Weakness after Disease

To understand why the body was weak in the wake of illness, it is necessary to go back a step, and remind ourselves of how disease was removed in early modern perceptions. As shown in Chapter 1, three hierarchical agents were thought to be responsible: God, Nature, and medical intervention. ‘Nature’ was ‘God’s instrument’, the ‘intrinsic agent’ and life force of the body, also responsible for nutrition, growth, and generation.¹⁷ Nature’s vehicles for performing her functions were the ‘natural spirits’, highly rarefied, ‘subtile and Arey’ vapours, ‘raised from the purer blood’, and carried around the body in the veins.¹⁸ At the bottom of the hierarchy was the medical practitioner, who was supposed to be ‘an assistant and helper of nature in time of neede’.¹⁹ Nature removed disease by rectifying the bad humours that had caused it: her chief methods were concoction (a form of internal cooking which erased the malignant quality of the humours) and expulsion (the ejection of superfluous humours through the ‘crisis of the disease’, the sudden evacuation of body fluids at the height of illness, in the form of sweating, vomiting, or other emission).²⁰ If Nature seemed to be struggling to produce these evacuations, the physician stepped in, and administered evacuative treatments, such as emetics and purges.

When these processes were judged as successful—an assessment based on the patient’s perception of feeling better, together with signs of concoction in the expelled excrements—the disease was said to have gone.²¹ The patient was not, however, yet pronounced back to health, since the body was usually weak. The Wiltshire gentlewoman Grace Thynne told her daughter Frances in 1723, ‘the gout is gone and I have nothing but the weakness left’.²² Weakness was defined as the ‘slowness’ or ‘imbecility’ of the faculties of the body, caused by the ‘dissipation’ or ‘decay’ of the natural, animal, and vital spirits.²³ To recap, the natural spirits were Nature’s vehicles for carrying out the body’s basic functions. The other two types—the animal and vital spirits—drove the higher faculties of the body and mind: muscular movement, the senses, and rational powers (animal faculty), and breathing, the pulse, and the emotions (vital faculty).²⁴ In turn, all three spirits were ‘nourished’ by ‘radical moisture’ (an oily substance) and ‘innate heat’ (a glowing warmth): these were the substances in which ‘life consisteth’, which gradually depleted with age.²⁵ Crucially, the processes of removing disease consumed these substances: the heat of concoction dried out the radical moisture, and the critical evacuations removed all three types of spirits, along with the bad humours. Speaking of diarrhoea, the German physician Walter Bruele wrote: ‘excrements ofentimes come downe with such force, that the spirits are also expelled with the humours: from whence [occurs] … a languishing of the strength’.²⁶ Patients and their families also recognized this cause.²⁷ Bereft of the requisite quantity of spirits, Nature was unable to carry out the body’s operations with her usual vigour. This situation was described using military metaphors: Nature was exhausted from her battle with the disease, ‘hardly [able to] recollect her forces … but recovers [them] … by degrees, … to reedifie and fortifie her batter’d walls’.²⁸ Such imagery is consistent with the finding in Chapter 1 that Nature was a warrior queen, and the body a battlefield.²⁹

The effects of the loss of the spirits were multiple forms of weakness, each connected to the particular spirit that had been evacuated, and varying in accordance with the length and severity of the disease. The dissipation of the animal spirits caused weak musculature,³⁰ slow mobility,³¹ poor memory,³² and dullness of hearing or eyesight.³³ The clergyman Thomas Brockbank (1671–1732) recorded that after smallpox, ‘I was so weak that my back wo’d not bare my shoulders, and I co’d [not] go without supporters’.³⁴ By contrast, the loss of natural spirits brought about thinness, paleness,³⁵ hair loss,³⁶ and constipation,³⁷ footsteps of disease associated with the weakened nutritive faculty. The biographer of the controversial clergyman and historian Peter Heylyn (1599–1662) recalled:

[W]hat strange alterations his sickness had wrought in him; for he was before a fresh lively complexion; … but now … of a pale discoloured countenance … his Cheeks fallen, his Eyes a little sunk within his Temples, and leanness of Face and whole Body.³⁸

The footsteps and weaknesses identified above were at a height immediately following the illness, after which point they usually began to recede, with strength increasing over time. The speed at which this process occurred ranged from minutes to years. In 1602, Lady Elizabeth Hunsdon (1552–1618) recorded that ‘within the space of one halfe howre’ her husband ‘returned agayne to his former estate’ after a ‘sudden sicknes’ which had temporarily deprived him of ‘all sence and motion’.⁴³ At the other end of the spectrum, ten-year-old Hannah Martindale from Lancashire ‘cannot stand upright’ after her long palsy, though she ‘gets some little strength every year’, recorded her father.⁴⁴ These variations in timing were attributed, above all, to the length of the disease, as is revealed in one of the Hippocratic aphorisms:

Bodies … wasted with long sickness, are to be restored … little by little, but those which have been brought low quickly and in short time, are sooner to be restored.

Categorizing the Convalescent

Where did convalescents fit in contemporary bodily categorizations? Drawing on Galen’s Ars medica, physicians usually envisaged three main bodily states: healthful (or sound), neutral, and unhealthful (or sick).⁴⁸ Healthful was defined as the balance of the ‘primary qualities’ (heat, cold, dry, and wet), together with the strong functioning of the faculties (animal, natural, and vital). Unhealthy was the opposite: individuals suffered the ‘perceptible impairment’ of the faculties, and the imbalance of the four qualities—this state included diseases, disabilities, and wounds.⁴⁹ Suspended between these two categories was the ‘neutral body’, otherwise known as the ‘crazie’ or ‘valetudinarie’ body.⁵⁰ Defined by Galen as ‘an exquisite medium between healthful and unhealthful Bodies’, the neutral body was a melting-pot for all those individuals deemed ‘neither perfectly whole, nor thoroughly sicke’.⁵¹ This category has attracted only limited attention from historians, perhaps because it is no longer recognized in modern medicine.⁵²

A number of groups of patients were encompassed within the neutral category, including people of ‘sickly Constitution’, who by ‘Nativity … are born’ this way; those individuals who were falling sick, though ‘not yet fastned to their beds’; and most importantly for our purposes, patients who ‘hath already discussed the disease … it selfe from it, yet is weak, feeble, exhausted, and of little force’.⁵³ Termed neutra convalescens in Latin, these were ‘Persons recovering, who recollect themselves from some Disease’.⁵⁴ Convalescents were no longer sick because the majority of the bad humours had been concocted and expelled, nor were they in health because the body was still weak; their bodies functioned, but they functioned slowly and weakly. By excluding the convalescent from the category of health, early modern doctors implied that this state was not just the absence of disease, but the presence of strength.⁵⁵ This subtle, but important, distinction has not been recognized in the historiography of early modern medicine.

