Category Archives: illness history

Why the Long History?

The heating in my office is back on, the students are returning to the flats next door, and the new academic year is rapidly advancing. Over the last few days I have found myself looking back over my summer of writing and thinking about my project as a whole, as I attempt to gather my thoughts and preserve my ideas, in the knowledge that until at least December, I will have precious little time to dedicate to writing chapters about migraine, as I turn my thoughts to teaching modules about Australia, migration and convicts.

Text page

British Library Royal 12 D XVII (Bald’s Leechbook) f. 7

Even since the beginning of the summer, the scope of my project has expanded far beyond my already stretched comfort-zone. Somewhat to my surprise I found myself spending much of July working on a chapter that begins in the tenth century with four remedies for ‘half’s heads ache’ in Bald’s Leechbook, and ends in the fifteenth century, with William Dunbar’s fantastic poem.

In early September I presented some of my work on migraine to the bi-annual European Association for the History of Medicine and Health conference, on the theme of ‘Cash and Care’. It was in many respects an excellent event – particularly the hospitality of our hosts – but I was shocked at how few papers considered any period before a very modern era, not least given the significance of the ‘medical marketplace’ scholarship over recent years. I began my own paper by talking about Linda Ehrsam Voigts’ work on the fifteenth-century banns of an itinerant medical practitioner, and joked that I had accidentally found myself working on the medieval period.

In the questions, a member of the audience commented that they had never heard of anyone trying to write a thousand year history of an illness before.

There is, perhaps, a reason for that.

And so since then, I have been thinking about this chronology: what am I trying to do? And why has this long time span come to matter so much to me, when many of my colleagues would consider it naively ambitious at best, if not simply impossible? Certainly, I cannot imagine a funding committee would have endorsed such a proposal when I began…

Historians have, of course, long advocated for paying attention to the longue duree. Fernand Braudel famously described events as ‘the ephemera of history’, as ‘surface disturbances, crests of foam that the tides of history carry on their strong backs’ . More recently, in their much-debated History Manifesto, the historians Jo Guldi and David Armitage argued that “historians once told arching stories of scale but, nearly forty years ago, many if not most of them stopped doing so. For two generations, between about 1975 and 2005, they conducted most of their studies on biological time-spans of between five and fifty years, approximating the length of a mature human life”. Guldi and Armitage identify a shift in our historical horizons. They have begun to expand once more, this time with the turn to ‘deep’ history. Medical historians have been among those diving in. In 2011 Monica Green urged historians of health to ‘go deep’ as well as ‘go global’ if we are to compete with the historical insights being produced in fields such as genomics & bioarchaeology.

My scale is not quite that expansive. For me, it is the availability of digitised material that has driven this chronology, sending a project that I had initially conceived as modern in scope, creeping ever further back through the centuries. A stream of highly fragmented, but extremely rich sources, has become navigable through online catalogues, digitisation projects and Google searches. Alongside bread-and-butter archival research, images of glittering medieval and early modern manuscripts – now freely available in high resolution – have repeatedly demanded my attention.

I will write more about the digital challenge soon, suffice to say that I have become acutely aware of the inbuilt distortions inherent to digitization that reinscribe hierarchies of class, race, gender & wealth privilege even while purporting to make archives ‘open to all’. My own project is geographically focused on Britain and Ireland, with glances across the English Channel and Atlantic to France and America. In the few cases where I discuss ‘global’ knowledge, I am aware that these are often ideas that have been appropriated by observers and collectors of the exotic in only the most superficial of ways.

13th century trepanation.

Mediaeval surgeon trepanning. 13th century.

Attempting a project of this chronological scale has proved a real challenge – not least in the amount of reading required to come even to the most basic understanding of any new era. As a colleague pointed out to me as I began to make plans, “You are not Owsei Temkin”. He was referring to Temkin’s magisterial Falling Sickness – his classic study of epilepsy, first published in 1945, which took readers on an odyssey through two millenia from ancient Hippocratic texts to John Hughlings Jackson, the nineteenth century ‘father’ of modern neurology. Temkin’s scholarship is staggering, but there are good reasons for looking at topics such as migraine over a long period, even if our attempts are on a far more modest chronological and intellectual scale than Temkin.

For a start it reveals surprising continuities. In many cases, medieval descriptions of the symptoms of ’emigranea’  as a piercing pain associated often with problems of eyesight seem closer to our own modern understanding of migraine with aura, than do eighteenth-century discussions in which migraine is associated with dizziness, unease, and seems to be – for want of a better word – altogether more fuzzy.

