The day first became associated with romantic love within the circle of Geoffrey Chaucer in the 14th century, when the tradition of courtly love flourished. In 18th-century England, it grew into an occasion in which couples expressed their love for each other by presenting flowers, offering confectionery, and sending greeting cards (known as «valentines»). Valentine’s Day symbols that are used today include the heart-shaped outline, doves, and the figure of the winged Cupid. Since the 19th century, handwritten valentines have given way to mass-produced greeting cards. In Europe, Saint Valentine’s Keys are given to lovers «as a romantic symbol and an invitation to unlock the giver’s heart», as well as to children to ward off epilepsy (called Saint Valentine’s Malady).