Incredible though it may seem, if you catch the plague, old and poor women will volunteer to be boarded up with you, to clean, cook and look after you.48 There is a good chance that they too will die; but they will be very well paid – as much as 6s 8d or even 8s per week.49 Six weeks’ isolation at 6s 8d per week is £2: this is the poor woman’s equivalent of the miner’s reward for breaking through the sough into a flooded mine and risking death in return for £2. But when those boards are nailed over your door and windows, plunging you into that dim purgatory between death and recovery, you could be incarcerated in your home for several months. In the case of Thomas Smallbone, of Bucklebury in Berkshire, both he and his mother-in-law die, followed by his son and wife, after which the house is inhabited by just his two remaining children and the servants. You do not want to imagine the plight of the children, especially when they too start shivering with fever. The house remains boarded up for eight months: only the servants survive.50
Given these circumstances, you can understand why some plague victims take extreme action. According to the register of Malpas, Cheshire:
Richard Dawson, being sick of the plague and perceiving he must die at that time, arose out of his bed and made his grave, and caused his nephew, John Dawson, to cast straw into the grave, which was not far from the house, and went and laid himself down in the said grave, and caused clothes to be laid upon [him], and so departed out of this world.51
OTHER DISEASES
The range of diseases suffered in Elizabethan England is considerable, perhaps as great as that experienced in the modern world. Your own cautious approach to sanitation should save you from the ‘bloody flux’ (dysentery), the ‘burning ague’ (typhus) and typhoid fever. Your knowledge about vitamins C and D should protect you from scurvy and rickets. There are many occupational illnesses that you will know to avoid, such as mercury poisoning from manufacturing mirrors, and lung diseases from working in mines. But there will be some illnesses that you cannot avoid. Tuberculosis is common and incurable; it is passed from one sufferer to the next in the breath. If you suffer from some form of mental problem you will find that people talk about you as ‘frantic’ – but they will have very little idea what to do. One option would be to send you to the Hospital of St Mary of Bethlehem, otherwise known as Bedlam, just outside London, which looks after a small number of the insane for a fee. Another is to provide a keeper, lock you away in a room with your head shaved (to cool your brain), carefully monitor your diet and occasionally bleed you by a vein in your head.
There is insufficient space to discuss every disease but two perhaps should be mentioned – the two ‘poxes’, smallpox and the great pox. The first treatise on smallpox, published by Simon Kellwaye in 1593, states that the cause is ‘alteration of the air, in drawing some putrefied and corrupt quality into it, which doth cause an ebullition of our blood’. The disease is carried in the pus of pustules and the ‘dust’ from drying scabs, so it is indeed wise to treat the air around sufferers as dangerously ‘corrupt’. If you catch it you will experience high fever, muscle pain, severe headaches, vomiting, diarrhoea and you will find that a mass of virus-filled pustules erupt over your face and body. In Elizabeth’s reign, however, it is generally considered a children’s disease, like measles, with which it is often bracketed by physicians. Although it often kills children, it is rarely lethal for adults in Elizabethan England; the queen herself survives a serious attack in 1562. Only in the 1630s will it become a terrifying killer, fatal to adults and children alike, and feared as much as the plague. Even so, you do not want to catch it; it leaves a mass of disgusting pocks or marks on your face and body, so that even surviving it can be horrific.
The other pox is the great pox, also known in England as the ‘French disease’. This too is a disease which changes over the course of time. When it first came to Europe from the New World in the 1490s it would kill you in a few weeks. By 1558 it has evolved into the infection you know today as syphilis, which causes nasty sores on the private parts and other areas of the body, but which people can live with for decades. It is transmitted mainly by sexual intercourse or, less frequently, in the womb, from infected mother to child. William Clowes, the surgeon who publishes a treatise on it in 1585, understands its origins perfectly well: ‘I wish all men generally, especially those that be infected, to loath, detest, hate and abhor that stinking sin that is the original cause of this infection.’52 As you can imagine, that is something of a vain hope in Elizabethan England. Attitudes towards women do not help: we have already heard of Katherine Vardine of Norwich, who is saved from her master’s venereal disease by a court decision. The physician Simon Forman is another man who uses his position to secure sexual satisfaction, seducing a large number of women who come to him for medical and astrological advice. (Now you can see why he did not like his room to smell of the privy.) It does not matter to him whether they are married; he seems to relish writing down the names of the husbands he has cuckolded. His medical notes reveal that he sometimes has sex with several different female patients in one day. Small wonder that syphilis continues to plague society.