Several other groups were sometimes added to the neutral category.⁵⁶ The historian Timo Joutsivuo confirms that in Renaissance gerontologies, ‘the relationship between old age and convalescence was well known’.⁵⁷ Patients frequently compared themselves to the elderly. The Shropshire minister and prolific writer Richard Baxter (1615–91) complained that he ‘continued … in languishing Pains and Weaknesses … just the same Symptoms as most men have about Fourscore [i.e. eighty] years of Age’.⁵⁸ Speaking of ‘Feebleness … [of] voluntary Motion’, the Swiss physician Felix Platter (1536–1614) noted that it occurs both in ‘olde folks … who are … sluggish and presently tired’, and in those ‘recover’d of … Disease’.⁵⁹ Lying-in mothers also qualified for the neutral category, on the grounds that childbirth, like disease, exhausted Nature and dissipated her spirits.⁶⁰ As Leah Astbury has commented, the vaginal bleeding that commonly followed the delivery of the infant was similar to the critical expulsion.⁶¹ Women as well as doctors recognized the similarities between convalescence from illness and childbirth. The Buckinghamshire gentlewoman Brilliana Harley told her son in 1639, ‘I am still so weake, and, I thinke, allmost as weake as after lyeing in of any of my chillderen’.⁶² The final group in the neutral category were ‘sucking infants’ (breastfed babies): treatises devoted to the diseases of children describe this age group as ‘weak’ and ‘tender’, owing to the high level of moisture contained within their body parts.⁶³ Occasionally, convalescing patients compared their physical helplessness to the plight of infants, suggesting that they too suffered from ‘childish’ weakness.⁶⁴ As will become clear later in the chapter, convalescent care in some ways resembled the treatment of these other neutral groups.

The neutral category elicited considerable controversy amongst the medical and philosophical elite.⁶⁵ Although vernacular medical texts rarely discussed the details of the debates, they do allude to the key points of contention. The art of physic made plain, by the dean of the Faculty of Medicine in Reims, Nicholas Abraham de La Framboisière (1560–1636), contains an imagined disputation between a medical candidate and the dean:

DEAN:

There is no such thing as a Neuter Body … I prove it thus … Sound and unhealthy are immediate Contraries, according to the Opinion of Aristotle: Therefore seeing Health and Sickness are diametrically opposite, there can be no middle Constitution between’em.

CANDIDATE:

I answer, Health and Sickness are immediately opposite according to Aristotle, but not according to the Physicians.⁶⁶

[S]uch a thing is determind by … daily use and custome … Hence proceed those answers of our friends …, if they aske how any man doth, what health he is in … [he will] answer in so many words; [‘]So so, indifferent, not very well, doubtfully, inclining, floting between both, instable, not sound, not as we could wish, or would have it[’].⁶⁷

Each category of body—healthy, unhealthy, and neutral—required a different sort of therapy. The prominent Fellow of the Royal College of Physicians Francis Glisson (c.1599–1677) declared that the ‘three Species’ of body, ‘are the subjects of the three kinds of Method to Practice’: namely, ‘a sound state indicateth the conservation of health …; a diseased state [requires] the removal of some affect’ (the process described in Chapter 1 by which illness was taken away), and ‘the Neutral state [needs] the caus[e] of the imminent malady … to be corrected least it break out into a Diseas[e]’.⁶⁸ Within the neutral category, further distinctions were drawn between sub-groups of patients. The Polish physician Johannes Johnstonus (1603–75) stated that whereas those who were falling sick required measures that would prevent the illness from taking hold, ‘persons … recovering’ require ‘two things’:

1. That they fal not back again into their sicknesses.
2. That they may soon recover their perfect health.⁶⁹

The Final Purge

The first component of analeptics relates to the non-natural excretion. After illness, patients and practitioners worried that the body might contain residues of malignant humours, ‘left over’ from the critical expulsion.⁷¹ The concern was that these humours would grow in the body, and cause relapse. Convalescent care sought to prevent this from happening by giving a ‘final gentle purge’ to ‘carry off’ the remnant humour. The Scottish physician John Macollo (1576–1622) warned in his posthumously published medical canons, ‘if the Crise [crisis] have been imperfect, it is the duty of the Physitian to purge [the] rest of the vicious humours, fearing lest by process of time, putrifying within the body, they renew the sickness’.⁷² Colourful metaphors were used to explain the need for this treatment. Walwyn recorded in his casebook that a gentleman, aged 30, whose ague had been ‘quite discharged’ was informed by his doctors that ‘the work … could not be perfect’, and that the disease would ‘return upon him … if he did not speedily take some fit Purgative to carry of the Relicks’. They likened disease to a dead dog: ‘[if] you kill a Dogg in your house, and you let him lie there, and [do] not quickly throw him out, hee’l soon make you weary of your Habitation’, and therefore a final purge is necessary after illness.⁷³ The remnant humour was also compared to dirt, which must be ‘swept clean’ from the house to keep it free from ‘future feares’.⁷⁴ Depicting the body as a house, and the humours as dirt or an animal, is common in early modern medical writings; it fitted with the identity of Nature as a ‘homely woman’, who kept the body ‘polite and trim’.⁷⁵