When we stretch out to a thousand years we see also that our current gendered pre-occupations, are far from inevitable – more of a blip, than the status quo. This is not to say that these assumptions are not deeply entrenched or that they will be easy to challenge. Far from it.

Taking the long view seriously, and populating the medieval, early modern, and modern period with a whole variety of people who experience, treat and discuss migraine takes us way beyond the old cliche of trepanation. It puts women back into the story as creators of knowledge, puts men back into the story as sufferers. Far from simply serving to reinforce a modern sense of superiority by highlighting the inadequacies of past knowledge, and the barbarity of practices long since abandoned, a long time span humbles our own knowledge, putting it into historical context. It emphasises the contingent nature of medical understanding, and the fragility of consensus.

Most of all, it is really really fascinating. I can’t wait to pick the chapters up again with a fresh set of eyes, when I get the chance.

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How migraine lost its legitimacy

In May 1782, a flamboyant character graced the King’s Theatre Masquerade in London. Gliding his way past the Venetian sailor, the gentleman in a coat of two different colours, and the usual unremarkable costumes of some eight hundred attendees, the High German Doctor cut a dashing figure. He introduced himself to the gathering as ‘Le Sieur Francois de Migraine, Docteur en Medicine’. Continue reading

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When bodies appear.

‘The head suffers from a certain internal pain which the physicians call migraine…It feels as if there is hammering and pounding in the head. Sound or talking is unbearable, as is light or glare’.

                        – thirteenth-century description of migraine from Bartholomaeus Anglicus, De Proprietatibus Rerum (On The Properties of Things) c.1245. Source: Faith Wallis, Medieval Medicine: A Reader (2010), p. 250.

I was reminded last week of one of my favourite books about bodies and illness. In The Absent Body Drew Leder asks a simple question: why, ‘if human experience is so rooted in the bodily, is the body so often absent from experience?’ (p.69-70).

Pain, Leder observes, makes our bodies appear to use, it reminds us of their presence. Pain ‘reorganizes our lived space and time, our relations with others and with ourselves’. Bodies that are normally silent, that we take for granted, seize our awareness at times of disturbance. Chronic pain, in particular, forces people into a constant dialogue (so often described in terms of battle) with their bodies. In the case of migraine this seizure is a deeply private one, invisible to those looking on. Leder’s book was one of the main reasons that I decided to look seriously into migraine’s history, to ask how, in different times and places, people have made sense of this often unfathomably painful intrusion of the body into their lives.

I first came across phenomenology several years ago. I am certainly no philosopher, but this way of thinking appealed because it is concerned above all with individuals’ relationships and interactions with their own surroundings. Phenomenologists recognise that people do not live in the world of rules and reasons conceived of by science, but in a much messier, more unpredictable world – the ‘lifeworld’. In his foundational book Phenomenology of Perception (1945), Maurice Merleau-Ponty described phenomenology as paying attention to “a general setting in which my body can co-exist with the world” (p.250). In another important text, The Poetics of Space (1958), Gaston Bachelard proposed analysing how people take root, day after day, in a “corner of the world” (p.4). The idea of the ‘lifeworld’ was not a new one. In 1934 Jacob von Uexküll had used the concept to explain how an animal’s existence is experienced through “meaning carriers”. These carriers of significance might include a sensitivity towards heat, or sound. Experience can also be affected by orientation, memories, preconceptions, fears and suspicions.

Pre-migraine

Debbie Ayles, ‘Pre-Migraine’. Credit: Debbie Ayles, Wellcome Images.

It is this emphasis on significance that I find most useful for thinking about the history of an illness such as migraine. This is not ‘environmental health’ in the way that we normally consider it, i.e. in terms of pollution and waste, but a much more personal and less tangible kind of relationship – in which noise, smells, light, changes in air-pressure or the phases of the moon are taken seriously.

One example of this that has stayed with me is a response to a Youtube animation of migraine aura (WARNING: this video contains black and white flashing images). In the comments posted below the video one woman described a time when she had experienced an aura while driving:

seeing multiple images such as repetitive road signs, lights from other cars coming at me while I was dizzy and not knowing if they were in my lane or not, and rays of colors shooting towards me all at the same time. Yes, I pulled over ASAP on a long, dark country road, scared to death and crying’.

People with migraine gain an acute awareness of their surroundings, As can be seen from this quote, and the excerpt I began this post with  this kind of environmental awareness has a very long history.

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