Sex also tends to lead to pregnancy. Obviously this is not a disease, but childbirth can easily result in complications and put the woman’s life in danger. Normally the birthing chamber is a female-only space, where midwives attend the woman in labour; men are not welcome. Giving birth is also a social occasion: a close female friend will feel slighted if you do not invite her to witness the event. However, when things go wrong, physicians and surgeons may be called upon. But very often there is nothing that can be done. Forceps are unknown. Caesarean sections are invariably fatal for the woman. Two per cent of all confinements end up with a dead mother.53 Giving birth to five children thus represents approximately a one-in-ten risk of death; yet many women give birth ten or times or more. As for painkillers, it is highly unlikely that anything effective will be provided. With so much pain and death, you have to wonder whether any children would be born at all if society were not dominated by men.
Medical Care in the Home
What do you do when you fall ill? In Elizabethan times, as now, you do not necessarily seek professional medical advice straight away. If you know what is wrong with you, you will know what sort of help you need – whether that be your spouse or your mother, a specific medicine from an apothecary or a professional physician or surgeon. If things are really bad and you think you may die, you will not ask for a physician but a clergyman, as the salvation of your soul will take priority. If, on the other hand, you do not know what is wrong with you, you will engage the most appropriate help stage by stage. First you will start with the medical knowledge available in the home, which might be quite extensive. If that is inadequate you will seek help from the women in the community and those unofficial medical men who sell ‘cures’ – ready-made medicines guaranteed to help any ailment or a specific condition. Only after all of those have failed will you send for a medical practitioner from the nearest town.
Medical help therefore involves several stages of amateur assistance. A housewife is expected not just to be a cook, mother, cleaner, seamstress and (in the country) a farmhand, she also needs to be an amateur physician. This is especially the case in medical backwaters like Romney Marsh, where there are no resident physicians. In such places women are expected to pool their knowledge and experience, and to share recipes for medicines that they have found to be efficacious. Printing has changed the medical landscape, for there are now many self-help books available which contain medical recipes. These go through many editions and are read by a succession of different owners. People borrow books and copy out the medical recipes, if they can write; so you don’t even need to own one. This is another good reason for women in this period to teach themselves to read – so they can assemble a larger body of knowledge with which to care for the family.
The homely remedies you will find in a self-help book vary enormously in nature and scope. Most of those in Thomas Dawson�
��s The Good Housewife’s Jewel (1585) are general-purpose medicines, such as ‘a strong broth for a sick man’ (powdered almonds, the brain of a chicken and cream, seasoned with sugar) or ‘a caudle to comfort the stomach, good for an old man’ (a pint of muscadine, stale ale, egg yolks, sugar and mace all boiled together, with bread soaked in it).54 Dawson’s ‘medicine for all manner of sores’ consists of seaweed, turpentine, olive oil, sheep’s fat or deer’s suet, bugloss juice, parsley juice and rosin all boiled together, then strained.55 A substantial minority of recipes in such books – between 10 and 20 per cent – incorporate animal parts or excrements, in the spirit of medieval medicines. Dawson, for example, recommends a recipe for broken sinews that starts ‘take worms while they be nice … stamp [i.e. crush] them and lay it to the sore, and it will knit the sinew that be broken in two’. His recipe to use on shortened sinews begins ‘take the head of a black sheep, camomile, sorrel leaves, sage, of each a handful, and bray these herbs in a mortar …’ Should you not fancy black sheep’s head in your medicine, here is an alternative ointment:
Take eight swallows ready to fly out of the nest. Drive away the breeders when you take them out, and let them not touch the earth. Stamp them until the feathers cannot be perceived in a stone mortar. Put to it lavender cotton, of the strings of strawberries, the tops of wild thyme, the tops of rosemary, of each a handful. Take all their weight of May butter and a quart more. Then make it up in bales and put it into an earthenware pot for eight days close stopped, that no air take them. Take it out and, on as soft a fire as maybe, seethe it so that it do but simmer. Then strain it, and reserve it to your use.56
All in all, the hearty broths in Dawson’s book sound far more health-giving than his medical recipes.