Laypeople as well as physicians advised giving ‘a gentle purge when the distemper is over’.⁷⁶ Domestic recipe collections often contain instructions for making a ‘very good purge for a weak constitution after feavour’ or some other disease.⁷⁷ In hindsight, patients and their relatives attributed future illnesses to their failure to purge the body. The Lancashire-born Presbyterian clergyman Adam Martindale (1623–86) reminisced that after smallpox as a child in the early 1630s, he ‘should have been soundly purged, but was not; which as I verily believe, caused a vehement fermentation in my bodie, which, after two or three yeares’ space, [came] out in an ugly dry scurfe’.⁷⁸ The reason for failing to take the purge—besides the expense—may have been that patients were tired of physic, and wanted to give it up at the earliest opportunity.⁷⁹ The consequences could be fatal. Peter Heylyn’s biographer claimed that ‘the reliques of his long quartane Ague not purged out by Physick … threw’ this man ‘into a malignant Fever’, of which he died.⁸⁰

In theory, the convalescent’s purge differed from those prescribed to the sick and healthy. Those who were still ill required stronger, and more frequent, evacuations, because their bodies contained larger quantities of bad humours. Conversely, ‘those persons that be perfectlie in health ought not to take a[ny] Purgation[,] since they doe not abound with corrupt humours’, wrote the anonymous author of a popular late sixteenth-century medical manual for the poor.⁸¹ The reason it was wrong to purge the healthy was that these medicines, finding ‘no excrements’ in the body, would set upon ‘solid and sound parts’, and ‘make a colliquation of good flesh’.⁸² Of course, in practice many healthy people did take purges, because it was believed that those bodies which were ‘inclined to fall’ into sickness might also contain some noxious matter.⁸³ It should also be noted that the convalescent’s gentle purge was not exclusive to these patients: it was apposite for other members of the weak ‘neutral’ category too, such as ‘big-bellied’ or lying-in women, the elderly, and young children.⁸⁴

After the final purge, it was necessary to comfort and strengthen Nature and the body, especially the ‘noble organs’—the brain, heart, and liver. The Latin term condita, meaning preserve or restore, was used to denote these treatments: they were designed to ‘strengthen the might’ of the ‘worthiest membres’ of the body in those ‘that begin to recover and waxe stronge’.⁸⁵ A variety of forms were recommended, including juleps and cordials (sweetened drinks and spirits), electuaries (powders mixed with honey or preserve), and topical remedies (plasters, baths, and ointments). A typical example is the surgeon Alexander Read’s (d. 1641) ‘Restorative for weak Convalescent persons after a long and tedious sickness’, made of pistachios, sugar, and fragrant spices.⁸⁶ Similar treatments can be found in domestic recipe books, which suggests that condita was a normal part of household medicine.⁸⁷ These drugs were thought to work through their effects on the spirits: once taken, they travelled to the noble organs, the ‘seats’ of the spirits, and proceeded to ‘corroborate and strengthen … the vertues naturall, vitall, and animall’ by expanding, comforting, and refreshing their respective spirits.⁸⁸ The forms of condita do not appear to have changed substantially over the early modern period, though it is possible that there was an upturn in the use of newly available ingredients, such as tea leaves, which were products of the expanding trade with the East.⁸⁹ It is also likely that as the period progressed, patients and their families were more likely to make use of ‘ready-made’ preparations, owing to the proliferation of apothecary shops.⁹⁰ Beyond the gentle purge and strengthening medicines, convalescents could ‘bid farewell to Phisick’.⁹¹

Sleeping through the Night

The next non-natural to discuss is sleep, a function defined as ‘the rest of the whole body, and the cessation of the Animal faculty’.⁹² Sleep was thought to occur when the stomach sent a ‘certain vaporous, sweet, and delightsome humidity’ to the brain, which blocked the nerves, the routes through which the animal spirits travelled; the result was the temporary suspension of the powers of the animal faculty—movement, sensation, and understanding.⁹³ During serious illness, the special vapour evaporated, or became ‘infected’ with the bad humours: the result was ‘unquiet’ or interrupted sleep. Dr John Hall recorded that his patient, John Nason, a barber, ‘had seldom any Sleep at night’, which was a sign of the severity of his illness.⁹⁴ Patients themselves usually attributed sleepless nights to pain.⁹⁵ Upon recovery, however, sleep came more easily: the abatement of pain ‘allured’ the animal spirits to ‘quiet rest’, and the rectification of the humours restored the sleep-inducing vapour to its proper quality.⁹⁶ Throughout the period, doctors and patients regarded uninterrupted sleep as a ‘good signe’ of recovery.⁹⁷ George Davenport from Leicestershire, aged 31, told his former Cambridge tutor in 1662, ‘I am like to do well … if I may ghess … by … [my] most profound sleep. I never waked in the night’.⁹⁸ The fact that continuous sleep was proof of growing strength seems to contradict the common assumption in the historiography that ‘Western Europeans on most evenings experienced two major intervals of sleep bridged by up to an hour or more of quiet wakefulness’.⁹⁹ If unbroken sleep was a token of improving health—the norm to which most people aspired—it could be an indication that segmentation was in fact less widespread than has been acknowledged.

