Dermatology and history in Wales (Cymru)
GEOFFREY HODGSON
University Hospital of Wales, Cardiff
British Journal of Dermatology (1974) 90, 699-712.
SUMMARY
The development of dermatology in Wales (Cymru) is traced against a short history of the independent kingdom which became the Principality. Skin diseases were treated by the earliest Cymry, Celtic druids, Celto-Christian priests, Anglo-Saxon leeches and court physicians, and later by medieval university graduates and unskilled village herbalists and, when industrialization came, by ‘truck doctors’ and general practitioners. The early dermatologists are described. Traditional holy wells and folk medicine form connecting links.
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The mountains in Wales have made its history and dermatology. Sheltering the Cymry, driven by invaders from Britain into the present confines of the Principality, they isolated them as a pastoral people until iron and coal in the eighteenth and nineteenth centuries initiated the modem changes. Even in 1840, the only towns of any size were Merthyr Tydfil with 22,000, Swansea with 15,000 and Lardin with 6000 persons (Jones, 1972).
Peculiar to Wales are its triads (Trioedd). These are prose compositions with terse statements of three related facts. The bards used them to help people to remember. The oldest, which were historical ethical, theological and legal, were collected by Caradoc of Llancarfan in the twelfth century in ‘Historie of Cambria’, translated by Humphrey Llwyd, from a text of Brut y Tywysogion. Some persist today as Welsh proverbs (Diarhebion Cymraeg), for example, 'three things that are difficult for a man - to cool the fire, dry the water and please the world'. A Glamorgan tribon, or verse form of a triad, runs:
'Tri pheth syn hynod poenus (Three things which are remarkably painful,
Sef dafaden ar y wefus Namely, a wart cancer (Dafaden wyllt) ('wild sheep') on the lip
Cornwyd mawr o dan yr en An abscess under the chin,
A gwen yr eneth glwyfus'. And a smile of a wounded girl.)
In the background of Welsh dermatology there are always the mountains with their streams running into holy wells. There are also the herbs of their valleys, whose healing mysteries were known to Celtic druids and Celto-Christian priests, to be recorded later in medieval manuscripts and to mature ultimately as modern drugs, or to persist as superstitions or as country treatments for warts even today.
PREHISTORIC TIMES
Presumably dermatology in Stone Age tribes (Palaeolithic 12,000-8000 B.C. and Megalithic 6500 B.C.) consisted of the treatment of minor wounds, and the removal of stones and parasites by tribal mothers moistening, rubbing or squeezing the skin (Cule, 1970). This is mentioned in a medieval Welsh leech book, 'What is the simplest remedy?', followed by the answer, 'Scratch thy hand until it smart and then spit on it' (Jones, 1959).
EARLY CYMRY AND CELTIC PEOPLE
Some of the ancient Cymry came from Iberia (modern Spain and Portugal) to which they had migrated from Hindustan and the Middle East. Later came others such as the Beaker folk (2000-1800 B.C.) with bronze weapons and distinctive pottery (Chadwick, 1971). Medicine (Meddyginiaeth) was one of the rural arts practised by the Cymry. The bardic priests were the teachers of knowledge (Gwybodaeth), which included the healing herbs.
In the mountains lived the Welsh goat of ancient Cymru (Burroughs Wellcome, 1903), mentioned by Shakespeare in Henry V ('not for Cadwaladr and all his goats'). Then it was used for food, and its blood for medicine, now it is the parade mascot of the Welsh Regiment.
There followed, in 500 B.C., a new people. These were the Celts (Keltoi or Galli) from the region of the Upper Danube, now Austria and Czechoslovakia. They spread over Europe to Italy, Belgium, France, Spain, and they even formed a state in Turkey, as St Paul's Epistle to the Galatians reminds us (Fig. 1). Their influence declined in the second century B.C. before the conquering Romans. They were fair-skinned, blond, with flowing moustaches and swept-back hair, which may explain why cancer of the skin is said to be most common in those of Celtic ancestry (Urbach, Davies & Forbes, 1966). The Goidel Celts (Gaels) went to Ireland and later to Scotland; they spoke Gaelic. The Brythons, in Wales, spoke the first written language of Britain, which is the parent language of the Welsh of today and was spoken also in the north of Cornwall, and which is the concern of many Welsh people today.
