At the same time the medical profession was becoming more respected. At the beginning of the sixteenth century there were still only a very few physicians who held a university degree, and of these most had taken a degree without actually examining a patient. There were even fewer surgeons who had obtained a licence from a university after having satisfied the authorities as to their competence. Most of those practising the craft were barber-surgeons, belonging to different guilds and allowed only to operate locally. Apothecaries were also grocers and pepperers. By the end of the century all this had changed.
The first step was taken in 1511 with a Medical Act whose preamble stated the problem with which it intended to deal:
Physic and Surgery is daily within this Realm exercised by a great multitude of ignorant persons as common artificers, smiths; weavers and women who boldly and customably take upon them great cures and things of great difficulty in the which they partly use sorcery and witchcraft to the grievous hurt, damage, and destruction of many of the King’s liege people.12
The Act required all physicians and surgeons to be graduates of a university or to be licensed by a bishop after examination by experts. Those who continued to practise in defiance of the Act were liable to be fined £5 a month. Shortly after this, Thomas Linacre, the king’s physician and translator of Galen, who held a medical degree from Padua, obtained a royal charter authorizing him to establish a Company of Physicians. This company, whose meetings were held in Linacre’s house near St Paul’s, later became the Royal College of Physicians, the oldest medical institution in England. It was authorized to examine and grant licences to physicians throughout the country.
Soon after its establishment, the king’s surgeon, Thomas Vicary, was granted permission to amalgamate all the various guilds of barbers and surgeons into one United Company of Barber-Surgeons. In the eighteenth century the surgeons were to leave the barbers and to form the Company of Surgeons which in 1800 became the Royal College of Surgeons of England. But, although united in name in 1540, the two practitioners had different crafts assigned to them: the surgeons operated on the body, the barbers on the teeth. Later, the apothecaries followed the example of the surgeons and the physicians by separating themselves from the ancient Grocers’ Company and by setting up the Society of Apothecaries.
By then the hospitals of the country had also been reformed.
Numerous hospitals had been built in England since 1123 when Rahere had founded St Bartholomew’s Hospital in London in fulfilment of a vow he is supposed to have made when recovering from malarial fever in a hospice on the Tiber island of S. Bartolomeo in Rome. By 1300 there were some 750 hospitals of various kinds in England. Many were established by the Church, others by trade and professional guilds, some, like Bartholomew’s, by private benefactors. In addition to these, infirmaries were maintained by abbeys and monasteries. But these, as the medical historian Frederick F. Cartwright has observed, were mainly for the religious houses’ own sick and aged brethren and only occasionally for travellers and strangers, the part played by the monastery in caring for the laity having been overestimated in the past, and the function of the parish church and priest being virtually overlooked. Churches, in fact, were often used as hospitals, the patients being crowded into the aisles in time of pestilence; and the more conscientious clergy considered it part of their duty not only to visit the sick but to use what medical knowledge they had in order to treat them. When hospitals were built, they, like manorial halls, frequently followed the design of churches, with beds in the aisles, perhaps divided into cubicles, a day-room in the centre where the nave of the church would have been, and a chapel at the east end.13
The treatment in these hospitals was necessarily primitive. Patients were commonly nursed by those less ill, though in some hospitals and infirmaries there were paid attendants. The doctors, intent upon the care rather than the cure of their charges and generally clinging to the orthodox Christian view that illness being divinely inflicted must be supernaturally alleviated, rarely administered any medicaments, relying upon the soothing qualities of various herbs and spices to bring relief. The remedies, potions, elixirs, nostrums and panaceas of itinerant quacks, such as decoctions of hog-lice as a cure for consumption, were, therefore, much sought after by the sick while the services of outside surgeons and barbers were necessary when any operations, including the usual blood-letting, were to be performed. These surgeons were laymen since churchmen, by decree of the Council of Tours of 1163, were forbidden to practise any treatment involving the shedding of blood; and while not actually forbidden – though it has been widely held to have been so because of a misreading of a papal bull prohibiting the boiling of the corpses of crusaders so that their bones could be more easily returned home for burial – dissection was disapproved of by the Church which believed in physical resurrection. The Church, indeed, disapproved of the study of medicine generally by clergy since the body was not a matter for their concern and ‘men vowed to religion should not touch those things which cannot honourably be mentioned in speech’. The early twelfth-century Abbot Faricius of Abingdon was considered unsuitable for a bishopric because he had practised as a physician before he became a monk.
At universities, which were under the jurisdiction of the Church, medical teaching was almost exclusively oral, consisting of the reading of and commenting on inaccurate Latin versions of Greek and Arabian writers; and for anatomical instruction the student had to rely upon surgical works in manuscript or upon private tutors. This contributed to extraordinary errors of belief, it being generally held that the stomach was a kind of cauldron in which food was cooked by the heat of the liver and that in the words of Bernard de Gourdon, professor at Montpelier, the stomach ‘possesses the power of attracting food to itself.
