To Benjamin Franklin from John MacMahon: Prescription and Directions, [23–24 August 1782]
From John MacMahon:1Prescription and Directions
(I) Press copy of ADS: Library of Congress; (II) ALS and press copy of ALS: Library of Congress
During the third week of August, Franklin suffered a severe attack of bladder or kidney stones, accompanied by a pain in the hip that extended down his left thigh. The latter problem was generally (and erroneously) attributed to gout.2 Franklin would be confined to his house for nearly six weeks. During that time, news of his illness spread throughout Europe, some of it false. In Italy officials learned from their diplomats at Versailles that Franklin had suffered a stroke; in England it was reported that he had had a fit of apoplexy.3
Elkanah Watson visited Passy on September 5 and was convinced that Franklin was dying. On September 17 Franklin, still in pain from “Gravel & Gout,” confessed to John Jay that he feared his situation was more serious than those around him realized, and seems to have asked Jay to draw up a will for him.4 Five days later he was said to be “much better,” though he would continue to allude to poor health over the next few weeks. By late October, Franklin was able to resume his rounds.5 The pain in his thigh, however, had rendered him so weak on the left side that he still had difficulty going up and down stairs as late as January.6
This was the first major episode of an illness that would eventually become chronic and debilitating. According to the case history which Franklin wrote some years later, the methods he employed during this attack “in order to bring the suppos’d Gout down into the Foot” included “warm Bathing, and a Poultis of Mustard.” This treatment caused his foot to swell but did not draw the pain down from the thigh, where it persisted. As for the stone, he remarked that as a young man he had suffered milder attacks but had been free of them for the past fifty years. During this acute episode, he “daily voided Gravel Stones the Size of small Pease, [and] took now and then some Decoctions of Herbs & Roots that were prescribed him by Friends or Physicians. …”7 Among the remedies Franklin tried were the saponaria pills specified in the following prescription, which were to be taken with an herbal decoction described in the accompanying directions.
Were they effective? Unfortunately not, and Franklin discontinued their use. Though he would receive advice and remedies from well-wishers all over England and France,8 he wrote in his case history that he “persisted … in nothing except the Use of Honey at Breakfast instead of or sometimes with Butter on his Bread, he remembering to have heard in the Conversation of Physicians, Honey mentioned as of great Service in Gravelly Cases.”9 Eventually the malady subsided, “but observing Sand constantly in his Urine, he continued the use of the Honey to the amount of perhaps a Pound per Week.” In spite of this precaution, he had another attack of the stone the following autumn, and chronically thereafter.1
[August 23–24, 1782]
I.
ce 23 Aoút
Rx Sapon. medic2 —— ½ oz.
f. pilul. singul. gran. vi.3
pulves. glycir. composs.4
d. ad [illegible]5
S.6 six pilules deux fois par jour
pour son Excellence M. Franklin
MacMahon
on enverra aussi une demi-once des semences de carotte sauvage et un verre d’emulsion édulcorée avec une once de syrop de diacode7
II.
ce 24 Aout
On fera bouillir une demi-douzaine de sebestes et autant de jujubes, une demi-once de pois chiches, deux gros de semences de mauve et autant de celle de guimauve dans cinq demi setiers d’eau, qu’on réduira à une pinte.8
Passez la décoction, que Monsieur boira par verrées de temps en temps dans la journée, il peut en boire un verre une heure avant les répas, mais il n’en boira que trois heures après le diner. Les pilules au nombre de six doivent étre prises le matin et le soir; il boira après les pilules ce matin une tasse de l’infusion de graine de lin et de carotte sauvage, et après la prise du soir, toute l’émulsion.9
Demain après chaque prise de six pilules il boira un verre de la tisane ci-dessus. Mc. M
1. Although MacMahon and BF had known one another since 1777 (XXV, 4), this prescription is our first evidence of BF consulting MacMahon professionally. Several weeks earlier MacMahon had recommended a treatment for WTF’s skin eruptions: MacMahon to WTF, Aug. 4, 1782, APS.
2. Benjamin Vaughan wrote Shelburne on Aug. 24: “Dr. Franklin is very much indisposed this week with gravelly complaints, but to-day is somewhat better. In the warm bath he for some days has voided small stones.” Morris, Jay: Peace, p. 325. On Aug. 28 Matthew Ridley visited BF and noted that he “had an attack of the Stone and has a little of the Gout”: Klingelhofer, “Matthew Ridley’s Diary,” p. 101. On Sept. 8, Richard Oswald reported that for the last ten days BF had “at first a Gravel in the Kidneys, which is gone off—but he continues very ill of a Rheumatic gout in his legs & thighs, which prevents his getting rest & sleep”: Oswald’s memorandum to [Shelburne], for which see XXXVII, 678–9n. In January, 1783, BF seems to have thought the hip and thigh pain might be due to sciatica: BF to Mary Hewson, Jan. 8, below.
