Introduction

This section examines the contribution of the Rev. John Wesley MA to health, holistic healing, and electrotherapy in the eighteenth century. A systematic review of the observations of twentieth century writers on his healing ministry and the use of electrotherapy is also presented. This enables us to make a fresh and original interpretation of his healing approaches, as seen in the light of the recent developments in holistic and alternative and complementary medicine during the last decade of the twentieth century.

Principles and Practice of eighteenth century medicine

In the seventeenth century the strengths and weaknesses of 'learned medicine' for those who could afford it were still those of the medicine of Antiquity, particularly that of Galen, on whose authority it leaned so heavily. It set great store by the management of a healthy life through the regulation of diet, exercise and the pursuit of moderation. The accent of its therapeutics lay on expelling toxic substances from the body (by purgation, procuring sweating and vomiting and the much favored technique of 'blood-letting'), on restoring 'balance', and on strengthening the body's own regular constitution; to this end a host of medicaments was used (Porter 1987).

That ignorance and error are largely responsible for man's woes, including most of his physical ailments, is also an ancient doctrine. Our intemperance draws incurable diseases down upon our heads, and physicians will tell you that it is in offending in some of the 'six non-natural things' that lie the causes of our infirmities. There are six categories of factors, which operatively determine health or disease, depending on the circumstances of their use or abuse, and human beings are unavoidably exposed to these in the course of daily life. They are: air; food and drink; sleep and watch; motion and rest; evacuation and repletion, the passions of the mind. Management of the regimen of the patient, that is, of his involvement with these six sets of factors, was for centuries the physician's most important task and has of course by no means lost its importance today (Rather 1968).

In addition to this concept of the 'six non-natural things' the work of Dr George Cheyne also had a significant influence on John Wesley. His voluminous writings represent well the intellectual activity of his era. Much of Cheyne's practice, especially his therapeutic concern with a 'low' diet was dictated by his own personal experience of gross obesity. His theories reflect the intellectual movements and conflicts of the period. Scientific achievements had little effect on the people; traditional religion, however, affected their lives quite directly. Soul and mind, as material entities, had to find a place in the philosophical explanations and systems of medicine and the biological sciences (King 1974).

The concept of obstruction played an important part in 18th century medicine. Cheyne's concept of disease reflected the then current thinking in physiology - that bodily processes depend on the free passage of fluids (or humours) through vessels of various types. Other factors, however, would also play a part such as the concept that food introduces an excess of torturous, urinous or other salts into the blood, which when not properly broken down by the digestive process, unite in clusters to cause obstructions. Evacuations help to eliminate these salts. Cheyne held strongly to this type of therapy - at least in the form of gentle sweats and purges. Mineral waters and tea act as diluents which thin the blood and 'dissolve and break the salts and keep them from running into clusters.' Mercury also had great merit in relieving obstruction, being fourteen times as heavy as water, and thus having great force in 'opening' obstructions (King 1974).

Medical training and practice

At the start of the 18th century the population of England and Wales was about 5.5 million; by the end of the century it had increased to nine million. During this period only a few graduates emerged from the nation's medical schools each year. Oxford provided four graduates a year; Cambridge usually supplied a few more. Edinburgh, then the centre of medicine in the English-speaking world, sent out as many as sixteen, and most people lived and died without ever seeing a doctor (Wilder 1978). Other doctors learned their profession by reading medicine or serving as apprentices under established physicians. There was also a strange and pernicious array of quacks practicing in the land, and Wesley often protested against their influence upon the poor and ill educated (Dunlop 1964).

The first half of the 18th century, and much of the second half, continued the tradition that had long dominated academic medicine, namely that logic was more important than observation, and that theory derived its force more from internal consistency than from empirical verification. Progress towards a more modern viewpoint came slowly, only after medicine accepted new standards of evidence, new criteria for validity, new evaluations of cogency (King 1974).

Other 18th Century health care practitioners

Many fields of irregular medicine were actually growing alongside the rise of regular physic, and the eighteenth century has been called 'the golden age of quackery'. To speak of 'quackery' is not automatically to impeach the motives of empirics, i.e. unqualified practitioners and nostrum mongers, nor to pass judgment on their cures as necessarily ineffective. Many proprietary remedies were remarkably similar to those prescribed by physicians, such as opium for pain and antimony to induce sweating, but other treatments were seen as entrepreneurial (or as unwarranted interventions), e.g. electric shocks (Porter 1987).

There were many, wise women and men alike, who made a good living from irregular medical practice. Many clergymen of that day also dabbled in physic, including Wesley's own grandfather who, when deprived of his living through politics, turned to the practice of physic (Baragar 1928). The regular physician, whose hard-won medical degree represented many years of intense study, looked down upon other groups; but only when financial matters intervened did this disdain change to intense opposition. The apothecaries were less well educated and had learned by apprenticeship and practical experience. The empirics stressed the facts of observation and considered these to be of primary importance, acquiring knowledge from chance observation and/or deliberate experimentation.

There were other individuals, such as the gentry and clergy, eminent men of the highest stature, neither physicians nor apothecaries, who were in no sense 'quacks', but who may also be called medical empirics (using trial and error in practice) in the best sense (King 1958). John Wesley was one of these and he also argued that medicine was formerly based on experience, until men of learning began to set this experience aside, to form theories of diseases and their cure, and to prefer these to experiments. Wesley's views are therefore superb examples of that school of medical theory known as 'Empiricism', i.e. that medical knowledge must be based upon experience, not upon theory (Callaway 1974). Obviously, today, we acknowledge that both theory and experience are necessary. In the 18th century, both extremes were being argued by capable but often hostile camps. The theorists have gained the approbation of history, since they were our direct scientific ancestors but in the 18th century, neither camp could treat sick patients reliably. The Empiricists at least had centuries of trial and error on their side (Callaway 1974).

