Ruptures, Their Causes and Varieties : With Various Methods for Curing Them

Rupturs, Their Causes and Varietie's - Title Page

Rupturs, Their Causes and Varietie's : With Various Methods for Curing Them by Applications Both Outward and Inward, with the Different Kinds of Trusses Discribed Together with the Druags and Simples, Their Places of Growth and Manner of Preparing Them is a historical medical text stored in the Kislak Center for Special Collections, Rare Books, and Manuscripts that describes the usage of trusses, their application to inguinal hernias, and herbal treatments for a variety of hernias and hernia-induced symptoms. This work provides a list of the instrumentation necessary to manufacture a truss, along with a procedure on how to apply the truss to the human body. Within the codex are several sections outlining the pathology of ruptures, or hernias, along with a detailed list of plants and vegetables that were believed to treat hernias. Although this book has an unknown author, it is believed to have been produced between 1750-1799. This book can be accessed through the Penn Libraries.

Background

Historical Context

Medicine in the Mid-18th Century England

Despite the notion that occupational diseases were rare before the Industrial Revolution in 1760, in the first medical textbook which dealt with occupational disease, A Treatise on the Disease of Tradesmen (1706), Bernardino Ramazzini referenced bakers, carpenters, and blacksmiths as people with the highest risk from their occupations. Skilled workers, before the creation of the steam engine as a result of the Industrial Revolution, relied entirely on human strength and as a result suffered from hernias and at times died from their exertion. Injuries would then be exacerbated by alcohol, given that some skilled laborers would routinely consume beer while working. The reason for alcohol consumption as opposed to other alternatives was due to unclean water, the fact that milk was typically reserved for infants, and the high prices for both coffee and tea.

Medical conditions, such as hernias, would be further exacerbated by the long working hours (12-14 hours per day, 6 days a week) which were typically enforced by corporations during the mid-18th century. At this same time, surgical interventions for ailments such as inguinal hernias would yield poor outcomes; in the case of the hernias, castration was a common result. Hence, improved trusses during the mid 1700s served as a relatively effective, non-surgical solution for hernias. Additionaly, trusses and other medical technologies were now accessible. Patient populations were able to purchase medical innovations, by the 1750s, as a result of a higher standard of living and longer life expectancies.

Medicine in the early 1700s was mainly practiced on a fee-per-service basis; however, as time went on, physicians, surgeons, and even apothecaries began to “professionalize” their practice through institutional appointments and private practice. Albeit their poor treatment outcomes, many of these early healers began to elevate the practice of medicine to become a lucrative career, one which ambitious parents would have their sons follow - a practice which ultimately lead to male-dominance in the field of medicine up until the most recent century.

Medicine in the mid 1700s saw physicians establish their place at the apex of the medical pyramid, few in number, and practicing in urbanized settings at high fees. Apprenticeship became the central route to become a practicing physician in 1750s England. After spending several years as an apprentice, young tradesmen would become journeymen, where they would receive a salary to work as an assistant for a practicing physician, form a partner group, or establish their own practice.

In the late 18th century, due to the scarcity of physicians, oftentimes a two to three physician group would practice in adjacent, rural towns and oversee the care of the population. These men would provide medical attention in various forms such as: delivering babies, providing herb-based medications, performing examinations, and even distributing their own proprietary medicines.

Paper Creation Process

Laid Paper with light coffee tone and chain lines from Rupturs, Their Causes and Varietie's

Papermaking played an important role in providing the materials for stationers in the period in which Rupturs, Their Causes and Varietie's was made. European papermaking utilized two molds and one deckle for every size of paper. This process was different from the papermaking process in Asia, where only one mold was used for each size of paper and the worker would act as both the coucher and the vatman. During the mid 1800s and up to the current century, variation existed in the finish and thickness of paper. As is visible in the leaves that make up this piece, the tone of the paper is not uniform. Variation in the tone of the paper was a result of the absence of chemicals in the manufacturing paper process, and was indicative of a high or low quality batch. A creamy tint was observed in high quality paper, while a poorer grade paper would present a light coffee tone and at times even a grey tone. In the first half of the 18th century, an increased consumption of paper made it difficult for papermakers to acquire the necessary rags to generate a finished product, and as a result many advertisements were run in both American and European periodicals to persuade people to “save rags."

Analysis of Materiality

Metadata

This codex was likely produced between 1750 and 1799. The manuscript is European in origin - specifically from England, due to the English text and syntax. Although there is no information on the specific publisher of this text, it can be deduced that it was likely ordered by a physician or medical student looking to document their findings on a treatment modality for inguinal hernias. There is no information regarding a specific publisher for this piece.

Provenance and Copyright

A look into the provenance of this piece reveals the transfers that took place between several owners. The earliest ownership of this piece that is visible was from a Mr. Lancaster, whose name is first seen on the second page. It appears that Mr. Lancaster then transferred this book to a Mr. R.L. Hall. Afterwards, this book was given from Mr. R.L. Hall to a Mr. J.H. Countryman, who then gifted the book to Dr. E.L. Eliason. Then, with the permission of J.H. Countryman - who appeared to still have the right to the codex at the time, due to the referenced dedication - Dr. E.L. Eliason was able to gift this codex to the University of Pennsylvania Medical Library within the Department of Surgery at University Hospital.

With respect to copyright, upon opening the codex one can find an unattached, printed leaf that appears to be from a Philadelphia-based company, known by the fictitious name of Chesterman & Streeter. Upon analyzing the folio, one can see that it appears that the parent company is known as Seeley’s Truss Establishment, suggesting that this codex was purchased later on by a truss manufacturer, likely for patent copyright privileges. This leaf is dated December 24, 1896, and contains the title “a word about trade protection,” providing more evidence to support the notion that subsequent owners of this codex issued copyright claims.

