Sickness in Georgian England, in Language, Self, and Society: A Social History of Language,ed. Peter Burke and Roy Porter (Cambridge: Cambridge Univ. Press, 1991), 27678.

77. Barbara Stafford, Body Criticism: Imaging the Unseen in Enlightenment Art and Medicine(Cambridge: MIT Press, 1991), 17899.

78. Rey, Pain, 99101.

79. Roy Porter, Western Medicine and Pain: Historical Perspectives, in Religion, Health and Suf-fering, ed. John R. Hinnells and Roy Porter (London: Kegan Paul International, 1999), 107.

80. Using religious sources, Gentilcore considers the need for labelling ones affliction in order to

respond to it (Fear, 204).81. Gillian Bennett examines popular descriptions of internal sensations as invading animals, while

Gentilcore looks at disease as possession by an external entity. Bennett, Bosom Serpents and Alimen-tary Amphibians: A Language for Sickness, in Illness and Healing Alternatives in Western Europe, ed.Marjike Gijswijt-Hofstra, Hilary Marland, and Hans de Wardt (London: Routledge, 1997); see alsoGentilcore, Fear.


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82. BIUM MS 5244, f. 78, Mlle de Refuge to Geoffroy, 22 April 1729; BL Sl. MS 4075, f. 321, M.Irwin to Sloane, 16 June 1724. Mlle de Refuge referred to batement.

83. BIUM MS 5245, f. 221, n.a. to Mme Fouqau (?), n.d. The anonymous French woman describedher pain as se tourne, se remue and battement. She also suffered from rheumatism and migraines.See also notes 51 and 72.

84. Silverman, Tortured Subjects;Vronique Demars, La Douleur, Srum de Vrit: lUtilisation duSerment dans les Douleurs de lAccouchement pour la Preuve de la Paternit Naturelle dans lAncienDroit, in Durand et al., La Douleur; Serge Dauchy, Le Jurisconsulte et le Mdecin: la Douleur Vue Travers les Recueils dArrts (XVIe XVIIIe Sicle), in Durand et al., La Douleur; Florence Carr,Le Criminel Face La Douleur: La Thse de Lombrosso, in Durand et al., La Douleur; Howard,Seventeenth-Century Childbirth.

85. BIUM MS 5241, f. 99, n.a. to Geoffroy, n.d. The patient was tres tourment particuliere-ment.

86. BIUM MS 5243, f. 103, n.a. to Geoffroy, 19 November 1723. He had picotements anddechiremens and was languissant.

87. BIUM MS 5242, Geoffroys consultation for Mme de la Buretiere, 19 September 1724, ff. 5355;Mme de la Buretiere to Geoffroy, 18 May [1725], f. 55.

88. BIUM MS 5242, Anonymous physician to Geoffroy, 3 January 1725, f. 48; Regime a observer,ff. 4950.

89. On the symptoms, see BIUM MS 5242, Mme de la Buretiere to Geoffroy, n.d., f. 57; on remedies,see her letters to Geoffroy, 18 May, f. 55; n.d. ff. 56, 58.

90. Mes [sic] inquietude continuelle et tristesse et tremblement. BIUM MS 5242, f. 56. She madesimilar complaints in f. 57.

91. Une repugnance effroiable. BIUM MS 5242, 18 May, f. 55.

92. Faitte moy lhonneur de mecrire et de me faire scavoire pour ma consolation a quoy tous ces[sic] remede peuvent servirs le soulagement que jen doit esperer. BIUM MS 5242, f. 57. She complainedabout his slow response in May, f. 55.

93. Based on BIUM MSS 52415245 (411 letters) and BL Sl. MSS 40754079 (828 letters), nearly 57percent of Sloanes letters and only 39 percent of Geoffroys were written by lay people; of these, about48 percent of English patients and 41 percent of French patients who wrote letters did so about theirown illness. BIUM MS 5241, f. 99, n.a., n.d.; ff. 100101, Geoffroy to M Louis Tou de Guijon, 23 July1728; f. 102, Jullien to Abb de Guijon, 31 July 1728; f. 103v, M de Guijon to Abb de Guijon (onlya short cover letter with Julliens letter), n.d.; f. 104, Geoffroy to M de Guijon, 10 August 1728.

94. Tissots collection is similar. Brockliss, Quatre Mdecins, 154; Sverine Pilloud, Mettre les

Mauz en Mots, Mdiations dans la Consultation pistolaire au XVIIIe Sicle: Les Malades du Dr Tissot(17281797),Canadian Bulletin for the History of Medicine16 (1999): 21545. For a detailed Frenchcase in which a man suffering from impotence and obesity sought the help of French physicians andTissot, see Daniel Teysseire, Obse et Impuissant: Le Dossier Mdical dElie-de-Beaumont, 17651776(Grenoble: Jrome Millon, 1995).