Yet if anything approaching expert surgery could not be expected in early medieval hospitals, most of those received into them were not in need of surgery anyway. The varieties of patient admitted into such a hospital as St Bartholomew’s or St Thomas’s, also originally a twelfth-century foundation, were described by Robert Copland’s gate-porter:
They that be at such mischief
That for their living can do no labour
And have no friends to do them succour:
As old people sick and impotent,
Poor women in childbed here have easement,
Weak men sore wounded by great violence
And sore men eaten with pox and pestilence,
And honest folk fallen in great poverty
By mischance or other infirmity;
Wayfaring men and maimed soldiers
Have their relief in this poor-house of ours;
And all others which we deem good and plain
Have their lodgings here for a night or twain;
Bedrid folks and such as cannot crave
In these places most relief they have,
And if they hap within our place to die
Then are they buried well and honestly.
But not every unsick stubborn knave
For then we should over many have.14
Most hospitals in England, however, were as ready to open their doors to all those in need of their protection as St Mary’s, Chichester, which was founded in 1172 and which undertook gladly to receive and assign a bed to ‘anyone in infirm health and destitute of friends … until he shall recover. In regard to the poor people who are received late at night and go forth early in the morning, let the warden take care that their feet are washed and, as far as possible, their necessities attended to.’ Most hospitals also undertook to take care of sick and weary travellers and pilgrims; and many were accordingly established on the roads to such places as Canterbury and Walsingham.
All over the country there were hospitals for lepers, perhaps as many as 100 in all, leprosy being so dreaded a disease from the tenth until the fifteenth century that, although probably no more than five in 1000 of the population suffered from it at any one time, it was treated as a crime and
sufferers from it as outcasts under the statute De Leproso Amovendo. Archbishop Lanfranc built a leper hospital for over 100 lepers at Harbledown near Canterbury, but most lazar houses – as they were called after the beggar who, in the parable recorded by St Luke, lay at the rich man’s gate ‘full of sores’ – were small establishments caring for less than forty sufferers; many had less than five inhabitants; twelve was considered ideal, this being a number coinciding with that of Christ and his eleven apostles. They were often endowed with land so that the inmates could be largely self-sufficient. The hospital dedicated to St James the Less, Bishop of Jerusalem, a lazar house for young women which was transformed by King Henry VIII into St James’s Palace, had extensive grounds in what is now St James’s Park where the lepers kept their hogs. Other leper hospitals possessed farmland, sometimes tilled by labourers who did not suffer from the disease, the only outsiders whom the inmates ever saw, apart perhaps from the occasional glimpse of a procurator who went about collecting money for their maintenance. The master or warden was generally a leper himself, so were the prioresses who governed the lazar houses for women and the segregated parts of those hospitals where both sexes were accommodated, usually in groups of primitive cottages around a chapel situated near a mineral spring whose waters might alleviate, though never cure, the disease. Conditions in all lazar houses were unpleasantly severe. In 1313 the inmates of a lazar house at Kingston rioted against the strictness of their regime and destroyed their own hospital. It was not only that their movements were so closely watched, but also that the futile attempts at curing their disease were so unpleasant. Being washed in the curative waters of a holy well, such as that beside which the leprosaria was built in the Leicestershire village of Burton Lazars, was no doubt perfectly unexceptionable. After all Naaman, the leprous captain of the host of the King of Syria, had been cured, as recorded in the Second Book of Kings, by dipping himself seven times in the waters of Jordan. But painful plastering, restricted diets, blood-letting and purging were also regularly prescribed, as was a remedy concocted from leeks boiled with adders.15
Once diagnosed as a leper by a jury or a panel of clergy, the leper was outcast from society; and a special Church office, not, however, usually followed in all its particulars, was prescribed for his banishment. He was taken from his house to church as though he were already dead; and in church he was told to kneel down before the altar between two trestles upon which black cloths had been hung. After he had heard Mass a priest cast earth on his feet with a spade and pronounced, ‘Be thou dead to the World, but alive unto God.’ The priest then made him swear never
… to enter churches, or go into a market, or a mill, or a bakehouse, or unto any assemblies of people. Also I forbid you ever to wash your hands or even your belongings in spring or stream of water of any kind; and if you are thirsty you must drink water from your cup or from some other vessel. Also I forbid you ever henceforth to go out without your leper’s dress, that you may be recognised by others; and you must not go outside your house unshod. Also I forbid you, wherever you may be, to touch anything which you wish to buy.16
The leper was also made to swear never to eat or drink with clean persons, nor even talk to them unless standing to the leeward side; never to touch a child; always to stand clear of strangers when begging for the scraps of food which would be thrown at him from a distance. He must give warning of his approach by a bell of wooden clappers and wear a distinctive cloak and hood. Female lepers had to wear thick veils. Unless a place was found for him in a lazar house, the leper was provided with a primitive hut in which to shelter, with a bowl in which he could keep such alms as he might collect, and the bell or rattle prescribed by the Church office.17
