Farewell, Brother Baron, 1750

'I am not an idle spectator' – a doctor does his rounds

[Note: if you have recently been bereaved, you may find some of this distressing – although it is also very moving, I think.]

It’s 1737, and Richard has just turned 21. He cracks open a new notebook, and he will proceed to write his diary every day thereafter for the next 13 years. He is the eldest surviving son (with an older sister) of Robert Kay, a doctor based in Baldingstone, near Bury in Lancashire and now part of Greater Manchester, and is already acting as his father’s apprentice. Is this a career for him? At this point, he isn’t sure:

This day father being abroad, I’ve been employed in his business and have had different sorts of patients, with different kinds of disorders, both with wounds, bruises and broken bones. But tho’ in my fathers absence I do supply in his stead, and many times undertake in different and difficult parts of Chirurgery [surgery], yet am not determined within myself what vocation of life to follow. (12th November 1737)

As a devout attendee at the dissenters’ chapel in Bury, he also considered entering the ministry. But his doubts abated, and six years later he decided officially to follow in his father’s footsteps (and those of his cousin, Samuel, who practised in Manchester and encouraged him), and off he went to London to study at Guy’s Hospital for a year. When he returned, he shared his father’s practice, and did the daily rounds of visiting local people and doing his best to treat their ailments and injuries. In 1750–1, a ‘miliary fever’ swept through the community – probably typhus. Within the space of a year, both of his parents, Robert and Elizabeth, had died of it, along with two of his sisters – and Richard himself, on 2nd October 1751. He was only 35. His last diary entry dates from 19th July 1750, and tails off mysteriously:

This day in the morning I returned from Manchester. In the afternoon…

And thus his short life was compassed, his diary his only lasting legacy, handed down through the descendants of a cousin and now held by the Chetham Library in Manchester on their behalf. It runs to more than 400 pages of handwritten entries, perhaps 200,000 words in total. There are no fireworks here – just the concerns of a young, devoutly religious man and the trials of his work. While he is pious and his diary entries show great earnestness, he also enjoys life, going hunting and fishing and attending fairs and races with friends. As a student in London, he went to see plays, noting poignantly that “seeing little in these hospitals but affliction and death, I find it necessary for me now and then to seek out some diversion”.

Larger events impinge little on this life, although there is a section in the middle where he shares his views and anxieties about the Jacobite Rebellion in 1745 led by Bonnie Prince Charlie. As a staunch Protestant, he is no fan of the man he calls “a Popish Pretender”, and prays for their failure. The rebels came as far south as Derby, via Manchester, and he is intrigued enough to have a squiz:

Having never seen the rebels, or any in a Highland dress, I set out this morning on foot in company with some other friends to see them march on the road from Manchester to Wigan… (10th December 1745)

But that might be something to come back to another time, as here I want to celebrate the ordinariness – his diary is a wonderful, understated document of social history. Dr William Brockbank (1900–1984), a luminary of medicine in Manchester, described the diary as “almost unique” in providing such a detailed account of a GP in this era.

Like his father, Richard travels around the locality by horseback, covering many miles and often working long hours. Those journeys didn’t always go well – I found at least five references in the diary to falling off his horse, and it’s a wonder he wasn’t more seriously injured (on 17th September 1746 he describes trepanning a man called Lawrence Lord, who had fractured his skull after such a fall and was “in a manner void of sense or pain” – maybe the trepanning actually caused that, although remarkably a month later Richard notes that Lord “recovers very well”).

The injuries and illnesses he encounters can be varied and grim:

Early this morning (I had only been in bed a few minutes) I was sent for to visit a man in Rossendale who the last evening as he was digging sand out of a sand-hole to mix with mortar for a house he was building for himself, had the misfortune to be took and covered over with a fall of sand where he lay twenty minutes or half an hour before he could be digged out. His head was bended down towards his thighs where we may suppose the sand not being well closed there was a little room left to breathe in. It is the wonder of all who saw him digged out that he had any life remainng. By the accident he hath his back broke, several of the vertebrae being dislocated near the diaphragm, and most of his ribs broke. (18th July 1745)

Richard’s trade makes him philosophical about “affliction and death”, but it must have been hard. Amputations were commonplace, and surgery undertaken without anaesthetic – particularly notable, he describes cutting out the countless cancers of a Mrs Driver, who ultimately died but nonetheless kept fighting back after multiple, unimaginably painful operations.

In one entry, where he lists many of the people he visited, he reflects:

My diary would be too prolix were I thus every day to enumerate the particulars of my proceedings, tho’ I meet with a great many occurences in life which are remarkable, and in the course of my business have frequently to deal with persons where their disorders are attended with favourable and many times with unhappy circumstances. I am not an idle spectator, an unconcerned visitor when I see the afflictions and distresses of my neighbours and fellow-creatures. (20th March 1749)

Below I’ll share a poignant story about his brother-in-law, Joseph Baron (born c.1701 and married to Richard’s elder sister Mary) which I found very human, and epitomises the emotional pain Richard had to endure when seeing the suffering of others.¹

14th June 1750

Brother Baron is bad of a pain in his right leg and belly; he was seized yesterday morning, has had of late several bad fits of the like disorder, we call it the gravel [I think this means kidney stones]; he has had of late also several symptoms of a gouty disorder. The children, Alice, Sarah and Joseph are at present visited with the smallpox; they are an afflicted family.