As well as signifying that the patient was on the mend, sleep was thought to play a crucial restorative role. This notion persisted across the period.¹⁰⁰ Lemnius stated in his popular book of secrets, ‘[he who] hath already discussed the disease … yet … is weak, feeble, [and] exhausted … may be restored by sleep’.¹⁰¹ Sleep achieved this restoration by moistening the brain and body parts, thereby furnishing the ‘whole man’ with new radical moisture. Imagery of plant irrigation was used to describe this process—the organs were ‘besprinkled’ with a ‘mild and pleasant vapour’, just as overnight the plants and fields were rejuvenated by dew.¹⁰² The spirits also benefited from sleep—exhausted from the disease, they were ‘refreshed’ and ‘recruited’ by ‘soft Slumbers’.¹⁰³ Such language suggests that the spirits were capable of experiencing human feelings. The other function of rest was to nourish the lean body: digestion was best performed during sleep, since it was at this time that Nature was undistracted by other tasks, and could concentrate solely on fattening the patient.¹⁰⁴

Medical authors prescribed different sleep routines for each bodily state. The puritan physician James Hart (d. 1639) wrote in his regimen that the sick should be ‘suffer[ed] to sleep when[ever] they can’, including the daytime, because it was ‘often out [of] our power to accommodate it … to the right and proper time’.¹⁰⁵ By contrast, the healthy were told that ‘the night should bee more convenient for sleepe than the day’ because the sunlight of daytime would draw the body’s innate heat in the wrong direction—outwards.¹⁰⁶ Convalescents fell in between: ideally, they should remain awake in the morning, but they were permitted to nap in the afternoon.¹⁰⁷ Special armchairs for daytime rest were emerging in this period, which may have been used for this purpose (see Figure 8, in Chapter 6).¹⁰⁸ Over the course of recovery, however, convalescents were instructed to let daytime sleep be ‘lost by litle and litle’, until at last they had acquired the ‘accustomed order’ of the healthy.¹⁰⁹ Daytime rest was also permitted for other groups within the neutral category, such as infants and the elderly: babies remembered sleeping in the womb, so required more rest after birth, while the dry constitutions of older people benefited from the moistening effects of sleep.¹¹⁰

Feeling Hungry

Sleep was rarely mentioned without reference to appetite, and together the two served as a litmus test for the state of the body. The first sign of approaching sickness was ‘tast … inspid; … the appetite … dull’.¹¹¹ Once illness arrived in full, it was said that ‘sick men loathe nothing so much as meate’.¹¹² The reason that the sick did not feel hungry was that Nature, the agent of appetite and nutrition, was not proficient at multi-tasking. During illness she was wholly occupied with the concoction and expulsion of the bad humours, and should not be ‘diverted from her office & work’ by the task of digestion.¹¹³ Once the bad humours had been rectified, however, this agent had time once more to carry out the digestion of food; the result was the return of appetite, a widely recognized sign of growing strength. ‘I praise God I am now in the way of recovery: I am able to … eate my meat with reasonable stomacke’, wrote the Essex gentleman Henry Cromwell to his sister in 1630.¹¹⁴ The loss or return of appetite was such an important measure of health that it became shorthand for sickness and recovery: a wigmaker from Manchester, Edmund Harrold, wrote in his diary in 1713, ‘Very ill … Could not … eat’, and in another entry, ‘Better today. Could eat’.¹¹⁵

Although everybody required sustenance to stay alive, the dietary priorities differed in sickness, health, and convalescence. In sickness, the main purpose of eating was to help Nature remove the disease by correcting the humours. To this end, the patient was given an ‘allopathic diet’, which meant consuming foods and drinks of the opposite qualities to the malignant humours.¹¹⁶ The healthy, by contrast, were entreated to preserve their humoral constitution by following a ‘sympathetic’ diet. The physician Thomas Cock (b. 1630), explained in his medical manual for the poor, ‘When you are in perfect health and temper, eat and drink things temperate: and when distempered and sick, eat and drink things contrary to your distemper’.¹¹⁷ However, in convalescence, the majority of the humours had already been rectified. As such, the aim of eating was less explicitly related to the balance of the humours, and more to do with the restoration of lost strength and flesh.

How were these goals achieved? There were many guidelines and hazards to bear in mind. The first was timing: Macollo warned, ‘When the body is not clear, the more it is nourish’d the more it is hurt’.¹¹⁸ It was believed that if nourishing foods were eaten before the final purge, they would be greedily ‘licked up’ by the residual humours, resulting in relapse. This idea derived from the Hippocratic aphorism, ‘How much the more thou shalt nourish and cherish impure bodies, by so much the more thou shalt harm and hurt them’. A commentator explained, ‘Because hard feeding whilst there be yet reliques of evil humors remaining in the body, increases the quantity of those evil humours, and so hinders their convalescencie’.¹¹⁹ Thus, the patient was to abstain from eating until after the final purge. The second factor to consider was the form of food. The Sussex physician Thomas Twyne (1543–1613), wrote in his regimen that for the first few days of convalescence, the ‘Recoverer [should] … retain the same diet’ that he had taken during illness, consuming only liquid foods. The reason was that ‘it is not good to chaunge suddenly from that wherto a man is accustomed … because of custome’.¹²⁰ Twyne was referring to the proverb ‘custom is a second Nature’, which meant that habit was almost as vital to bodily functioning as Nature herself.¹²¹ Liquid foods were advantageous because they could be quickly distributed around the body, despite being less nourishing than solid foods.¹²² The best forms were jellies, possets, broths, and soups, in some ways resembling baby food; these meals were commonly served in ‘posset cups’ (see Figure 3).¹²³

Figure 3

Posset cup, 1650–1700; Science Museum, Wellcome Images, reference: L0057146 (CC BY 4.0). Posset was a thick liquid food, commonly taken by convalescents and other ‘weak stomached’ patients; typically it was made from warm milk, (more...)