Wesley had set up an empirical system that, if we judge by popularity alone, worked at least as well as its more orthodox rival (King 1958). Wesley also awakened an interest in sanitation (and health promotion), long absent from the Christian world, with the revival of an ancient Hebrew dictum that 'cleanliness is next to Godliness' (Ott 1980a). In many ways the system of John Wesley was ahead of current medical opinion - he deprecated those dreadful eighteenth century panaceas - bleeding, blistering and purging. He actually believed that fresh air was helpful, and that cleanliness was next to godliness, ("the bath becomes still more efficacious by dissolving some soap in it"). He also spoke out against the complicated, useless and at times revolting formulations often containing 15-20 ingredients, that were in vogue at the time (Menzies 1980), in favor of simple single and less toxic remedies.

'Primitive Physick' (1747)

A combination of basic concerns - the maltreatment of the poor, the general incompetence of medical practitioners, and the innate greed of mankind in general - becomes the principal motivation behind the volume (Rogal 1978) of John Wesley's 'Primitive Physick, or An Easy and Natural Way of Curing Most Diseases', which was published anonymously in 1747. Among Wesley's chief concern as a bookseller was to make books affordable, Primitive Physick was so cheaply printed that it was among the dozen or so most widely read books in England from 1750-1850 (Brantley 1984). The book sold at a price low enough that even the poor could buy it (Dunlop 1964); for example it sold for one shilling in July 1747, a cheap price even then (Rousseau 1968). The total number of copies printed is unknown, but it must have been one of the all-time medical best sellers (Stewart 1969), and unlike the dozens of other similar works written in the eighteenth century, it contained remedies for virtually every disease known to man (Rousseau 1968). In Wesley's lifetime it went through twenty-three editions and subsequently reached its thirty-second edition.

The first part of the book consists of a preface, to which are appended rules for the preservation of good health. The second part, (1780 Edition), consists of over nine hundred recipes and directions for two hundred and eighty-eight named ailments (Wesley Hill 1958). Extremes of good sense and nonsense are found among these 'receipts' although its author intended it to be a shield against quack medical practice (Dunlop 1964). Some of the remedies proposed are simple enough, none can deny; many are calculated to be beneficial; whilst the employment of a few, to say the least, would be extremely perilous (Stamp 1845). Wesley probably knew as much as most members of the medical profession, in fact, on no less than twenty instances throughout the volume, he paraphrases or cites directly from prominent physicians and theorists - such figures as Sydenham, Boerhaave, Cheyne, Mead, and Huxham (Rogal 1978). The majority of his cures were hardly original, but taken from the major medical figures of his time, together with folk medicine, old women's nostrums and some cures of his own invention. For the most part, Wesley's suggested remedies were simple, easily understood, inexpensive, and safe. Cold water, hot poultices, herb teas, and general hygienic measures were his standard treatments. Although many of the remedies are quaint by modern standards, they are much less bizarre than most other eighteenth century recipes (Menzies 1980).

Despite the contributions of the leading physicians of the day, Wesley thought that their advancement of anatomical, physiological, and pathological theory added little to medical therapeutics (Dunlop 1964) and so his book of 'Primitive Physick', by which he meant to imply a return to the simplicity of tried remedies in place of those of medical philosophers, who substitute theory for experience (Cule 1982), was his attempt to redress the balance. Wesley felt that cures can and should be discovered by accident and that discovering cures and experimenting with them was the primitive way by which was gathered up the whole corpus of healing (Payne 1985). However, he also includes the following caveat in 'Primitive Physick', "that in uncommon or complicated diseases, where life is more immediately in danger, every man without delay should apply to a Physician that fears God" (Wesley 1747). This, however, did not keep him from advocating his own empirical cures for lesser ills, and throughout his life he sought for medical knowledge where he could find it (Dunlop 1964).

It was not until 1760 that Wesley's name appeared on the title-page. In this edition, too, he added 'Tried' to those remedies which he had found to be of greatest efficacy, and enthusiastically commended electricity as coming "the nearest an universal medicine, of any yet known in the world" (Wesley 1760). The "tried remedy" has a lasting appeal and the very term itself creates its own authority. It was what John Wesley often meant when he referred to a good result being "shown by experiment", but which nowadays is usually expressed as "shown by experience" (Cule 1990).

The preface

Wesley's very long preface summarizes the history of medicine from the earliest times to the present, with primitive man living in his perfect creation and suffering no sickness until his blissful state was marred by original sin, which then sired all diseases (Rousseau 1968). The preface goes on to offer down-to-earth rules covering diet, fresh air, exercise, sleep and cleanliness, rules for good health which would need only moderate up-dating to be useful today (Stewart 1969). For example, 'In the sweat of thy face salt thou eat bread, till thou return to the ground' - Wesley's interpretation indicating that 'the power of exercise both to preserve and restore health is greater than can well be conceived, especially to those who add temperance thereto' (Wesley 1747). Another example is his express belief that too much sleep may be the cause of many disorders, particularly nervous disorders. He exhorted, "You have no other possible means of recovery, in any tolerable degree, your health both of body and mind, Do not murder yourself outright" (Wesley 1831). As for the relationship between too much sleep and disorders, Wesley could only theorize (Ott 1980b). Nevertheless it seemed to John Wesley that "while we sleep all the springs of nature are unbent," and if we sleep longer than is necessary, "they (i.e. the springs) are relaxed more than is sufficient, and of course, grow weaker and weaker" (Wesley 1831). It is most interesting that recent sleep research suggests many similarities between excess sleep states and chronic fatigue syndromes such as Myalgic Encephalomyelitis (Horne 1995), and perhaps time may also show that a return to John Wesley's regimen recommendations for sleep may be the answer to this twentieth-century problem, i.e. that men require on average just six to seven hours of sleep and women seven to eight hours (Wesley 1831). The preface follows on with his understanding of what is now called psychosomatic or stress-related conditions, which was extraordinary for his day. "The passions have a greater influence on health then most people are aware of," he wrote and, "Till the passion, which caused the disease is calmed, medicine is applied in vain" (Wesley 1747).