John Partridge’s The Widowes Treasure is aimed at older women who make a living from providing medical assistance. We have already heard of women looking after plague victims, but it is important to realise that they are not just opportunists desperate for money: they are experienced women who will travel to the next parish to attend a sick person if so required. They are not called nurses at this time – ‘nursing’ means wetnursing – but they tend the ill in much the same way as a nurse would: cleaning bedclothes, feeding the patient and generally helping at the bedside. Normal payment for attending a seriously ill person is 4d per day and 4d–6d per night.57 The recipes with which Partridge provides these women include everything from therapeutic drinks to aid passing water, to ointments and extreme medicines for people suffering from fatal diseases. To help a person get to sleep he advises: ‘Take a spoonful of woman’s milk, a spoonful of rosewater, and a spoonful of the juice of a lettuce, boil them in a dish. Then take some fine flax and make your plaster as broad as you will have it lie on your forehead, then moisten it with the same liquor and grate a little nutmeg over it.’58 For toothache he advises you to ‘take roots of henbane sodden in vinegar and rosewater, put the decoction in your mouth’. A recipe for killing body lice involves quicksilver (mercury) in grease rubbed into a linen belt tied around the patient; another for the same purpose suggests anointing the lice-ridden sufferer with powdered frankincense mixed with boar’s fat.
Things could be worse. In parts of the country you will come across superstitious practices, such as lowering an infant with whooping cough into a cesspit and holding him there in the corrupt air. Snakeskin is widely thought to be a remedy for a number of diseases and, according to William Horman, so is the ‘unwashed wool that grows between the hind legs of a black sheep’. I doubt you will find anyone who can explain the medical reasoning behind that last one. It makes the theory of the humours look reassuringly sophisticated.
Medical Practitioners
If you have tried all the available local help and are still suffering, your next resort will be to a professional medical practitioner. There are three categories, which slightly overlap. A physician diagnoses and treats illnesses that occur within the body; a surgeon treats broken limbs and the surface of the body, including any wounds and ulcers; and an apothecary provides medicines and ointments for both inward and outward use. Apothecaries are often connected to a physician, who will direct you to collect the medicines that he prescribes from ‘his’ apothecary. Strictly speaking, an apothecary is not qualified to diagnose your condition, but if the cause of your suffering is obvious he may well sell you something to ease the pain or cure it.
At the start of the reign you will find very few qualified medical men. Most physicians are unregulated and, unless you can afford the services of a university-trained doctor of medicine, you may be better off with a barber-surgeon. But Elizabeth’s reign witnesses a great surge in the numbers of men qualifying as physicians and surgeons; by 1603 there are more than two thousand medical practitioners in the country.59 In addition, the immense popularity of self-help books leads to a demand for specific medicines, and so more apothecaries open up shops. At the end of the reign there are about 190 physicians, surgeons and apothecaries practising in the diocese of Canterbury alone – one practitioner for every 400 people, not including midwives and wetnurses. The same proportion can be found in London.60 Although not every region in England has as many practitioners as the south-east, the ratio does not compare badly with modern medical provision: at the time of writing, the United Kingdom has one medical practitioner for every 250 people.61
Physicians and surgeons can be qualified in a variety of ways. The most highly qualified are those who have studied at a university and gone on to read for a medical degree, either a Bachelor of Medicine or a doctorate in medicine. There are only about a hundred such men in the country, due to the length and cost of the training, which is especially expensive for those who study at a foreign university, such as Leiden, Basel, Padua, Heidelberg, Bologna and Montpellier. The most eminent of all are the fellows of the College of Physicians in London. In 1572 there are eighteen of them, their number growing to thirty by 1589.62 They supposedly oversee medical practice throughout the kingdom and take action against unlicensed physicians and surgeons. In reality, however, it is only Londoners who tend to fall foul of the College’s monopoly-protecting court.