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  Seeley's Truss Establishment (Front of Folio)

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  Interior (Inner Folio)

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  Exterior (Back of Folio)

Substrate Analysis

This codex appears to be made of handmade paper – a type of rag-based laid paper. The distinguishing feature that reveals that this paper is laid paper and not wove paper is the presence of chain lines. When paper is laid, it is placed on a screen, and it is shaken. The screen in which it is shaken has wires; thus, chain lines and laid lines are formed. Additionally, the pulping which occurs next to the chain line suggests that the paper is original, handmade paper. As a result of this papermaking process, this piece does not encounter the issues, such as the brittle book problem, that codices made from wood pulp and with high levels of acid during the 1900s encountered.

A leather binding encapsulates the book and marbled endpaper present on the pastedown. Foxing, a form of iron-based chemical deterioration appears to be present on both leaves with and without ink, implying that the ink itself was not the only agent that caused this form of substrate deterioration. Moreover, the deckle and rough edges of the many leaves in this codex do not seem to have been significantly trimmed.

Page with Pagination, Foxing, Truss Diagram, and Text from Rupturs, Their Causes and Varietie's

It is likely that the codex itself was produced by a stationer. Moreover, the level of detail on the title page, the headings, and in subsequent section headings suggest that the composer of this piece was likely a professional scribe.

This piece has a bibliographical format of a quarto and it is 26 x 20 cm bound. The iconic rectangular structure seen in this codex is the commonplace codex format used in the 1700s. With respect to binding and structure, this codex is bound with a spine that appears to be contemporary with the time period from which it was made, denoting little intervention from preservationists. This can be further deduced from the dilapidated state of the binding, likely owing to the extensive usage of this codex by trained physicians, apprentices, and/or common folk at the time.

There do not appear to be any asemic marks on the book, a feature which suggests that this piece was likely used as a reference, as opposed to a form of an early notebook. This codex could have been used as a notebook, given the presence of blank pages; however, these pages remained blank upon inspection. The blank pages provide more evidence for the notion that the codex was likely purchased from a stationer and subsequently used as a template for transcription by a professional scribe.

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  Marbled Endpaper and Ownership (Pastedown)

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  Leader Binding (Outer Codex)

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  Leaf and Ownership (Mr. Lancaster)

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  Recent Ownership (Mr. J.H. Countryman, Mr. R.L. Hall, Dr. E.L. Eliason)

Navigation and Readership

There are catchwords present at the bottom right of the some of the pages in this codex. Additionally, there are page numbers inscribed at the top right of pages containing text. These pagination mechanisms imply that users of the codex could easily use the page numbers as reference points. Ease of navigation processes like pagination were likely the result of the expectation that readers could use the page numbers to reference certain pages, while also tracking their place within the codex.

In this codex, there does not appear to be any dedication; however, there are three ownership marks which were later added on to the front of the first leaf of the codex. The first dedication comes from a man known as Dr. Lancaster to a Mr. R.L. Hall. The second dedication was inscribed into the flyleaf upon transfer from R.L Hall to J.H. Countryman. The final ownership mark depicts the transfer from J.H. Countryman to Dr. E.L. Eliason and the University of Pennsylvania.

Codex Content

Trusses

Page with Herbal Treatments for Hernias from Rupturs, Their Causes and Varietie's

Trusses were invented to treat a variety of groin hernias. Typical groin hernias range from indirect inguinal, direct inguinal, femoral, to supravesical hernias. Although herniorrhaphy procedures were pioneered in the 18th century, they were typically unsafe, and it was only until the later end of the 19th century that Edoardo Bassini established the modern herniorrhaphy procedure. As described within this piece , trusses were created to provide support for a herniated area by using a belt and pad arrangement in order to hold the herniation in a proper position. Although commonplace in the 17th and 18th century, trusses are currently not prescribed by physicians.

Herbal Medicine

Herbal medicine practiced by early humans relied heavily on trial and error, the process by which plants that were determined to be edible, poisonous, relieve symptoms, or induce other symptoms such as discomfort. Indeed, throughout the evolution of medicine, one of the several sources of cures has been from remedies derived from plants. In order to preserve the medical information garnered from plants, much of it was transmitted in treatises or books referred to as herbals. As visible in this codex, the herbal section contained the names and descriptions of plants along with their medical virtues and properties.

Preservation and Legacy

This codex provided insight into trusses and herbal medicine used during the 18th century. Currently, trusses are still available on the market; however, their effectiveness relative to surgical intervention has been a cause for concern. Reports highlight complications such as testicular atrophy, hernia incarceration, ilioinguinal or femoral neuritis, and even thrombosis of the iliac vessels from some patients who do not seek surgical intervention. It is recommended that people suffering from hernias seek medical assistance before attempting to self-remedy via purchasing a truss. Given that surgical interventions were relatively unsafe during the mid-18th century, this codex reveals how truss usage coupled with the consumption of herbal remedies were used to treat patients. This codex provides insight into a historical and revolutionary medical technology that is still produced in the common era, and also grants readers insight into the herbal medicines available in England for patients suffering from a wide array of ailments. Currently, this codex is housed and maintained in the Kislak Center for Special Collections, Rare Books, and Manuscripts. It is stored in a clamshell protective case, (along with the copyright ephemera), made of lignin-free and acid-free materials.

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  Clamshell Protective Case - Frontal View

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  Clamshell Protective Case - Lateral View