Although many of Wesley's specific remedies now seem quaint, humorous, and, at times, grotesque, the moral force of his preface remains alive. In his critique of 18th century medicine, Wesley attacked not merely the 'fine spun theories' of the physicians of his time. More significantly, he attacked their arrogance, their desire to become 'something more than Human,' their avarice, and their abstruseness - vices that have by no means disappeared for the medical profession today (Callaway 1974).

A Collection of Receipts - the remedies

The second part of his book presents 900 recipes and cures for 288 afflictions from abortions to wounds (Dunlop 1964). Its recipes were laid out alphabetically in the manner of a dictionary, and listed in simple English seven or eight - sometimes more - cures for each ailment; there was nothing 'scientific' about it according to Rousseau (1968). The recipes within Primitive Physick, though exciting the mirth or scorn of many twentieth-century observers, were in fact carefully selected by Wesley and represent the elect of eighteenth-century prescriptions for the purposes mentioned and form a basis for assessment of what was the best in eighteenth-century medical treatment (Wesley Hill 1958). He generally provides several remedies, which he recommends should be tried in order, if necessary. He realized that not all were easy to obtain, and that what cured one would not always cure another (Payne 1985). There is a relaxed, familiar, uncomplicated quality about the book. It is innocent of diagnostic hints so that the user of the book is directed toward the symptomatic relief of chronic, rather than acute disorders. The word 'cure' is tossed about carelessly, and the user of the book could find great room to maneuver (Stewart 1969). Though he was still a son of the 18th century and its superstitions, he was ahead of his time in many ways, (Dunlop 1964). For example, it is interesting that physicians of his day and for many generations afterwards ridiculed his immediate cold water treatment for burns. We now know he was absolutely correct. He also clearly recognized the nature of scabies or itch (Stewart 1969), and his treatment of vomiting and diarrhea with warm lemonade, a treatment to replace the electrolytes (sodium, potassium and citrates), is unsurpassed even by today's standards. On the other hand, there was also some attention given to magical treatments of the day e.g. fevers treated with pills of cobwebs, cramps treated with a roll of brimstone under the pillow, a live puppy held on the abdomen for intestinal obstruction (this treatment was borrowed from the great Dr. Sydenham). To his credit, however, we must note that Wesley avoided most of the truly bizarre or dangerous or revolting treatments of his day, e.g. he permitted bleeding the patient for few conditions and deplored the almost universal use of this malignant remedy by physicians and, although he recommended the use of metallic mercury for certain conditions, he agreed that it was dangerous (Stewart 1969). Wesley had a wonderful way of dealing with those who presented a multiplicity of complaints. "Use the cold bath - this has cured many. This cured Mrs. Bates of Leicestershire of the cancer in her breast, a consumption, a sciatica and rheumatism which she had nearly twenty years. She bathed every day for a month and drank only water" (Wesley Hill 1958). Electricity is also recommended as a cure for over twenty illnesses in Primitive Physick. It was one of his favorite remedies and he describes it as "far superior to all the medicines I know". In the preface of the 1760 edition he spoke enthusiastically of electricity, 'certainly it comes the nearest an universal medicine of any yet known in the world' (Wesley 1760). Historical or contemporary writers have given little attention to this statement and the full implications of these words have yet to be appreciated.

John Wesley directed his handbook on the practice of medicine to a wide audience; in so doing, he chose the vehicles of directness, simplicity, and pure practicality. Nevertheless, despite its obvious emphasis upon matters of the body - matters pertaining to preserving the lives of his fellow men - John Wesley could not keep his 'Primitive Physick' entirely free from what was, for him, the most important area of concern: the soul of man. Therefore, the only single remedy in which he could place his absolute faith becomes, really, the essence of the piece. "Above all," he maintains, "add to the rest, for it is not labor lost, that old-fashioned medicine - prayer; and have faith in God, who killeth and maketh alive, who bringeth down to the grave and bringeth up" (Wesley 1747). "For the love of God, by the perfect calm, serenity and tranquility it gives the mind, becomes the most powerful of all the means toward health and long life" - (which make John Wesley one of the founders of psychosomatic medicine as well as Methodism - (Weinstein 1956)). Moreover, John Wesley's own prescription for life - his complete faith in the gospel - had as much to do with the spread of 'Primitive Physick' throughout eighteenth century Britain and America as did all the remedies and suggestions imprinted upon its pages (Rogal 1978).

'The Desideratum' (1759)

Wesley from 1751 onwards had become very interested in the subject of electricity generally, and in relation to the treatment of disease in particular.
The study of electricity was, in the 18th century, a most popular combination of amateur science and parlor magic. After reading Franklin's letters on electricity, Wesley came to feel that the subject was important enough to impress on his followers as 'The Desideratum'. All the important facts about electricity are now succinctly and ably presented with extracts from the published experiments and observations of these eighteenth-century workers. After these extracts comes the therapeutic applications of electricity, and Wesley gives a list of thirty-seven 'disorders in which it has been of unquestionable use.' He observes that 'a great part of these are of the nervous kind and perhaps there is no nervous distemper whatever which would not yield to a steady use of this remedy. It seems, therefore, to be the Grand Desideratum in Physic, from which we may expect relief when all other relief fails (Wesley Hill 1958).

Electricity made plain

Citing Richard Lovett, Wesley wends his rhetorical way through ten prefatory paragraphs of generalized testimonials regarding electrifying, and concludes with the formers opinion that "the electrical method of treating disorders cannot be expected to arrive at any considerable degree of perfection, till administered and applied by the gentlemen of the faculty" (Wesley 1759). Such a moment in the history of medicine will never arrive, according to Wesley, until "the gentlemen of the faculty have more regard to the interests of their neighbors than their own; at least, not until there are no Apothecaries in the land, or till Physicians are independent of them" (Wesley 1759).