A licence is a different sort of qualification, granted not after training but after acquiring sufficient practical experience. Practitioners can obtain one from the College of Physicians or a university, but the great majority are licensed by a bishop. Surgeons may also be recognised officially by joining a city’s company of barber-surgeons, membership of which is attained by serving an apprenticeship and passing an examination.63 However, in the south-east only just over half of all the physicians and surgeons are licensed, university-trained or have served an apprenticeship. In the West Country and in the north, even fewer practitioners are qualified.64 You will also notice that there are many part-time ‘physicians’, men who combine their medical work with other occupations. William Clowes, a professional surgeon, is rather disparaging of such amateurs. In his book on syphilis he expresses astonishment at how medicine and surgery are abused by ‘painters … glaziers … tailors … weavers … joiners … cutlers … cooks … bakers … chandlers … tinkers, toothdrawers, pedlars, ostlers, carters, porters, horse-gelders, horseleeches, idiots, apple-squires, broomsmen, bawds, witches, conjurers, soothsayers, sow-gelders, rogues, rat-catchers, renegades and proctors of spittle-houses, with such other like rotten and stinking weeds’.65
In Elizabeth’s reign every full-time apothecary and surgeon is based in a town, and so are most licensed physicians. This has led some modern historians to presume that you cannot get medical help in the country.66 Don’t believe them. Norwich has at least seventy medical practitioners (one for every 200 people in the city), and Canterbury has about forty (one for every 125 citizens), so it is certainly much easier to obtain medical help in an emergency if you live in a town; but surgeons and physicians do travel out to see their patients in rural areas. In the case of Canterbury’s physicians, about half their business lies outside the city.67 In addition, sick people send fri
ends or servants to the apothecaries in towns to pick up medicines, just as we do today. In rural counties in the north and the West Country, however, where practitioners are much scarcer, people travel far further for medical help. They are also more inclined to make do with the medical knowledge in the community.68
Will any of these people actually be able to help you if you fall ill? Given the widely accepted ideas about the humours of the body, the positions of the stars, the eagerness with which a surgeon will bleed you, and the seriousness with which a physician will look at and sniff your urine, you may doubt it. However, you should not ignore the fact that the popularity of medicine is increasing with enthusiasm, not decreasing with cynicism. Faced with a serious illness, large numbers of people will pay substantial amounts of money for medical help. On average a physician in 1600 will receive 13s from a wealthy client and 10s from a less well-off one. An apothecary will charge 20s and 8s respectively, the less-prosperous patients being prescribed cheaper medicines. These are large sums of money by most people’s standards, and they show that people put faith in their physicians. Those that survive serious illnesses such as typhus and smallpox, and have the scars of their pustules treated successfully, will tell you that it is money well spent.69 Whether you will agree is likely to depend on what you are prescribed. If you are suffering from gout and a physician prescribes colchicum, you are likely to be satisfied: the same remedy is still in use today. You are in good hands if he gives you aniseed for gastric wind or a cough; again, this remedy is still in use today – as are many herb-based medicines from the period. However, you will be less pleased if, at great cost, he tells you to take powdered Egyptian mummy (mummia): this is every bit as dubious as Horman’s unwashed sheep wool. And as for Sir Hugh Plat’s remedy of ‘the powdered skull of a man killed in war’ as a cure for tertian fever – I would seek a second opinion. In fact, seek it from the Stratford physician John Hall for an emetic infusion and syrup of violets, which is what he uses to cure the poet Michael Drayton of the same disease.70
The Time Traveller's Guide to Elizabethan England Page 36