Another important consideration was liking. At the beginning of convalescence, it was vital to indulge the patient’s dietary predilections. The Manchester physician Thomas Cogan (c.1545–1607) provided a justification in his regimen for sickly students:

[L]iking causeth good concoction [i.e. digestion]. For what the stomacke liketh, it greedily desireth: and having received it, closely incloseth it about untill it bee duly concocted … wherein wee have great delight … it doth us more good.¹²⁴

The next priority was nourishment: it was essential to build up the convalescent’s lean body by giving highly nourishing foods. In Galenic theory, the most nutritious foods were substances which resembled the human body: nutrition was a process of assimilation, with the ingested matter being transformed into the substance of the body.¹²⁹ Consequently, animals were deemed more nutritious than vegetables, because their ‘fat and gluttonous substance has neerest affinity with mans radicall moisture’.¹³⁰ Likewise, flesh was considered to be superior to fish, since humans bore a closer resemblance to the former.¹³¹ Given that life ‘consisteth’ in heat and moisture, it followed that foods richly imbued with these qualities would fatten and strengthen the body the most effectively.¹³² Amongst non-aquatic creatures, further distinctions were drawn based on the animal’s abilities and location: Hart averred that animals that could fly would ‘affood the body a … subtill nourishment’ because ‘the wings of such fowles … are in perpetuall motion’.¹³³ By contrast, ‘four-footed beasts’, which lived on the ground, provided less wholesome nourishment. This view was informed by natural philosophical notions of the ‘Chain of Being’, the hierarchy of living things: Allen Grieco has shown that fowl and birds were deemed ‘nobler’ than quadrupeds and fish, because they were associated with the superior element of the air, whereas land- or ocean-bound creatures were analogous to the lower elements of earth and water.¹³⁴ The sky was closer to the heavens and to God, while the earth held connotations of death and hell.¹³⁵ Given this cultural backdrop, it is unsurprising that the most nutritious creatures were thought to be those which could fly.

As well as being nutritious, the convalescent’s food had to be ‘easie of digestion’.¹³⁶ Foods of this type were those that did not require much alteration from their present state. A classic example was the humble hen’s egg, a staple ingredient in meals for the weak throughout the period.¹³⁷ In praise of eggs, the Wiltshire MP and physician Thomas Moffet (1553–1604) stated, ‘They nourish quickly, because they are nothing but liquid flesh’.¹³⁸ In domestic recipe books, restorative broths typically contain between twelve and thirty eggs.¹³⁹ The clue to digestibility was colour: white, pale tones signified that the texture of the food was also light, and could be broken down with minimal effort.¹⁴⁰ For this reason, white meats such as chicken and partridges were pronounced best, whereas dark-coloured meats like beef and venison ‘may not be allowed’ because they are too heavy and dense.¹⁴¹ These colour preferences, which endured throughout the period, may have been informed by religious ideas: light was a symbol of Christ, and darkness a metaphor for evil.¹⁴² To make the foods easier to digest, practitioners recommended mashing or liquefying the ingredients; this would spare the patient from the ‘unpleasantnesse’ of ‘any mastication or chewing’.¹⁴³ Such a technique was used for other neutral groups too, like the elderly, ‘whose teeth cannot be cheewing’, as well as infants, who did not yet possess a complete set of teeth.¹⁴⁴ The cooking process could also help to make the foods more digestible: the best method was boiling, because it was most similar to Nature’s own form of digestion in the stomach.¹⁴⁵ Over the course of convalescence, other cooking methods could be gradually introduced.¹⁴⁶

The digestibility of the convalescent’s food is one quality that overlapped with the diet of the diseased: doctors assumed the stomachs of the sick were even weaker than those of recovering patients. However, healthy individuals required the opposite. This is revealed in a regimen allegedly authored by the twelfth-century Italian physician Johannes de Mediolano, and published in English in 1650:

For they that be strong and lusty, and exercise great labour must be dyeted with grosser meat because in them the way of digestion is strong, and so they ought not to use slender meats, as Chickens, Capons … or Kid, For those fleshes in them will burn, or be digested oversoon.¹⁴⁷

Turning from the quality of food to the quantity, convalescents were advised to ‘be temperate in eating and drinking … tak[ing] a little and often’.¹⁴⁹ Although moderation was important in all states of health, it was thought to be critical in convalescence, due to the residual weakness of the digestive faculty.¹⁵⁰ This advice sounds simple enough, but judging by doctors’ reports, it was notoriously difficult to follow. The young Oxfordshire physician Thomas Willis (1621–75), who would later become renowned for his theories on the nerves, noted that his patient, Abel Paine, ‘for many days … had not tasted flesh [so] that [on the] day [of his recovery] he ate about half a roast chicken’. Three hours later, he was ‘stricken with nausea, a signal loss of strength, and … difficulty in breathing’.¹⁵¹ Physicians warned that the appetite is often ‘sharp’ after acute illness, which makes self-restraint especially challenging.¹⁵² The social celebrations that were arranged to mark the person’s recovery added to the danger, since they provided opportunities for overeating, along with other excesses. Lemnius complained:

[W]hen men recover of their disease many witty merry companions come to see them, and they invite them to rejoyce, and make merry … Hence they eat, and drink healths … and commonly … they sing bawdy songs … To this I add the delicate and voluptuous meats, which the humours being augmented by, do stimulate and prick the obscene parts … and cause erection … [thus they] return to … gluttony, and profuse lusts.¹⁵³

Growing Cheerful

The next non-natural to consider is emotion, known in our period as the ‘passions of the soul’.¹⁵⁶ While historians have paid considerable attention to the perceived impact of the passions on the body, much less work has been conducted on the influence of the body on the passions.¹⁵⁷ The following paragraphs illuminate both sides of the relationship.

