Dosage and the Impact of Age

Increasing medical expertise during the seventeenth and eighteenth-centuries often involved the growing recognition of anatomical differences between adults and children. Despite female author Sarah Jackson’s receipts (in her book The director: or, Young woman’s best companion, 1754 & 1755) being published in a time of anti-dissection, they contain profound examples of the dosage of medication being altered to accommodate the needs of a child. Having previously witnessed the means by which ‘age’ remained an ambiguous (or missing) factor, it is interesting to acknowledge the growing importance of expertise in child-specific dosages.

Historiographical debate has focused on child-specific dosages. Historian Lisa Smith introduces the eighteenth-century concern of raising healthy children. Smith performed an analysis of medical texts in the epistolary format, finding that women were more likely than men to write to doctors concerning their child’s health (1). On the other hand, historian Jonathan Andrews explains how early modern institutions intended to discover ‘how children’s minds, bodies and constitutions were conceptualised’, and ‘why treatments were adjusted and made more specific for children’ (2). Therefore, Smith and Andrews provide contrasting views as to whether we should regard child dosages as maternal responsibilities or empirical and medical expertise.

It is important to acknowledge that we can rarely be sure of the fact that these women wrote their receipts themselves. Despite not explicitly mentioning the contributor, many receipts were copied from elsewhere. However, as ‘compilers’ (i.e. collecting receipts from other texts and compiling their own book), they made the conscious decision to include these receipts for a number of reasons. Jackson’s inclusion of the receipt for An excellent Surfeit-Water states that ‘The Dose for a Man is two Spoons full, for a Child one Spoonful’ (3). In this case, the lack of standardised measurement is immediately indicative of the absence of empiricism. Instead, it appears to be a mere recognition of the necessity to lower the dosage for a child. This could be considered to be simply part of a woman’s maternal responsibility, as supported by historian Lisa Smith. In this case, the receipt book as a whole would support a woman’s role in childcare alongside refining medical expertise. We might depict the likes of Sarah Jackson as ‘medical’ authors or compilers. However, domestic receipts ran alongside medical receipts. If we associate domesticity with the role of the female in the household, this would suggest that caring for children overlapped with both medical and domestic elements of eighteenth-century literature.

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An excellent Surfeit-Water – Reproduced with the permission of Special Collections, Leeds University Library (Cookery S/JAC)

Notably, the transmission of receipts from one owner to the next included the intermingling of receipts by both men and women. This means that we cannot know for sure whether the receipts presented in Sarah Jackson’s book were written by a man. If this is the case, the previous statement (suggesting that receipts depicted a woman’s concern for her child’s health) should be re-considered. There are more receipts in Jackson’s book which suggest elements of experimentation are related to the improvement of child dosages. Theories of female ‘concern’ for child health are gradually replaced with the desire for medical expertise in these later instances.

Sarah Jackson only published two editions of her book in 1754 and 1755. Despite only one year’s difference, we witness the disappearance of For a Cough in a Young Child, replaced with An infallible Remedy for the Hooping-Cough in Children, a Day Cold or Cough in the Adult. Notably, the entirety of the ingredients are altered, along with the purpose and versatility of the receipt. This displays the possible role of experimentation in early modern households. Experimentation might have been performed by the author or compiler in order to better understand the anatomical differences and similarities between man and child. To have trialled and modified (in this case – eradication and replacement) proves to us that early modern institutions truly did aspire to gain knowledge on childhood health.

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An infallible Remedy for the Hooping-Cough in Children – Reproduced with the permission of Special Collections, Leeds University Library (Cookery S/JAC)
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For a Cough in a young Child – Reproduced with the permission of Special Collections, Leeds University Library (Cookery S/JAC)

This refined medical expertise, proposed by historian Jonathan Andrews, is continued in the receipt for The Red Powder famous for Curing of Fevers of all Sorts, and Agues. The explanation for the administering of dosage is as follows: ‘To a Child fifteen Grains, to a Youth twenty-two Grains, to a Man or Woman thirty, or more’ (4). The introduction of standardised measurements of ‘Grains’ heightens the precision (and empiricism) of the receipt. Moreover, the categorisation of both ‘Child’ and ‘Youth’ as well as adults depicts an awareness of the gradual anatomical changes to the human body. It is therefore evident that Jackson’s choice of receipts, while depicting maternal responsibilities, strongly associate with eighteenth-century medical expertise.

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The Red Powder – Reproduced with the permission of Special Collections, Leeds University Library (Cookery S/JAC)

However, when studying these receipts, the latter sheds light on the lack of anatomical awareness of gender differences. The same dosage is to be administered to both men and women. This could be due to issues of anti-dissection. Alternatively, there are receipts in which gender dosages are more specific, however this requires further study.

(1) Lisa Smith, The Relative Duties of a Man: Domestic Medicine in England and France, 1685-1740, Journal of Family History (2006)

(2) Jonathan Andrews, History of Medicine: Health, Medicine and Disease in the Eighteenth Century, Journal for Eighteenth-Century Studies (2011)

(3) Sarah Jackson, The director: or, Young woman’s best companion (1755)

(4) Sarah Jackson, The director: or, Young woman’s best companion (1755)

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Dosage and the Impact of Circumstance

We decided to start our research by concentrating on the modification of dosages in varying circumstances. This might bring forward instances of what we have labelled ‘female medical expertise’, whereby women chose to acknowledge the importance of receipts that focus on conditions affecting dosages.