John Wesley conducted his enquiries into electricity with characteristically thorough and painstaking research. The first part 'The Desideratum' is concerned with setting out in forty-two numbered paragraphs all the information that he had been able to gather together. His own comprehensive and intriguing survey concludes with this: "To throw all the Light I can on the Subject, I subjoin a few Extracts from several other Writers" (Wesley 1759) The whole of it makes quaint and rather naive reading today. Having investigated the nature of this 'elementary fire' as he called it, Wesley went on to describe the uses to which it may be put and in particular its healing properties. Wesley proceeds to specify "several Disorders wherein Electrification has been found eminently useful" (Wesley 1759). The list of disorders is of great interest. Forty-three specific ailments are mentioned. Among them are blindness, choruses, contraction of the limbs, gout, sciatica, pain in the back, and in the stomach. We know that he found the treatment particularly efficacious in cases of melancholia and, what are sometimes loosely called today, nervous disorders. With his enthusiasm, Wesley cannot resist a timely word of caution: "In order to prevent any ill Effect, these two Cautions should always be remembered, First, let not the Shock be too violent; rather let several small Shocks be given. Secondly, do not give a Shock to the whole Body, when only a particular part is affected. If it be given to the Part affected only, little Harm can follow even from a violent shock" (Wesley 1759).

Electricity made useful

Wesley, as curious and eager as any man ever was to investigate what was new, showed his natural disposition as a 'physician' in conceiving the possibility of this new discovery being used in the business of healing (Wesley Hill 1958). Wesley's major concern with electricity was over the possible applications to medicine, and he devoted almost half of his book to citations of the 'disorders' it could cure and of cases where it had been proved to do so (Schofield 1953). Doubtless in a great number of cases his treatment, while it did no harm, did no good; but here, in these initial stages of this kind of treatment, an immense and important value lay in the effort made and in making known results of the trial-and-error technique (Wesley Hill 1958). He had gathered his proof from many sources, Mr. Lovett's name being frequently mentioned. Various cases are reported from Newcastle-on-Tyne, Uppsala and Stockholm, from London and Edinburgh. Wesley had spread his net wide. There are bruises and strains, deafness, fistulae, ear-ache and tooth-ache, and hysterical cases. For example: "Sarah Ellison, catches cold in lying-in which fixed a sharp pain in her teeth and the side of her face. She used all manner of means to remove this for upwards of six years. Among many others she had, at several times, 3 teeth drawn and was fourteen times blistered, but without effect. In July 1754 she received six shocks through the head. The pain ceased immediately and returned no more" (Wesley 1760).

Wesley in his enthusiasm may have optimistically over-rated many of his results, but the main thing is that he was out to do good and to use every proper means that came to hand to do it. Undoubtedly he did much by these means to relieve suffering and inspire new hope while he blazed this new trail. In this his negative as well as his positive results were of value in ascertaining 'in what manner it might be most effectually applied in any case wherein it was proper' (Wesley Hill 1958).

Basic principles and practice of electrotherapy in the 18th Century

In the eighteenth century electricity was the novelty which was holding men's attention, and Wesley at once seizes it for illuminating religious teaching, as this new discovery did not disturb his religion in the least. His faith was grounded in a personal relation to God, and the various modes of God's operation through the agency of natural law did not affect that faith. In the face of new knowledge Wesley's views of that part of God's operations might have to undergo modifications, but the core of his religious life remained unchanged. Accordingly Wesley became an electricity enthusiast (Pellowe 1927), and in about the year 1750 John Wesley procured an apparatus for electrifying patients, this may still be seen in his museum in City Road, London.

Wesley's Electrical Machine - it is one of at least four known to have been in his possession - consists of a hollow glass cylinder (7.5in long by 4.5in in diameter) supported on two wooden uprights. Through it runs a metal bar to which a handle is attached, by means of which the cylinder can be freely rotated. A leather pad (to which is firmly attached a piece of black silk) is pressed against the cylinder. It is controlled, very simply, by a thumbscrew. On an attached platform (8in long by 5in wide) and mounted on a glass insulating column, is a metal arm with a thin rod (9.5in long) attached to it, at the end of which is a small metal ball 1in in diameter. The whole 'machine' is mounted on four glass insulating legs (4.5in in height). Presumably the patient caught hold of the ball and as the metal arm made contact with the rotating cylinder, got a shock - the intensity depending upon the vigor with which the handle was turned. Also on view is a Leyden jar of the period, it being 6.5in in height and 4in in diameter. Treatment by this method of storing an accumulated charge was also used, but it is recorded that Wesley himself preferred the machine. Possibly the more vigorous and obvious method appealed to a man of his temperament (Woodward 1962).

John Wesley and Richard Lovett were pioneers, enthusiasts, and ready to apply the use of electricity on every possible occasion, often in the face of much opposition, and not unmingled with attempted ridicule on the part of the medical faculty. The fact that these two were the first English speaking electro-therapists is most worthy of emphatic historical record - more than it has received - when we think of it as the source of that broad and vigorous river that has since flowed with increasing volume for the healing of the nations (Wesley Hill 1958). Wesley's enthusiasm is shown in his praises of this new healing aid - 'a thousand medicines in one, especially for nervous disorders', 'the greatest medicine yet known to the world' (Wesley Hill 1958).

Eighteenth-century treatment for mental illness

Originally priest and physician were one and served the same functions. When more came to be known about the body and its illnesses, a group of practitioners arose who concerned themselves only with the body, whilst all things pertaining to the mind or soul, the immaterial substance, remained the province of the priest. Being neither by aptitude nor training equipped to deal with mind, physicians naturally treated mental patients through their bodies as though they were suffering from physical disease, by whatever means were in general use at the time, whether vomiting, bleeding, issues, sextons or starvation (Hunter 1956). This briefly was the psychiatric scene in the first half of the eighteenth century into which portable electric machines were later introduced. Here was a new ethereal principle that could be felt when passed into the body and seen when drawn off as sparks, which caused strange sensations, had the power of making muscles contract, and paralyzed limbs move. It was hailed as a panacea and tried on every kind of illness whether mental or physical, and excellent results were reported in all sorts of conditions. In 1767, the Middlesex Hospital became the first teaching hospital in London to buy an electrical machine and the first asylum to employ an electrical machine was in Leicester, where in 1788 a room was set aside for electrifying patients (Hunter 1956).

18th Century indications v 20th Century applications

In summary, the disorders in which electricity was according to Wesley of unquestionable use, are shown below.