As with the other non-naturals, the passions provided clues into a person’s state of health. The ‘Messenger or forerunner’ of illness was a creeping feeling of anxiety. Once illness had arrived in full, ‘a horror … invades the sick’, wrote the popular medical writer and astrologer Nicholas Culpeper (1616–54).¹⁵⁸ Patients routinely expressed grief and fear during illness.¹⁵⁹ Upon recovery, however, they began to grow cheerful. ‘My mind is more cheerly, and I get strength’, reported the Suffolk conformist clergyman Isaac Archer in 1679.¹⁶⁰ Laughter and cheerfulness were taken as clear signs of growing health.¹⁶¹ Medical texts drew on the Aristotelian concept of the soul to explain these emotional responses. Hart averred:

[A]lthough the substance of the soule and body differ much, God hath … tyed and united them so fast …, that there is no small … sympathy betwixt them: insomuch that either of them being affected, the other suffereth also.¹⁶²

Cheerfulness was not just a sign of recovery: it was also the means by which the weak body was restored to full strength. The author of The sickmans rare jewel (1674) states that this emotion ‘recreates and quickens all the Faculties, … makes the Body to be better in liking, and fattens it’.¹⁶⁴ Sandra Cavallo and Tessa Storey have explored the perceived effects of cheerfulness in an Italian context, commenting that this emotion was understood to be a ‘calm, tranquil happiness’ which gently lifts and expands the spirits, ‘thereby increasing the overall body heat and vitality’.¹⁶⁵ Since the strength of the body was synonymous with the quantity and liveliness of the spirits, the augmentation of these substances necessarily invigorated all the faculties of the body and mind.¹⁶⁶ This passion also helped the patient to put on weight, since the newly enlivened natural spirits would propel the digested aliment from the interior organs to the rest of the body, thereby facilitating the process of nutrition.¹⁶⁷ These ideas about the positive effects of cheerfulness continued throughout the period.¹⁶⁸

Although cheerfulness usually accompanied recovery, it was not a universal response. As we saw earlier, one of the footsteps of disease was ‘faint-heartedness’ and anxiety.¹⁶⁹ Common causes included the traumatic memory of pain, and the fear of relapse.¹⁷⁰ What made these emotions all the more distressing for patients was the belief that they could precipitate the return of disease. The Essex puritan clergyman Ralph Josselin (1617–83) attributed the renewed illness of his eight-year-old daughter Jane in 1653 to her ‘feare and griefe [at] see[ing] her mother so tormented … with a felon [boil] on her finger’.¹⁷¹ Medical writers explained these effects by reference to the spirits: in motions of fear, these special vapours shrank and recoiled to the heart.¹⁷² Since the spirits were the chief instruments through which Nature concocted and expelled bad humours, their sudden reduction in volume impeded her defence against the returning disease. These emotions also hindered nutrition: the centripetal direction of the spirits from the surface of the body to the heart starved the outer parts of nourishment—the result was the continuation of bodily wasting.¹⁷³

In view of the divergent effects of cheerfulness and anxiety, convalescent care centred around the promotion of the former and the avoidance of the latter. The surest way to cultivate happy feelings was to surround the patient with ‘merry company’ and affectionate visitors. Speaking of her niece Kate in the 1650s, the Catholic nun Winefrid Thimelby wrote, ‘I beleeve the company of her brothers and sisters will help much to her perfect recovery’.¹⁷⁴ Olivia Weisser has commented that the visits and letters of family and friends were found to be so therapeutic that they were called ‘cordials’, the term for medicines that strengthen the heart.¹⁷⁵ Indeed, patients often implied that these interactions were superior to physic. Robert Paston (1631–83), the First Earl of Yarmouth, told his wife Rebecca during his recovery from scurvy, ‘your company will be the most soveraine remedye nature can apply’.¹⁷⁶ For children, play was encouraged during convalescence as a way to delight their spirits.¹⁷⁷ Alongside these positive measures, relatives and friends sought to protect the patient from anxiety by concealing bad news. In 1675, the Somerset gentlewoman Ursula Venner (1640–1710), warned her brother-in-law that although ‘the danger is over’, their father ‘is soe extreamly we[e]ping at all kind of buisnesse that I would desire you to send him as little of ill news as possible’.¹⁷⁸ Of course, these forms of emotional support were unlikely to have been available to every convalescent: it was not always possible to hide bad news, nor did all convalescents enjoy such loving family relationships.

In contrast to some of the other aspects of convalescent care, cheerfulness was beneficial in all bodily states. Doctors agreed that ‘nothing is more necessary for the Preservation of Health, than to live merrily’.¹⁷⁹ In sickness, cheerfulness was thought to ‘rouse up and unite’ the body’s spirits, so that they were able to more ‘effectively co-operate with Nature, and strengthen her in the performance of the … expulsion of the noxious humours’, wrote the medical author and minister John Harris.¹⁸⁰ In fact, sudden joy could produce instantaneous healing: the sympathy between the soul and body was so great that the happiness of the soul might automatically bring health to the body.¹⁸¹ Nonetheless, in practice it was difficult to provoke cheerfulness during sickness: the pain of illness, together with the ‘true sorrow for sinne’, conspired against these intentions.¹⁸² Likewise, it was impractical to always promote cheerfulness in the healthy, since sorrow was an inevitable companion of life.¹⁸³ As such, the emotion of cheerfulness assumed a special status during convalescence: it was both a sign and a catalyst of growing strength.

Sitting up to Going Abroad

The final non-naturals to consider are exercise and air. Convalescence was basically a process of increasing physical exertion and exposure to the air. In acute sickness, the patient was usually confined to bed, breathing in warm indoor air—taking to bed, or ‘decumbiture’ as it was known, signified the beginning of sickness.¹⁸⁴ Once the illness was gone, however, the patient could begin to return to normal life, a trajectory that was marked by a number of key spatial movements. In 1666, fourteen-year-old Samuel Jeake from Rye in Sussex described his recovery from smallpox as follows:

Each action and location signified a certain level of strength, which made them useful measures of a person’s progress towards health. The final action, going outside, or ‘abroad’ as it was usually known, was often used as a metonym for complete recovery. This can be seen in the correspondence of the MP William Fitzwilliam (1643–1719), who wrote in 1708, ‘We are very glad to hear of Mrs Bull’s being abroad again’, implying she was better.¹⁸⁶ Such sayings indicate the vital, yet often overlooked, importance of place as a measure of health.¹⁸⁷