3. Van Berkenrode, the Dutch ambassador, learned of BF’s illness at Versailles on Aug. 25; see his Aug. 26 letter, below. Francesco Favi, the Tuscan chargé d’affaires, and Daniele Delfino, the Venetian minister, reported in their dispatches that BF suffered a stroke: Antonio Pace, Benjamin Franklin and Italy (Philadelphia, 1958), p. 118. On Oct. 5, Jeremy Bentham reported having heard from a reliable source in Paris that BF was recovering from “a fit of the apoplexy from a retrograde gout”: Timothy L. S. Sprigge et al., eds., The Correspondence of Jeremy Bentham (11 vols. to date, London, 1968–), III, 142.
4. Watson’s journal entry of Sept. 5 records his alarm: Elkanah Watson Papers, Journal No. 5, New York State Library. For BF’s own assessment see his letters to David Hartley and John Jay, both dated Sept. 17.
5. Klingelhofer, “Matthew Ridley’s Diary,” pp. 113, 122–3, where Ridley notes that BF was on the road to Paris on Oct. 28 and dined with Jay on Oct. 30. On Oct. 27, Ridley told JA that BF was still weak, but was now able to sit at table: Butterfield, John Adams Diary, III, 37–8. See also BF to Jay, Oct. 9, below.
6. BF to Mary Hewson, Jan. 8, 1783.
7. BF, “Case,” [on or before March 1, 1784], APS.
8. Of the many remedies BF received, the only one dating from the period of this volume was sent to M. Brillon on Aug. 29 by a friend responding to what must have been an urgent appeal. The writer assured Brillon that he was sending by express 28 jugs of Griesbach water, famous for curing the stone: Library of Congress. Miscellaneous remedies that the editors have been unable to date are described in the Editorial Note on Remedies for the Stone, [after Aug. 24].
9. In 1744 BF explained to his parents why he thought honey might be effective in treating stones: II, 413–14.
1. See George W. Corner and Willard E. Goodwin, “Benjamin Franklin’s Bladder Stone,” Journal of the History of Medicine and Allied Sciences, VIII (1953), 359–77. BF’s case history, and the medical opinions of five eminent physicians and surgeons of London to whom it was submitted in July, 1785, are printed there.
2. Saponaria medicinalis. This botanical drug contained saponin, a glucoside found in several species of Saponaria, including s. officinalis or soapwort. A decoction of Saponaria leaves was also used at this time for cases of “visceral obstructions.” For the pharmaceutical information in these footnotes and general help in deciphering MacMahon’s barely legible prescription, the editors thank Glenn Sonnedecker, professor emeritus, School of Pharmacy, University of Wisconsin-Madison, and director emeritus, American Institute of the History of Pharmacy.
3. Fiant pilulæ singulæ granarum vi., i.e., make each pill to contain six grains.
4. Pulvis glycyrrhizae compositus (compound licorice powder), a widely used product containing senna, glycyrrhiza (licorice), washed sulphur, oil of fennel, and sugar. Professor Sonnedecker believes that while this was often used as a laxative, the pharmacist would have used it ad lib. as a flavoring and binder, since no quantity is specified.
5. “D.” could stand for “dividatur,” instructing the pharmacist to divide the pill mass into a specific number of pills.
6. Signa (write), i.e., direct the patient to take six pills two times per day.
7. Diacodion, a syrup made from white opium poppies. This narcotic emulsion was a single dose to be consumed at night; see the directions, below.
An unsigned, undated note in French, written by someone concerned about this pain medication, is among BF’s papers at the Library of Congress. The writer has been assured that BF is taking only moderate doses of the “sirop de pavots blancs” (white poppies). Mr. MacMahon knows, as does the writer, that large doses of narcotics taken internally cause problems for gout sufferers. He proposes applying to the affected extremity a topical unction of sweet almond oil mixed with a small amount of camphor. If this does not ease the pain sufficiently, one could add to the unction eight drops of liquid laudanum. This can be applied two to three times per 24–hour period.
8. These ingredients, not listed on the prescription above, are: sebesten plums, jujubes, chick peas, and seeds of the mallow and marsh-mallow plants. A demi-setier was equivalent to eight Parisian pints.
9. The infusion of flax seeds and the seeds of wild carrot was a diuretic, often prescribed for the stone; see the Editorial Note on Remedies for the Stone. See also Corner and Goodwin, “Benjamin Franklin’s Bladder Stone,” p. 368. The emulsion, containing an opiate, is described at the end of MacMahon’s prescription, above.
Benjamin Vaughan sought independent confirmation of MacMahon’s recommended treatment from two Englishmen in Paris, presumably physicians. He sent their opinions to WTF on Aug. 26 (APS). W. Lisle and Mr. Hume concurred that the prescription was what an English physician might have ordered: the soap pills were a good medicine and active at the dose prescribed; the opiate taken in an emulsion at night was established practice; and while neither marsh-mallow nor mallow would be used in England, the ingredients were mucilaginous and the decoction appeared to be adapted to the complaint. Vaughan wished his inquiry to remain confidential “lest Dr. McMahon might feel hurt at it.” Vaughan also solicited the opinion of Dr. William Withering in England; Withering’s response is résuméd below, [after Aug. 24].