The bards were, in the tenth century, at the Court of Hywel Dda ('Howell the Good' (A.D. 900-950) (Fig. 2)), divided into Chief bard (Pencerdd), bards of the royal Household (Bardd Teulu) and minstrels (Cerddorion). Later and in medieval times there were also bards on circuit (Cwrs) to the gentry and itinerant begging bards (clerwyr) (Archdruid Cynan, 1973).
Gorsedd of Bards
The original ovate (green robes), bards, musicians, and literati (blue), and druidic (white) orders, today compose the Gorsedd of the bards, who now proclaim the annual National Eisteddfod. This is a competitive congress of bards, the earliest recorded gathering of which was in Cardigan in 1176 under the patronage of Lord Rhys.
In Celtic times the druids, being responsible for healing, would have treated skin disease. Their white dress signified holiness and purity, they carried out secret and religious rites, and they practised mysticism. They were next in importance to the King. There were three types of female druids according to Irish sources (Moloney, 1919): the sisterhood with special powers of healing and divination, married women who lived a short time with their own husbands and then with the druids and a menial class. Their mysterious rites of healing together with human sacrifices and with prophecies were performed in sacred groves.
They used applications of sacred herbs, such as the 'All Heal' (Pren Awyn) mistletoe, which had to be cut with special ritual by a golden sickle on the sixth day after the new moon in winter (Burroughs Wellcome, 1903). The sacred wheat was gathered in autumn, the oak in summer and the shamrock (the Irish emblem) in spring. Disorders were also treated by drinking from holy wells, dedicated to the Celtic healer’ God Sirona, the source of sunlight and warmth (Wellcome Historical Medical Museum, 1928), and probably also to Mercury, Apollo and Jupiter. Treatment was also given at the temple of Nudd, or Noden, on the river Severn at Lydney (Cule, 1971).
ROMAN TIMES
It was nearly a century after Julius Caesar landed in 55 B.C. before most of Britain was conquered by Claudius (A.D. 43) with the defeat of Caractacus. But the Welsh tribes (the Silures of Monmouth and Glamorgan in the south, and the Ordovices of Powys in the north) withdrew into the mountains, and, nourished by the Druid stronghold in the island of Anglesey (Dodd, 1972), put up fierce resistance, until subdued in A.D. 74-78 by Agricola, who savagely destroyed the Druids' groves. Their exhortative resistance was, however, later carried on by bards (Archdruid Cynan, 1973). Conquered Wales was contained by legionary fortresses at Isca (Caerleon) (A.D. 90) in Monmouth, and at Chester (A.D. 102). When in 406 A.D. the Roman Emperor Constantine removed his troops, he left Wales and its dermatology much as they had been before the Romans came, except perhaps for some military practices based on Greek medicine.
THE EARLY WELSHKINGDOMS AND ANGLO-SAXON BRITAIN
During the Dark Ages, Wales was for some 200 years after Roman times sporadically invaded by Irish tribes who brought Christianity, then by the Saxons, the Norsemen and Danes, and finally by the Normans in the twelfth century. The Welsh fought also among themselves, between princes and between north and south, until union gradually came during the ninth and tenth centuries during the struggles for supremacy. King Gruffydd ap Llewellyn defeated the English king Harold, at Welshpool (A.D. 1039) and finally created the independent United Welsh kingdom. During these centuries several important events occurred in Wales. The Dragon of the great Pentragonship (the Welsh dragon of today's Welsh flag, from the standard of King Cadwaladr, the last Welsh king of Britain) had been recognized circa A.D. 420, when the Romans left. St David, 'Dewi Sant' (A.D. 462) (Fig. 2), the patron saint of Wales, founded a Celtic church and finally destroyed pagan druidism. The leek, tradition says, was worn by Welsh soldiers on St David's day A.D. 640 to distinguish them from Saxons dressed as Welshmen (Burroughs Wellcome, 1903). Later the Saxons built Offa's dyke, isolating Wales from Mercia (A.D. 700), and the great Welsh king Hywel Dda (Fig. 3) codified the Cymric laws (A.D. 900-950), which were later to be replaced by English common law.