Despite placing the focus of our research upon female medical expertise, the following receipts are likely to have been passed from one generation to the next by both men and women. This problem of authorship and ownership (showing the strong likelihood of overlaps between male and female involvement), means we have to decide how we wish to define female medical expertise. We have chosen to outline ‘female medical expertise’ as:

  • The way in which these women consciously decided to include particular receipts in their books.
  • The heightened likelihood of receipts being experimented on by both the female compiler and the reader.
  • The way in which alterations between two editions of the same book display the revisions made by these women to their medical literature.
  • (In relation to this post) Female compilers engaging with receipts that contain empirical and precise methods (e.g. standardised measurements).
  • Any other factors we might discover while conducting this research.

During the mid-eighteenth-century, the modification of household medicines was particularly prominent. Historian Elaine Leong proposes that household drugs were impacted upon by customisation. The variation of ‘strength according to their own requirements’ plays a central focus in the study of dosage alterations (1). Using the argument proposed by historian Leong, we might begin by suggesting that female medical expertise is, in this case, categorised as the conscious decision to include receipts that encourage customisation. Alterations of dosages relied upon three dominant factors: age, gender and circumstance. Circumstance-based dosages are associated with terminology such as ‘strength’ and ‘constitution’. Consequently, the dosage administered is impacted upon by the individual’s perception of their patient’s build, framework, and existing state of health. This is particularly prominent in Anne Battam’s 1750/1759 The lady’s assistant in the oeconomy of the table, in which there are two receipts relating to the alteration of dosage. The following examples are heavily based on inference and judgement; the reader must choose how many dimensions they wish to modify.

Battam chose to include the receipt To make the famous friar’s balsam, whereby the dosage must be altered ‘either by outward application, or taking it in drops, according to the age and constitution of the patient’ (2). Firstly, the method for administering the dosage is an added dimension – the reader is given a choice. The recommendations depict the writer’s presumption that the reader can determine the most effective way of administering the treatment as well as the dosage required. The methods are impacted directly by both ‘age’ and ‘constitution’. Despite these being vague judgements based purely on two factors, it is important to acknowledge that the receipt encourages methodological experimentation based on the perceived wellbeing of the patient.

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To make the famous friar’s balsam – Reproduced with the permission of Special Collections, Leeds University Library (Cookery A/BAT)

This is mirrored in Battam’s inclusion of Dr Willis’s Spring-ale, in which the dosage is administered ‘according to your age and strength’ (3). This receipt also adheres to the trend of relying on the reader’s perception of their patient’s health, followed by a mere estimation of the dosage that their ‘age’ requires. The lack of categorisation regarding age and different levels of ‘strength’ provides implications as to how both doctors and their followers (such as Battam) regarded dosage as important but not yet precise. Therefore, the ambiguous and unspecific instructions given by people whose advice was sought and respected suggests an incomplete understanding of the implications of altering dosage.

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Dr Willis’s Spring-Ale – Reproduced with the permission of Special Collections, Leeds University Library (Cookery A/BAT)

Notably, Sarah Jackson also conforms to this contemporary interest in the impact of circumstance on dosage in her 1754/1755 book The director: or, Young woman’s best companion. Similar to Anne Battam, Sarah Jackson’s inclusion of the receipt for Elixir Salutis, or never failing Cordial administers the dosage ‘according to the Constitution and Strength of the Patient’ (4). The use of ambiguous adjectives such as ‘constitution’ and ‘strength’ is again evident. This leads to the persistent problem of inference; the imprecise vocabulary relies on the reader’s perception of the literary meaning as well as their existing medical knowledge.

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Elixir Salutis, or never failing Cordial – Reproduced with the permission of Special Collections, Leeds University Library (Cookery S/JAC)

 

Nevertheless, Sarah Jackson includes a receipt which introduces new circumstances with the alteration of dosage, such as the likelihood of gaining successful results under varying conditions. This is prominent in To help delivery, in which the likelihood of success might be impacted by a change of circumstance, in this case a stillbirth. Whilst still relying on the midwife’s judgement, the receipt explains how ‘half a Dram’ of the ingredients must be given ‘in a little warm Ale’. However, ‘if the Child be dead give a Dram of it’ (5). This significant change in circumstance is mirrored by a change in dosage, suggesting the receipt has been tested prior to publication. Therefore, it is evident that early modern households recognised the necessity to increase the dosage to match the increased discomfort of the patient. Interestingly, this is the only given example of a circumstance-associated dosage in which a standardised measurement is provided. The ambiguity of administering medicine based on singular descriptions such as ‘strength’ and ‘age’ was no doubt a recurring issue.

From this, it would be of benefit us to study examples of receipts in which ‘age’ is more specifically addressed. This would lead to a better picture of female medical expertise in the mid-eighteenth-century.

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To help Delivery – Reproduced with the permission of Special Collections, Leeds University Library (Cookery S/JAC)

 

(1) Elaine Leong, Making Medicines in the Early Modern Household, Bulletin of the History of Medicine (2008)

(2) Anne Battam, The lady’s assistant in the oeconomy of the table: a collection of scarce and valuable receipts (1750)

(3) Anne Battam, The lady’s assistant in the oeconomy of the table: a collection of scarce and valuable receipts (1750)

(4) Sarah Jackson, The director: or, Young woman’s best companion (1755)

(5) Sarah Jackson, The director: or, Young woman’s best companion (1755)