Wesley's (1769) list of disorders treatable with electricity

Agues - (fevers-malaria)

St Anthony's Fire - (Erysipelas)

Blindness, even from a Gutta Serena

Bronchoscope - (goiter)

Chlorosis - (iron-deficiency anemia)

Coldness of the feet - (?Raynaud's syndrome)

Consumption - (tuberculosis)

Contractions of the limbs

Cramp

Deafness, Dropsy

Epilepsy

Feet Violently disordered

Felons - (Whitlows)

Fistula Lachrymals

Fits, Ganglions, Gout, Gravel

Head-Ach - (headaches and migraines)

Hysterics

Inflammations

Kings Evil - (Scrofula - tuberculosis neck glands)

Knots in flesh

Lameness, Leprosy

Mortification - (gangrene)

Pain in the Back, in the stomach

Palpitation of the Heart

Palsy, Pleurisy

Rheumatism

Ringworms (Ringworm)

Sciatica

Shingles

Sprain

Surfeit - (over-indulgence)

Swellings of all kinds

Throat-sore

Toe hurt

Tooth-ache

Wen - (sebaceous cysts)

"It will be readily observed, that a great Part of these are of the nervous Kind; and perhaps there is no nervous Distemper whatever, which would not yield to a steady Use of this Remedy. It seems therefore to be the grand Desideratum in Physic, from which we may expect Relief when all other Relief fails, even in many of the most painful and stubborn Disorders, to which the human Frame is liable" (Wesley 1759).

And how correct Wesley's (1759) statement seems to be. For if we examine the following list of conditions, which are treatable by electricity, especially in the form of electro acupuncture, as we enter the twenty-first century, we then find that many of the conditions listed are the same as Wesley's, with the exception of infectious conditions, e.g. agues and consumption (tuberculosis) etc.

List of Indications of disorders treatable today

Indications Today

a. acne vulgarism, acutely painful conditions; anxiety states and panic attacks; alcohol addiction; amenorrhea; anal fissure; analgesia during childbirth; angina pectoris; ankle joint pain; arthritis of jaw joint; asthma-bronchial;

b. bleary colic and duskiness; bronchitis - chronic;

c. cardiac neurosis; cardiovascular disorders; cholangitis; collapse; conjunctivitis - chronic; constipation; Cox arthritis; coxarthrosis.

d. deafness; depression; diarrhea; dizziness; drug addiction; Dupuytren's contraction; dysmenorrheal; dysphasia;

e. eczema; enuresis; epicondylitis; exhaustion states.

f. facial paralysis; fainting; fertility-male; frozen shoulder.

g. gastric and duodenal ulcer; gastritis; gastroenterological disorders; gonarthrosis; gynecological disorders;

h. hand pain; headache; hemorrhoids; hemi paresis; herpes; hyper emesis gravid arum; hypertension; hypotension.

i. impotence; intercostal neuralgia; irritable bowel disease;

k. knee joint pain.

l. labyrinthitis; lactation deficiency; leg ulcers; locomotor's disorders; lumbar pain.

m. muscular-skeletal disorders - all; mental disturbances and illnesses; Meniere's syndrome; migraine; motion sickness; ME; MS;

n. neurodermatitis; neurological disorders; nicotine addiction;

p. per arthritis humeroscapularis; peripheral blood supply disturbances; prostitutes; purities vulvae; post herpetic neuralgia.

r. renal colic; respiratory disorders; rheumatoid arthritis.

s. salpingitis; sciatica; sense organ disturbances; sexual disturbances; skin disorders; spondylosis-ankylosing; spondylosis - cervical; sinusitis - frontal and maxillary; stress management;

t. tennis elbow; thorax trauma; tinnitus; torticollis, trigeminal neuralgia and other facial pains including TMJ.

u. urological disorders, symptoms and psychogenic problems;

w. wound healing deficiency; wrist pain/carpal tunnel syndrome.

(after Pomeranz and Stux 1989)

This late twentieth-century listing is even longer and more comprehensive than Wesley's (1759) list, and no doubt he would see in modern orthodox and alternative or complementary medical electrotherapeutic practices a complete vindication of his advocacy of 'electrification'.

Holistic Health Care

It was Socrates who said: "The reason for the frequent failure of Greek doctors is their inadequate knowledge of the whole, the health of which is a necessary condition of that of the part" (Tournier 1957). So from ancient times and through to the present day, the basic understanding of holism requires that the patient is seen as a multidimensional being who, affected by circumstances on one dimension, can have the results of those circumstances appear on another level (Webbern 1996).

Holism: definitions and principles

Holistic medicine is a philosophical approach to the study of man in health and disease. The patient is not just someone with an illness but is a dynamic open ended system, which is intelligent, and constantly maintaining a homoeostatic and balanced environment. The system is an interface between the outer environment and the inner spiritual realms. The principle of holistic medicine is to support the system in its attempts to heal itself. In this context, healing is not only the maintenance of function but also the removal of stress factors from the body/mind system (Blom 1995). This means that, for example, someone with unresolved stress on a mental level (e.g. poverty or unemployment), can show symptoms of that stress on not just an emotional but also a physical level. So, for treatment to be given to cure the physical symptom alone, without attempting to discover and address the cause, is denying the principles of holistic practice and thus the opportunity of curing that patient fully (Webbern 1996).

Wesley's contributions to holistic health care

Wesley did not lack confidence in his beliefs and was able to give to large numbers of patients the assurances that they needed in relation to the simple "certain cures" of which he wrote, whilst developing a reasoned view of which orthodox remedies were harmful. The efficacy of such a simplistic, positive approach in improving the patient's well being is now well recognized. He felt the need for treating the whole person, body and soul, and was thus a proponent of holistic medicine, although in his cautious, critical approach to the current pharmacopoeia, he would not have recognized himself as an exponent of 'alternative medicine' (Cule 1990). The question of whether, or not, Wesley should be regarded as an orthodox medical practitioner or as an alternative medical practitioner will be discussed in some depth later. Nonetheless, Wesley in recognizing that the best treatment is always selective, showed himself to be a thoughtful and safe prescribe within the boundaries of traditional medicine, bearing in mind that in the eighteenth century the new facts of medical science were not enough to provide a firm basis for therapy (Cule 1990). Whilst these observations may be true to some degree, Wesley was also innovative and utilized effective unconventional treatments such as naturopathic treatments, electricity and prayer with considerable enthusiasm.