Doctors believed that the exercise and exposure to air that accompanied the above physical movements contributed to the restoration of strength after illness. Hart explained, ‘exercise … increase[s] the natural heat, [causes] a more speedy … distribution of the spirits …, and addition of strength to all the members therof’.¹⁸⁸ Pure, temperate air ‘engenders both Vital and Animal Spirit’, and ‘opens the pores’ of the skin, thereby enabling any remnant humours to escape, and preventing relapse.¹⁸⁹ Since the spirits shared the ‘arey’ consistency of the air, breathing was the most direct way to replenish these substances. Laypeople concurred about the strengthening effects of exercise and air, though they were less likely to describe the precise physiological processes involved.¹⁹⁰ The best air for the convalescent was fresh and fragrant mountain or country air, a preference which endured throughout the period. In 1598, the Countess of Shrewsbury, Elizabeth Talbot, urged her son-in-law and step-daughter to ‘come into the cuntrye[,] [because] this eayre is better for you both than London, and especially … after your ague’.¹⁹¹ Over a century later, the Northampton physician John Freind (1675–1728) advised his patient, Mr Hill, to ‘go to Mount Cassel’, in northern France, ‘where the fresh air … will I hope not only recover, but mend his constitution’.¹⁹² Perhaps this favouring of country air stemmed from the notion that the body’s agent, Nature, felt most at home when in the wider, macrocosm of Nature—the hills and countryside.

The non-naturals of air and exercise were not without danger, however. Throughout the period, laypeople and doctors attributed relapse to the patient’s premature activity or exposure to the air. The Dutch physician and professor Ysbrand van Diemerbroeck (1609–74), cited one patient of his, Henry Koelem, who, ‘trusting too much to his strength’ after a malignant fever in 1635, went ‘abroad too soon’, which sent him ‘into a more dangerous Fever then [sic] his first … by reason of his strength debilitated by his former Sickness’.¹⁹³ Even apparently minor actions, such as sitting up in bed, could have significant consequences.¹⁹⁴ The reasons for these effects relate to Galenic ideas about the impact of cold air and exercise on weak bodies. Immediately after illness, when the body was frail and thin, Nature’s main priority was nourishment; to force the body to exercise would therefore ‘stop the Work of Nature so luckily begun’, and delay the restoration of strength.¹⁹⁵ Exposure to cold air caused relapse by shutting the pores of the skin, thereby blocking the exits for the body’s remnant humours, or causing them to putrefy.¹⁹⁶ Thomas Moffet recorded that one ‘Harwood of Suffolk, a rich Clothier, coming suddenly [into] an extream frost from a very hot fire into the cold aire’ after an ague, ‘his blood was presently so corrupted, that he became a leaper’.¹⁹⁷ Premature actions and air exposure were also common causes of illness amongst other ‘neutral’ patients, thus once again demonstrating the commonalities between these groups. Van Diemerbroeck complained that ‘Child-bearing Women, in their Lyings in, frequently … trust themselves into the Air sooner than the time of their Lying in will permit; whence arise those dangerous Diseases’; he cited one acquaintance, who in the second week of her month, ‘look[ed] to[o] soon after her House Affairs, and presuming to Combe her Head, fell into an Epilepsie’.¹⁹⁸

Convalescent care sought to prevent these potential dangers by carefully ‘ordering’ the patient’s progression through the actions, and ensuring they did not attempt anything too soon. Throughout the period, friends and family sent letters to recovering patients advising them to refrain from going abroad until they were quite ready ‘to bear those journeys’.¹⁹⁹ Frances Seymour told her mother in the early 1700s, ‘I am very sorry, dear Mama, that you are still so weak … and as much as I wish to see you[,] I would not have you venture on your journey … till you find yourself perfectly recovered’.²⁰⁰ The clue as to when patients were ready to perform the actions was their sense of strength and ease. James Harrison, a lecturer and chaplain, wrote to Lady Joan Barrington about the condition of her husband in 1630: he told her that ‘Mr Barrington [is] much better … but not yet so well as that he dares goe much abroade, but he finds most ease in being quiet within’.²⁰¹ Thus, the subjective experience of the patient was the best guide; this was because Nature made her wishes known through the patient’s feelings.

Another tip for managing the progression through the actions was for convalescents to ‘try their strength’, and attempt everything gradually. It being ‘so long a time since she had any use of her legs’, eleven-year-old Martha Hatfield from Yorkshire, ‘made [a] triall how she could go, and she went up and down the room’, before embarking on a longer stroll around the house.²⁰² Patients like Martha, who had not walked for some time, might need help in weight-bearing; relatives supported their shoulders, or procured a crutch or staff for this purpose.²⁰³ The patient’s exposure to the air, as well as exercise, had to be increased incrementally. Nicholas Abraham de La Framboisière suggested that, ‘such [as] are newly recover’d from Sickness … must by degrees … accustom themselves to a more free and plentiful Air’.²⁰⁴ The reason everything had to be done ‘by degrees’ is implicit in the common saying, ‘Nature abhors all sudden change’.²⁰⁵ When patients did decide to venture outdoors, they were advised to ‘only stir abroad on warm days, and with very warm clothes to keep out the cold’.²⁰⁶ Such measures, also recommended for lying-in mothers, would ensure that the pores of the skin remained open.²⁰⁷ Patients themselves put in place special arrangements to help limit the hazards posed by exercise and air, such as delegating strenuous work to friends or colleagues, or securing comfortable transport for journeys.²⁰⁸ Mary Cowper (1685–1724), Lady of the Bedchamber, recorded that her convalescing mistress had ‘gone a walking’ as far as Kensington, and ‘the Coaches brought [her] back again’.²⁰⁹ Walking only half the way was a sensible compromise, ensuring that exercise did not become ‘excessive’. These arrangements were obviously dependent on the good will of relations and colleagues, as well as the occupation and financial position of the individual. Patients in low paid jobs, working under the authority of others, may not have been able to benefit from these sorts of flexible measures.