Little is known of any dermatology in the early troubled years. Three groups of persons probably practised dermatology. First were the Celtic monasteries and clergy, until ordinances of the Popes in the twelfth and thirteenth centuries finally forbade the practice of medicine. They used herbs from cultivated gardens, cast out devils with insignia and continued to use the holy wells (ffynon). Among the holy wells of Wales there are some 437 named after Celtic Christian saints (Jones, 1954), and of the many others some had adjectival names indicating medicinal use. Outside the monasteries the leech doctors (Laece; the Anglo-Saxon word) did the healing 'dermatology'. They diagnosed 'Elf shot' (Grattan & Singer, 1956) by the magic puncture and denting of the skin, and gave treatment by blood letting, cauterization and talismans inscribed with magic words. Tumours, for instance, were exorcised by placing upon the man iris leaf on which was written, 'In nomine Patris et Filii et Spiritus sancti. Amen' (Jones, 1959). The dermatologist at the King's court was the Court Physician. King Hywel Dda (A.D. 900-950) had granted him, in precedence, the twelfth place at court with special privileges equal to those of the chief bard (Pencerdd). The Court Physician treated the royal household free, but he could charge a fee of twelve legal pence for 'a red ointment' (which is a mistranslation of treatment for a major blood vessel; Cule, 1966) and four pence for an application of herbs for a swelling. The most famous of these men was Rhiwallon, physician to Prince Rhys Gryg, Lord of Llandovery and DynevorCastles. He and his three sons, Cadwgan, Gruffydd and Einion, are known as the 'Physicians of Myddfai' in Carmarthen. They made a collection of herbal recipes for general illness and for many skin disorders, which had been used at the Court of Hywel Dda and before. Direct descendants of the Myddfai physicians practised medicine until 1739, when Jon Jones, the last lineal descendant of Einion, died. The modern book, 'The Physicians of Myddfai', was written in Welsh, was compiled by William Bone of Llanpumpsaint and preserved in his family until 1800, and was translated in 1861 into English by John Pughe, FRCS, of Aberdovey. The first part is probably authentic and dates from the thirteenth century. Treatments for eczema, impetigo, warts, smallpox, ringworm and leprosy are included. The origin of the Myddfai Physicians is also given in the book as the ‘Legend of Llwyn-y-fanbach’ - the 'Lady of the Lake' in Carmarthen.
The Legend of the Lady of the Lake
The son of a widow sees the beautiful fairy of the Lake, Rhiannon, and seeks to marry her. Her fairy father makes him choose her from her beautiful sisters, all of whom look alike. He can do this only when she puts her foot forward to identify herself. She consents to live with him so long as she is not given three 'causeless blows' (Tri ergyd diachos'), such as a playful tap on the shoulder or in another interpretation, so long as she is not touched with iron (i.e. the Celtic iron feared by the earlier Cymry). It was inevitable that she should vanish back into the lake, but she reappeared to teach Rhiwallon, her son, the healing herbs.
MEDIEVAL WALES
Now began the disintegration of the early Welsh kingdom. The Norman wars in Wales (A D 1087-11.0) are obscure but are recorded in ballads about King Arthur and Merlin and the quest for the Holy Grail, although it seems improbable that Arthur lived in Wales (Williams, 1941), and in tales recorded by Lady Charlotte Guest as told by story-teller bards (Cyfarwydd) (in the Mabinogion, Jones & Jones 1957) who nourished up to the fifteenth century. Then followed two wars of independence, and Llewellyn ap Gruffyd (c.1258) was the first to style himself the Prince of Wales; the second later became Edward II. Owen Glendower (A.D. 1400-1415) (Rees, 1972), seeking aid from France, made sorties from the heights of Plynlimon mountain. He established his authority over all Wales and made a parliament at Machynlleth until Henry Tudor (Henry VII), bearing the standard of the red dragon at the battle of Bosworth, ascended the English throne, and made a union of the two kingdoms of England and Wales. Henry VIII (Fig. 4), however, by the Act of Union (1536), finally destroyed the Welsh kingdom by incorporating all Welsh counties into England. University education in England was available at Oxford and Cambridge, from the thirteenth century, and also elsewhere in Europe, but not within Wales. Under the Normans the Welsh holy wells became dedicated to other saints. Some curative wells treated leprosy (clafr) but there were also established church lazar houses and, in Cardiff, a leper hospital founded by the townspeople stood near the site of the old Royal Infirmary (Cule, 1970) The ‘Black Death’ plague (1348-9) decimated both the lowland Englishry and the upland Welshry (Ziegler, 1969).