In keeping with its literal meaning Wesley viewed health as wholeness or 'well-working' and his reading of seventeenth and eighteenth century physicians greatly influenced his perspective on health. For Wesley, the healthy body was critical to the individual's emotional well-being. As he quoted on numerous occasions, a 'corruptible body presses down the soul" (Wesley 1831;6:219) and "in the present state of human existence, when one part of the body is disordered, the total person suffers". This view is also reminiscent of St Paul, "That there should be no schism in the body; but that the members should have the same care one for another. And whether one member suffer, all the members suffer with it; or one member be honored, all the members rejoice with it" (1. Cur. 12:25-26). It may well be that John Wesley's 'Whole' view had a Biblical inspiration (Richardson 1996). In short the body must be kept finely tuned for the good of one's total being (Ott 1989). However, Wesley did not suggest that health of body and health of soul are one and the same, but he did write of a remarkable and mysterious correlation between the two (Ott 1980a). The mind-body issue was considered under the rubric of the union of the soul and body and it was not that he was indifferent on the question of the soul's union with the body. Rather, for Wesley, the union was a mystery (Ott 1980b, note 15). Three themes gleaned from the medical community of his day supporting John Wesley's concept of health as wholeness are examined in some detail by Ott (1991) and are in essence:

1. that the body machine must work as a unit, whose parts are closely related;

2. that disturbance is communicated throughout the whole by 'sympathy' for example the emotions of the mind are capable of bringing about changes in the body;

3. that it is vital to understand the ancient and natural means of promoting healing and health - vis medicatrix naturae - the healing power of nature.

Wesley's commitment to the natural was evident in his consistent stress upon the relation between sensible regimen and good health, within a theological framework which stressed that the individual could live out the biblical mandate to be a good steward of the 'exquisite machine', the body (Ott 1991).

I will move on now to consider Wesley's interest in the passions and their considerable influence on health, "more so than most people are aware" (Wesley 1831;14:316), and his view that until the passions or emotional concerns are brought under control, the use of medicine will be to no avail (Ott 1989). Experience seems to show that violent and sudden passions dispose to, or actually throw people into acute diseases, and that deep and lasting sorrows sometimes weaken a strong constitution and lay the foundations for bodily disorders which are not easily removed. It remains to Wesley's lasting credit that he stressed the inter-relationship of physical and psychic or emotional well-being (Ott 1989). By passions Wesley intended such feelings as love, joy, hatred, sorrow, desire, fear, hope, and "a whole train of other inward emotions". These emotions constitute a "spring of action" for the soul. The opposite, for example, of being 'low-spirited' is completeness, wholeness, being at peace with oneself. If there is no peace, then one's health is in jeopardy, and so as long as the soul and body are united, then the emotions are bound to have their influence on the body (Ott 1980). This emphasis is consistent throughout his writings. (Ott 1989). "A contemporary perspective is that people talk of an age when we are exempt from passion. But the absence of passion really means anticipated death. If the frown of anger is no more, then the smile of pleasure will have gone as well; if there is no more indignation, neither will there be forgiveness; if there is no more anxiety, there will be no more hope either" (Tournier 1972).

Wesley's holistic prescription

John Wesley consistently urged Methodists towards a life-style conducive to good health and towards a programme of preventative medicine and therapeutic interventions, or, for example, a life of physical activity (Ott 1991). Wesley viewed a sensible regimen as the divinely appointed pattern of health and wholeness, and considered health as wholeness could be realized and preserved through the appropriate practice of sensible regimen (or manner of living) and the faithful use of 'that old unfashionable medicine, prayer' (Ott 1989). "Since the love of God, as it is the sovereign remedy of all miseries, so in particular it effectually prevents all the bodily disorders, which the passions introduce, by keeping the passions themselves within bounds. By the unspeakable joy and perfect calm, serenity and tranquillity it gives the mind, it becomes the most powerful of all means of health and long life" (Wesley 1747). On a contemporary level, prayer is still an important intervention for many and is recommended by physicians who practice the 'medicine of the person', especially common prayer in the community of faith which constitutes the Church, and which can often have psychological effects very similar to those of a medical cure. "In it I can feel that release of new life which renews my entire being. I can discover my person, my true feelings which have been held back or repressed until then, my likes and dislikes, my aspirations and my true convictions" (Tournier 1957). "Prayer may be said to be the breath of our spiritual life. He that lives cannot possibly cease breathing" (Wesley 1961;I). A Christian prays always, at all times, and in all places, and 'with all sorts of prayer, public, private, mental, vocal (Wesley 1765: Eph.6.18), and with the four parts of all prayers: deprecation (pleading for forgiveness and mercy), petition (asking), intercession (praying for others) and thanksgiving. Prayer prepares and enables him who prays to receive God's blessings (Wesley 1961;I - and after Borgen 1988).

Discussion

Eighteenth-century medical knowledge was still medieval medical knowledge, and we know that in this era there were few doctors in England who had attended medical school. The most enlightened physicians of Wesley's time placed the vis medicatrix naturae centrally in their therapy, and used such methods as they thought would assist and not hinder her healing power. However, Wesley's view of health and disease was essentially theological, and he was not content to think purely in terms of nature's healing, but looked beyond to the author of nature, deeming him to be wholly desirous of the good of his creatures (Wesley Hill 1958). By and large contemporary medical men despised Wesley and his work. The Establishment contempt was doubtless due to the fact that Wesley was not properly qualified, made little or no charge for his services, and was hugely successful (Menzies 1980).