Advice about exercise and air differed for each bodily state. Hart cautioned that in acute illness, patients should ‘not … use any exercise at all’: such diseases were ‘so violent and fierce’ that Nature could not afford to divert her spirits from the vital tasks of concocting and expelling the humours.²¹⁰ Likewise, exposure to outdoor air was to be avoided in these illnesses, on the grounds that it would hinder the critical evacuation of the noxious humours, instead sending them inwards towards the ‘noble organs’. Van Diemerbroeck confirmed that ‘when … the Small Pox begin to appear, then the catching Cold will be the occasion of a great mistake, for that it detains the superfluity within, and carrys it to the Principal Members’.²¹¹ The advice for the healthy was rather different: fresh air and ‘vehement exercise’ were ‘so necessarie to the preservation of health’ that without them ‘no man may be long without sicknes’, wrote the humanist and lawyer Thomas Elyot (c.1490–1546) in his best-selling regimen.²¹² These non-naturals maintained the strength of the healthy body by stirring up the spirits and promoting the perspiration of superfluous humours. The convalescent’s regimen was a transition between these two extremes, and involved some special exercises. The Bedfordshire doctor, John Symcotts (c.1592–1662), provides insights into these forms of exercise in a letter to his patient, Mistress Halford:

[E]xercise by degrees is requisite, otherwise the serous and watery moisture which abounds … will in you superabound. Which measure of exercise, because your weak body will not admit of, you must … Let your upper parts, as neck, shoulder, arms, back and breast, be rubbed every morning before you rise with soft cloths, first more gently, after more strongly as you are able to bear it.²¹³

Conclusion

Thomas Saunders from Hertfordshire was told by his doctor in 1671 that ‘the convulsions seem totally to have left’ his young son, ‘so that there remaynes cheefely to be attended, the universal weaknesse’. Saunders recommended that this deficiency could be remedied by a combination of ‘gentle exercises’, a diet of ‘easy digestion’ such as ‘tostes … sopped in gravy’, and ‘strengthninge’ medicines.²¹⁷ This chapter has shown that a concept of convalescence existed in early modern England: it denoted the gradual restoration of strength after illness, and was regarded as the second stage of recovery, which took place once the disease had been removed. Convalescents were considered worthy of their own special type of medical care, ‘analeptics’, which was designed to promote the patient’s growing strength and guard against relapse. These aims could be achieved through the careful monitoring and management of the six non-naturals. Miss Kemey ‘sleeps well and eats an egg and sits up for two or three hours’, wrote the Bishop of Bath and Wells, Thomas Ken, in 1686, which he interpreted as signs and spurs of her growing strength.²¹⁸ Cheerful passions, an appetite for nutritious food, and the ability to ‘walk abroad’, signified that the patient was ‘on the mending hand’, while simultaneously helping to strengthen the body by expanding and enlivening the spirits, the instruments of bodily and mental functions. Personified to a high degree, the spirits were synonymous with the patient’s own strength and well-being.

The discussions have concentrated on the roles of practitioners and the patient’s family in convalescent care, but it should be pointed out that the other two healers identified in Chapter 1—God and Nature—remained crucial. It was the Lord who ordained the full restoration of health; His instrument was the body’s internal agent, Nature, who set about strengthening the body by inducing certain inclinations and appetites in the patient, like a desire for tasty food and a breath of fresh air. She depended, however, on her ‘servant’, the patient’s practitioner or relatives, to actually satisfy her cravings, and supply her with the things the body needed, such as an armchair for afternoon naps, easily digestible meals, and merry company. In the light of these interactions, it becomes clear as to why the non-naturals were known as non-naturals. The six dietary and life-style factors were exterior to the body’s internal healing agent, Nature; she could induce appetites in the patient, but relied on the practitioner to satisfy the body’s wants. Besides these insights, the discussions have shed fresh light on the meanings of health and disease, states which have often been equated with balance and imbalance; other crucial components were location and function: sickness was being in bed, unable to eat or sleep; health was being able to sleep, eat, walk, and go abroad. Health was not only the absence of disease, but the presence of strength.

While much work has been conducted on the gendering of bodies, far less has been written about bodily categorizations based on states of health.²¹⁹ We have seen that the convalescent was placed in the ‘neutral’ category of bodies, alongside other individuals who were deemed ‘neither sick nor sound’. By resurrecting this forgotten category, the chapter has sought to expand our knowledge of early modern bodily classifications, and encourage comparative studies of groups within the neutral category. Much of the discussion of the neutral body is based on published medical literature, which raises the question of whether the wider populace also recognized this category. My impression is that while laypeople were less inclined to use the term ‘neutrum’ than physicians, they certainly were aware of the half-way state between sickness and health. This is evidenced by, as Levinus Lemnius put it, ‘daily use and custome … Hence proceed those answers of our friends …, if they aske how any man doth, what health he is in … [he will] answer in so many words; “So so, indifferent, not very well, doubtfully, inclining, floting between both”’.²²⁰

An underlying question in this chapter has been to what extent the care of convalescents differed from the treatment of patients in the other bodily categories, health and sickness. The therapeutic intentions were clearly distinctive: the care of the sick centred on the removal of disease; the treatment of the healthy sought to preserve the current state; analeptics was devoted to the restoration of strength and the prevention of relapse. However, we have seen that there were some intersections between the three, since convalescence was a liminal state; over the course of recovery, the patient’s regimen became increasingly similar to that of the healthy person. There were also some striking similarities between the care of groups within the neutral category, including the elderly, the newborn, and lying-in mothers. What all these patients had in common was weakness, although the causes and duration of their debility differed.

Little evidence has been found to show major change over time in the care or perception of the convalescent. The footsteps of disease—weakness, emaciation, and vulnerability to relapse—were reported consistently across the period. Likewise, the methods that were used to restore strength, such as nutritious and easily digestible food, plenty of sleep, and gentle exercise, went uncontested into the eighteenth century. Such continuity does not mean that convalescent care was based on ahistorical ‘common sense’, or was somehow divorced from medical theory. Rather, it reflects the endurance of the belief in the role of the spirits in the restoration of strength.²²¹ The majority of the examples cited in this chapter pertain to members of the middling and upper echelons of society; further research is required to find out if analeptics was also available lower down the social scale.