By the sixteenth century there were two distinct medical traditions in England and in Wales (Williams, 1928). The educated University graduate migrated to the towns to treat the upper and the middle classes, and the ignorant village leech, or itinerant quack, versed in druid herbs and Anglo-Saxon magic, treated the country folk and the poor. The holy wells of medieval Wales became the doctors of the poor (Jones, 1954). Many wells had dermatological reputations. At some, warts were pricked with pins and needles, which were then thrown into the well. Others cured wens, sore legs, erysipelas, cancers and sores. In Denbigh, at Fynnon Ddyfnog, special rooms were provided for cure of scabs, the itch, and 'some said it cured Pox' (Jones, 1954). Written contributions in dermatology began to be made by Welsh doctors, who had been educated in law, theology and other disciplines, and also by rich landowners who collected manuscripts. Thomas Phaire (1955), who died 1560, wrote the first book on paediatrics in English, the 'Boke of Chyldren'. He recorded such skin diseases as 'Scalles of the head', 'Scabbyness and ytche', 'canker in the mouth', 'failyng of the skynne' and 'chafing of the skynne', 'small poches and measles', 'sacer ignis or chingles', and 'swellyng of the head' as from the sides of bacon or salt beef falling from hooks in the ceiling, as well as stiffness of the limbs as when a child is found in the frost or street cast away by a wicked mother; which gives some idea of the then current social conditions.
Humphrey Llwyd of Denbigh (1568), a geographer, translated the Thesauris Pauperium', as the 'Treasury of Health', recommending arsenic for curing 'Wyddfire' or ringworm, and David Samuel (1751-1798), travelling with Captain Cook, described scurvy and syphilis in the Sandwich and Friendly Isles (Wellcome Historical Medical Museum, 1928). There were also leech books compiled from the old manuscripts, such as Hafod 16 (Jones, 1955, 1956, 1958, 1959) and 'the Welsh Leech book', (Llyfr o Feddyginiaeth) (Lewis, 1914). Herein are treatments for erysipelas, boils, bites, pockmarks and scales. Lice were removed by grinding wild sage with a pennyworth of mercury and superfluous hair by nettles boiled with vinegar.
MODERN WALES (17TH - 19TH CENTURIES)
After the Reformation, changes in religion, the awakening of scientific teaching and the coming of industry significantly changed Wales and its dermatology. Non-conformist doctrines led to the destruction of Roman Catholic churches and effigies, with impairment of established well cults. Pilgrimages still continued to some wells, such as St Winifred's at Holywell (Jones, 1954). The scientific possibility that chemicals in the water, instead of miracles or magic, might be responsible for cures encouraged analysis of the waters. After the discovery of minerals, curative spas began to be established at Llandrindod Wells and Llandudno. The Reverend Theophilus Evans, with scurvy, was encouraged to bathe at Llanwrtyd Wells after seeing a very healthy frog emerge (Jones, 1954). 'Black sulphurous mineral springs' in Llanbister, Radnorshire (Williams, 1905), and elsewhere were famed for the cure of 'cutaneous distempers'. The Industrial Revolution in Wales in the eighteenth and nineteenth centuries, with its coal mines and steel works (1750), lead and copper (1800-1850), wool and slate (1850) (Rees, 1972), led to canals and railways, and to larger towns of coal miners and steel workers. Dermatology was part of the medical care of workers by truck doctors (payment of wages in goods or cheques valid in stores owned by the employers) and later by practitioners on contract to employers.