Wesley as a physician or as an holistic alternative medicine practitioner

Wesley lived in a time of much illness when rapacious medical frauds seemed to be the rule rather than the exception. He studied medicine, which was no great task in his age, and then happily withstood, perhaps even invited, the criticism of practitioners. He was as qualified as most of the physicians of his time, and more so than many of them (Stewart 1969). But was John Wesley really qualified to practice medicine? If we consider his own list of requirements, published in 1748, for the practice of medicine, then it is evident that he did not meet them all (Bardell 1979):

1. "Seeing life and health are things of so great importance, it is without question highly expedient that physicians should have all possible advantages of learning and education".

2. " That trial should be made of them by competent judges before they practice publicly".

3. "That after such trial they should be authorized to practice by those who are empowered to convey the authority".

4. "And that while they are preserving the lives of others, they should have what is sufficient to sustain their own (Wesley 1931;II).

Wesley, however, believed that he was qualified as he satisfied the first requirement, stating that "for six and twenty years I made anatomy and physic the diversion of my leisure hours; though I never properly studied them, unless for a few months when I was going to America where I imagined I might be of some service to those who had no regular physician among them" (Wesley 1931;II). Wesley Hill (1958) also suggested that "The title Physician may rightly be granted to John Wesley because of his medical knowledge and skill," and more recently Cule writes: "his only unorthodoxy was the lack of any medical qualification, but he avidly read the works of those who had" (Cule 1990).

What authority had Wesley to take upon himself the role of physician? He acted on his own authority. He felt within himself the power or ability to meet the needs presented to him in the absence of many regular medical men, and with the inability of the poor to afford medical treatment - treatment which was most often inadequate and useless if not actually dangerous (Wesley Hill 1958). Nonetheless it was Wesley's theology which was the greatest single factor in fashioning the physician in him. Behind all he did there lay a certain view of God, of a universe whose supreme values were spiritual. He sought to heal men and women because he believed that he was thus fulfilling a God-given mission (Bowmer 1959).

Dr Wesley Hill, a medical doctor, goes on to describe John Wesley as a great amateur physician. His immense, up to date medical knowledge, his sound sense, practical skill and sense of vocation, his advanced teaching of hygiene and physiological methods of cure, his readiness to break new therapeutic ground, his downright denunciation of the senseless blood-letting so popular with his contemporaries, his stricture of meaningless polypharmacy, his castigation of those evil-smelling concoctions and medicaments derived from filthy sources - all this adds up to a considerable total, especially when it points straight along the path that medicine has since travelled (Wesley Hill 1958:32). These views seem quite acceptable in the light of mid twentieth-century knowledge. As we approach the twenty-first century, and in view of the recent developments in the acceptance and practice of alternative and complementary medicine, I would like to suggest a fresh interpretation in that we could more accurately describe John Wesley as a great holistic alternative or complementary medicine practitioner rather than an orthodox medical practitioner.

The BMA in 1986 used the term 'alternative' to describe medical systems that are based on beliefs about the nature and causation of disease which are at variance with or antagonistic to current orthodox knowledge (Bakx 1991). The report also uses the word 'alternative' to qualify the word therapy. Here, the latter is only regarded as 'alternative' if it is worthy of use as a complement to, or a substitute for, orthodox practices. Wesley's practice of theological medicine, including the use of prayer, was certainly at variance with the orthodox humoral theories of the day. His therapies were usually used as a substitute for rather than to complement the more toxic orthodox treatment in vogue at this time. In this respect the use of monopharmacy rather than polypharmacy, electrotherapy rather than bleeding and blistering, prayer rather than purging and puking was prescribed, and this more gentle approach was denigrated by the orthodox practitioners of his time. Interestingly, the last two decades of the twentieth-century have seen a patient-led return to these less toxic treatments, including electrotherapy in its many guises. This is now to be found in conventional orthodox medical and physiotherapy techniques such as Transcutaneous Electrical Nerve Stimulation (TENS) and Interferential - electrical stimulation therapy - using several different currents, as well as in alternative and complementary techniques such as electro-acupuncture and Acupuncture-Like TENS (ALTENS) - a situation, that I am sure would have been warmly welcomed by John Wesley himself!

Holistic medicine

John Wesley realized that peoples' minds affected their physical, as well as their spiritual, life. He taught that it was not fear of sickness or death, but the fear of just being human that was the most prevalent and destructive fear of all (Wilder 1978). He consistently urged the Methodists towards the sound practice of the six non-naturals but his emphasis on the relationship between the non-naturals and good health also mirrored a long-standing conviction of the orthodox medical community. Wesley, however, enveloped this commonly accepted opinion in a theological framework which stressed, among other points, that sensible regimen was the divinely appointed pattern for a life of health and wholeness (Ott 1980a).

In 1955 Wesley Hill had examined the question, was John Wesley a medical Methodist? Medical Methodism was a school of medicine founded around AD 60, and which claimed a method by which medicine was made easy to understand. However, perhaps the closest connection between Wesley and those early medical Methodists, lay in their common belief in the efficacy of the physical means of diet and exercise as a therapeutic regimen (Wesley Hill 1955).

Throughout his writings, Wesley developed the theme of health as wholeness, i.e., a well-working of the whole. Well-working was the hallmark of the original created order. Though tarnished by Adam's disobedience, mankind is still endowed with an "exquisitely wrought machine", designed to function properly within the limits of mortality (Ott 1980b); in Wesley's mind, holiness, happiness and health moved closely together (Rack 1982).

Wesley appeared to have had very little use for contemporary orthodox medicine. He set up an empirical system that, if we judge by popularity alone, worked at least as well as its more orthodox rival (King 1958). 'Primitive Physick' was his great contribution to the simplification of what he saw as the best and safest in current therapy (Cule 1990), for he was a practical individual who, in medicine, wished to remain on a very simple level. There are several features of prime interest that characterize Wesley's therapeutic approach. For one thing, we note his devotion to frugality with drugs, a feature that must have infuriated the gentlemen of the faculties of medicine at the universities, and perhaps also the apothecaries who made their living selling medications. Also notable is his strong tendency to pragmatism in therapeutics. He was obviously in favour of whatever worked, and he would cheerfully recommend certain treatments as being strictly tried and tested, often on himself. Another feature was that he obviously used the principle that almost any sort of intervention is therapeutic, provided it is harmless and the sufferer believes that it has a chance of helping. The very simplicity and straightforward practicality of his treatment was inherently effective in many cases. The faith of the patient in the therapy is of the greatest importance (Stewart 1969). But perhaps the most important single feature in Wesley's therapeutic approach was his unconscious utilization of a precept that he could not have known or defined, i.e. 'homoeostasis', a concept formulated by the physiologist W B Cannon in 1939.