15th June

Brother Baron is much out of order.

16th June

This day I’ve spent in visiting; there are several patients more who I should have seen today but Brother Baron’s illness, he having made no water for some days past, has prevented me.

17th June

This Sabbath day in the morning I visited Brother Baron and found him much better. He had made plenty of water.

19th June

Brother Baron does not complain of much pain, yet is low-spirited and seems to be something feverish.

23rd June

This day I’ve spent in visiting towards Bolton. In my return through Bury this afternoon about 4 o’th’clock I called to see Brother Joseph Baron, and found him much as before, sometimes sitting in his easy chair with his gown on, and sometimes walking about in the room. He had made little water since Thursday, yet complained not of much pain unless sometimes an uneasiness in his left hip or upon his backbone towards his seat. He ate and drank what was thought proper and was pretty cheerfull, till near 7 o’th’clock this evening when being upon the close-stool in the corner of his room, he spoke the following words: that tomorrow would be Midsummer Day, that James Hardman in Rochdale (Brother’s relation) died on that day, and so must I.

Hearing this, I answered with some surprise, I hope not. Says he, Brother, I am done, I am inwardly done. [There are details of Brother Baron’s stools I will spare you here.]

I left him betwixt 8 and 9 this evening when I returned home without having any hope of his recovery seeing that his body is now turned into a mortfying state. Our manservant brings word he had a sick fit not long after I had left him.

O unhappy crisis of this his lingering and deceitful disorder; O my dear Brother, what shall I say, or what can I do; the sentence of death I fear is gone out against you. As a physician I cannot help you; as a Christian and as an affectionate friend and a loving brother I must pity and pray for you…

In how short and narrow a compass of time do we enjoy health and are visited with afflictions; days of joy and sorrow are near to each other. In the midst of life we are in death: this is the Lord’s doing, ’tis thy divine appointment; and we must believe that whatever thou dost, is well done; and that whatever is, is right.

[Richard continues with an extensive religious meditation and prayer here, which I have mostly skipped over, but it is driven throughout by the pain of seeing someone close to him also close to death.]

The present great concern we are under teach us to improve; sanctify the heavy and discouraging affliction thy servant and our dear relative is labouring under; spare his life if it be the will of God; consider what a great dependance his numerous family have upon him, how useful he is, and of what great consequence his life is not only to his family but to all his friends; Lord, he is one who we think can ill be spared…

24th June

This day this Sabbath day early in the morning I got up having had no sleep tonight friends at Bury being so much in my thoughts, after spending some time in my closet [the place he withdraws to for reflection and prayer] and having breakfast and prayer in the family I visited Brother Joseph Baron. Sister told me he had often slumbered, and had a better night than she expected; when I came into his room he was slumbering, his son Samuel waiting upon him. After some time he awaked, and in his usual way of speaking, said, So Brother, are you there? I asked him how he did; he asked me what I thought of him; finding a languid pulse and a cold sweat upon his hand and breast tho’ his countenance was very little changed than when in health, his complexion being fresh and ruddy; I answered, Brother, I fear you are dying this morning.

He said, with a surprising composure, Yes, I believe I am. He told me he had not signed his will, and would have me assist him about it, raising him up in bed. He complained how unactive his hand was, and that a Time had been when he could have wrote his name better; after he had lain down again, he complained of great pressure upon his legs and thighs, desiring me to lighten the weight of clothes, and soon after said that he could not possibly breathe unless he must be helped up… [At this point Richard notes they would normally all have been off to chapel, and Joseph’s “house has been a kind of general rendezvous for friends, for near twenty years past”.]

After we had in an officious Manner seated him in his chair with his gown on, he seemed much easier, and complained of little pain afterwards: he was very sensible that he was dying, and spoke concerning himself as becometh a dying Christian; it was very affecting to hear him speak his concern for the good of his family, giving them his counsel and proper directions, taking his farewell with one and another of them and praying to God for them…

He now leaned down his elbow upon the chair, his strength weakened and countenance changed. My father supported his head, and when he had seemingly rested himself a few minutes in his posture he raised himself up in his chair, looked at us, and in his usual speaking and composure said, I AM GOING. Immediately then a convulsion seized his eyes and countenance, he fetched a sigh or two, and breathed no more.

[Joseph Baron was buried the next day. Just 15 months later, Richard himself was interred at Bury Chapel; his gravestone, shared with his parents and siblings, survives today in the yard of the Unitarian Chapel in Bank Street.]

1. The first (anonymous) publication of extracts from Richard’s diary was in A Lancashire Doctor’s Diary, 1895, available online. I have drawn upon William Brockbank and Marjory Kay’s article ‘Extracts from the diary of Richard Kay’ in Medical History 3(1), 1959 and The Diary of Richard Kay, edited by William Brockbank and the Rev F. Kenworthy (The Chetham Society, 1968). Spellings and punctuation have been lightly modernised. There is more about Richard and his family at the Kay Family Association website.