95. BIUM MS 5241, f. 119, Sr Pecquet de Ste Victoire to Geoffroy, 12 April 1730; f. 121, 7 January1730; f. 122, 7 May 1730; f. 152, 18 November 1729; f. 124, Geoffroy to Sr Pecquet de Ste Victoire,17 April 1730; f. 125, 15 May 1730; f. 153, 18 November 1729.

96. Most of the letters are undated, which complicates identifying a chronology. Based on internalevidence in the letters, the earliest letter is ca. 1722, before her husband died, and the latest is ca. 1732.

She suffered from the same (or related) ailments throughout and died 13 February 1734.97. BL Sl. MS 4061, f. 289, C. Watson to Sloane, n.d. The letter was post-1729, referring to her

daughter Catherines miscarriage. She married Edward Southwell in August 1729.

98. BL Sl. MS 4061, f. 29192, C. Watson to Sloane, n.d. She refers to her husbands illness, so theletter predates March 1722.


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99. BL Sl. MS 4061, f. 298, C. Watson to Sloane, [1732?]. Colby was treating her by 1732.

100. BL Sl. MS 4061, f. 302, C. Watson to Sloane, n.d. The date cannot be identified. Nearby letters(ff. 287, 306, 289) refer to her daughters dowry, upcoming marriage, and miscarriage, while others(ff. 295, 300) discuss her husbands illness.

101. BL Sl. MS 4061, f. 306, C. Watson to Sloane, [172829?] This letter mentions her daughtersupcoming marriage.

102. BL Sl. MS 4078, f. 38, C. Watson to Sloane, 20 June [1732?].

103. BL Sl. 4078, f. 1, D. Colby to Sloane, 16 May 1732. He later wrote to Sloane that Lady Sondessuffered from a violent convulsive disorder, suggesting that she visit either Bath or London for the air:BL Sl. 4078, f. 3, 1 October 1732.

104. BL Sl. MS 4078, f. 38, C. Watson to Sloane, 20 June [1732?].

105. BL Sl. MS 4076, f. 282, Mr. Pulleyn to Sloane, n.d.

106. BL Sl. MS 4077, f. 332, Mr. Pulleyn to Sloane, 7 August 1734. It is not certain that this is the

same person or incident of disease, although it seems likely. The online manuscript index at the BritishLibrary lists Pulleyn as the letter writer in Sl. MS 4076 and Peter Palleyn as the one in Sl. MS 4077.(However, the second letters autograph appeared to be Pulleyn to me.) The disease is also probablythe same, since Pulleyn described it in the first letter as being similar to gout, the disease treated in thesecond letter.

107. Fife has used the terms linear and circular (Agendas, Gender, and Audience, 6370);see also Shlomo Argamon, Moshe Koppel, Jonathan Fine, and Anat Rachel Shimoni, Gender, Genre,and Writing Style in Formal Written Texts, Text: Interdisciplinary Journal for the Study of Discourse23 (2003): 32146; Minna Palander-Collin, Male and Female Styles in Seventeenth-Century Cor-respondence. Language Variation and Change11 (1999): 12341; Janet Holmes, Women, Men andPoliteness(London: Longman, 1995), 2.

108. Rousseau recounts the dismissal of Dr. John Radcliffe by Queen Anne after he diagnosed her withvapors, when she wanted a disease that could be readily treated. See also Elaine Showalter, Hysteria,Feminism, and Gender, in Gilman et al., Hysteria Beyond Freud, 286335; Rousseau, A StrangePathology, 14950.

109. Lynn Botelho, When the healer becomes the patient: old age and illness in the life of ElizabethFreke, 16411714, lecture, Johns Hopkins University, 21 April 2006.

110. See Brody, My Story is Broken.

111. See also BL Sl. MS 4052 ff. 27374, 15 February 1732 (fatigue, limits to endurance of pain, andavoidance of malingering); MS 4061, ff. 287 (suffered colic and weakness), 293 (the effects of the steelremedy), 304 (still ill despite bleeding and blistering), 306 (medicines agreed with her); MS 4078, ff.

57 (complained that Sloane had not read her last letter properly), 5960 (fatigue, loose bowels, swollenleg, failure of her remedies and worry over her sick child).

112. Brody, Stories of Sickness, 6.

113. On gout, see Thomas Benedek, Gout in Women: A Historical Perspective, Bulletin of theHistory of Medicine71 (1997): 122; Roy Porter, Gout: Framing and Fantasizing Disease, Bulletinof the History of Medicine68 (1994): 128. For only a few examples on hysteria and hypochondria,see George S. Rousseau, Towards a Semiotics of the Nerve: The Social History of Language in a NewKey, in Burke and Porter,Language, Self, and Society; Vila, Enlightenment and Pathology; Mullan,Sentiment and Sociability; and Williams, Hysteria and the Court.

114. Diagnoses and treatments had to make sense to patients; see Steven Shapin, Trusting George

Cheyne: Scientific Expertise, Common Sense, and Moral Authority in Early Eighteenth-Century DieteticMedicine, Bulletin of the History of Medicine77 (2003): 26397.

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Pain in the 18th C