Dr. Cannon states that there are mechanisms operating to keep certain physiological variables, such as concentrations of body fluids and electrolytes and temperatures and pressures, within limits consistent with the normal function of the organism (Stewart 1969). A good medical therapy is one designed to supplement this natural mechanism, supporting and strengthening it, and never rendering it inoperative. Wesley seemed to have a feel for homoeostasis (Stewart 1969).

Wesley also felt that medicine should be freely available for all, irrespective of ability to pay, and that those dealing with the sick had to take the whole patient into account. Further, he emphasised the importance of a healthy, nonindulgent, temperate life-style. He seems to have been careful to treat chronic rather than acute cases and to refer complicated ones to a physician or apothecary engaged for his dispensary (Rack 1982).

Empiricism

As Wesley assessed the matter, the trend of eighteenth-century medical care was away from the experimental or empiric approach to a rational or theoretical discipline, Consequently, "simple medicines were more and more disregarded and disused, till in a course of years, the greater part of them were forgotten". In place of simple remedies, physicians introduced an abundance of compound medicines consisting of so many ingredients, that it was scarce possible for common people to know which it was that wrought the cure. Such a practice of compounding medicines, Wesley argued, can never be reconciled to commonsense. Experience shows that one thing will cure most disorders, at least as well as twenty put together. As for the tendency to compound medicines, it can be "only to swell the apothecary's bill. Nay," Wesley added, " possibly on purpose to prolong the distemper, that the doctor and the apothecary may divide the spoil" (Ott 1980b). Judging by his discussion of approaches to medicine he regarded himself as a good 'empiric', following methods of trial and observation rather than tortuous classical theories of disease (Rack 1982). Choice of treatment for a disease had perforce to remain empirical until the cause of that disease was known, when a remedy appropriate to it could be applied. Of course empiricism of itself is comforting. Whilst it relies on experience, it is supported by faith and dogma and is perpetuated by the mystery and power of the medical practitioner (Cule 1982:328). However, one may leave the ultimate comment to Wesley as he dryly remarked that "those who understood only how to restore the sick to health, they branded with the ignominious name of empirics" (Wesley 1747).

Electrotherapy

Though unqualified practitioners, both Wesley and Lovett had a very real and genuine belief in the efficacy of electrical treatment, and their enthusiasm did a great deal for the early development of a science of which they were the first known practitioners in this country. Moreover, their work and their writings survived them for many years, and were frequently quoted by their qualified successors. Priestley in his book 'The History of Electricity' credits their work and concludes that "if in such unskillful hands it produced so much good, and so little harm, how much good, and how much less harm would it possibly have produced in more skilful hands!" (Turrell 1921). "What an amazing scene is here opened for after-ages to improve upon!" (Wesley 1909), and how well this statement fits in with Wesley's life work too. These words were the prophecy of the wondrous increase in knowledge and practical application of electricity that has come about since these simple beginnings were made in the use of electricity in the healing art. The fulfillment of this prophecy is seen in the host of subtle diagnostic devices and the wide rage of curative procedures available as aids to the modern physician (Wesley Hill 1958), and how much more so in the late 1990s. Wesley, by early 1753, had formed a clear thesis from which to consider and then confront the subject of electricity and the process of electrification. Wesley approached the project with characteristic order and thoroughness, but Rogal suggests that he can hardly be identified as a pioneer in the administration of electricity for medicinal reasons. He carried forth the project more because of his faith in the phenomenon rather than his substantive knowledge of the healing arts; the Methodist leader attempted to compensate for his lack of knowledge and training by depending upon the work and the publications of more experienced predecessors and contemporaries who had practised healing the sick and the lame with various forms of electrical treatment (Rogal 1989).

Whilst these statements may be true to some degree it cannot detract from the great contribution that Wesley made to the practice of electrotherapy in the eighteenth, nineteenth and twentieth centuries and, dare I suggest, that of the twenty-first century too. His famous electric shock treatment can be cited as evidence of modernity, though in the eyes of a modern theologian it was used more like a quack's panacea (Rack 1982). Again I would argue that there is evidence that Wesley's electrotherapy was far in advance of his time by at least two and a half centuries! One only has to compare the two charts given earlier comparing the therapeutic application of the eighteenth-century with the twentieth-century to find a common theme. Had he just been a charlatan then he would have advocated electrical treatment for every kind of illness. Whereas the main applications for both eighteenth-century and twentieth-century practitioners would appear to be for musculoskeletal, neurological and psychological problems, and I have no reason to doubt that this will continue through into the twenty-first century.

Implications for 20th and 21st Century research and practice

The medical historian, like the physician, must seek out those past events, connections, meanings, and background which enter significantly into the present, as parts of its living fabric (King 1958). The divine influence of John Wesley lives on to the present day not only through the millions of members of the Methodist Church but also through his major contributions to holistic health care and preventative medicine. The implications of this work for the twenty-first century will now be considered.

Whether we should regard John Wesley as a 'quack' or accept him as an orthodox practitioner may be an open question, but what we cannot do is to ignore his safe and holistic approaches to eighteenth-century medical therapeutics in the form of simple medicines, naturopathic techniques, health prevention and electrotherapeutic procedures. Moreover, his approach anticipates a trend that is once again to be seen in evidence in the Western world. His stated interest in the experimental approach is also worthy of note, albeit bearing little resemblance to contemporary research, but he would surely welcome and endorse the world's current research programme into health care and not least in electrotherapy.

Wesley's holistic practice of medicine may also