As the incidence of leprosy increased in the thirteenth century, so the regulations governing the control of lepers became ever more stringent. In 1276 the Assize of London decreed that no leper should, under any circumstances, be allowed into the city; and in 1310 barbers were placed at the gates to assist the porters in detecting any leprous person who might illegally endeavour to gain admittance. At Berwick-on-Tweed it was ordained that no leper should come within the gates of the borough; and, if one got in by chance, the sergeant was enjoined ‘to put him out at once’. ‘If one wilfully forces his way in,’ the regulations continued, ‘his clothes shall be taken off him and burned, and he shall be turned out naked. For we have already taken care that a proper place for lepers shall be kept outside the town, and that alms shall be given there to them.’18
It being supposed, with some justification, that one of the causes of leprosy was the consumption of rotten fish, town authorities frequently issued regulations, such as that made at Berwick: ‘If there be no leper-folk, the rotten pork or salmon shall be utterly destroyed.’ At Oxford, when the city granted the Chancellor of the university jurisdiction over the market, he was required to forfeit ‘all flesh or fish that shall be found to be putrid, unclean, vicious or otherwise unfit … on this condition that the things forfeited be given to the Hospital of St John’.19
Leprosy began to decline in England at the beginning of the fourteenth century when, in those lean and hungry years, lepers were the first to die. In the subsequent years of plague more lepers were carried off, particularly in the more densely populated areas of the south and east; and by the end of the Black Death there was no further need for the establishment of new lazar houses while some of those already in existence were being converted to other purposes. The only foundation after 1347 is that of William Pole in 1411 on land granted by Henry IV who, it has been suggested, may have had leprosy himself, though it is evidently more likely that he was suffering from an unusually painful form of eczema. By the end of the fifteenth century, leprosy had been wiped out except in the extreme north and west.20
As the number of lazar houses declined, other hospitals began to offer more specialized treatment than those of the early Middle Ages. In some the old were cared for, in others sick travellers and pilgrims, in a few the insane, in several orphans and unmarried mothers. Holy Trinity Hospital, Salisbury, established in 1379, cared for ‘lying-in women until delivered, recovered and churched’ as well as for the ‘mad until their senses return’. Both St Mary Without Bishopsgate and St Bartholomew’s in London undertook to provide for the babies of women who died in childbirth until the children were seven years old. St Thomas’s Hospital had eight beds, endowed in 1423 by Richard Whittington who stipulated that women should be treated in confidence so that their chances of marriage should not be impaired. The Priory Hospital of St Mary’s Within Cripplegate, known as Elsing Spital after its founder, a rich mercer, William de Elsing, was established in about 1329 for blind men and women. Bethlehem Hospital, which was founded as the Priory of St Mary Bethlehem outside Bishopsgate in 1247 and had a hospital attached in 1329, cared for ‘distracted’ patients from 1377, that was to say it kept them chained to the wall by leg or ankle and, when violent, had them ducked in water or whipped.21
Many hospitals were closed by the Dissolution of the Monasteries, and for long the king, preoccupied with other problems, had resisted their re-establishment. In 1538 the citizens of London petitioned the king and sought leave to refound the hospitals themselves once their old possessions had been returned to them:
For the aid and comfort of the poor sick, blind, aged and impotent persons, being not able to help themselves, nor having any place certain wherein they may be lodged, cherished and refreshed till they be cured and holpen of their diseases and sickness. For the help of the said poor people, we inform your Grace that there be near or within the City of London three hospitals or spitels, commonly called Saint Mary Spitel, Saint Bartholomew Spitel, and Saint Thomas Spitel, founded of good devotion by ancient fathers and endowed with great possessions and rents … [If permission to refound these hospitals were to be granted] a great number of poor, needy, sick and indigent persons shall be refreshed, maintained, comforted, found, healed and cured of their infirmities, frankly and freely by physic
ians, surgeons and apothecaries … so that all impotent persons not able to labour shall be relieved and all sturdy beggars not willing to labour shall be punished, so that with God’s grace few or no persons shall be seen abroad to beg or ask alms.22
The petition went unheeded. St Mary Spital, which had been founded in 1197 and which, when it was closed in 1538, had 180 beds with two patients in each, lay deserted. So did St Bartholomew’s, which was described in 1540 as ‘vacant and altogether destitute of a master and all fellows and brethren’. So, also, did St Thomas’s which, established in about 1106 and later dedicated to St Thomas the Martyr, had been closed after a visitation by Thomas Cromwell who described it as Southwark’s ‘bawdy hospital’ and recommended that Becket should be ‘decanonised’.23
Of these three hospitals, St Mary Spital was never reopened; but in the reign of Edward VI permission was granted to re-establish St Thomas’s as a hospital for the sick and aged, at first with twenty beds. At about the same time Christ’s Hospital was founded for orphans who were to be provided with the distinctive long blue coats and yellow stockings which are still worn by the boys of the school, now rehoused at Horsham in Sussex, the colour of the stockings being chosen, so it is said, to keep away the rats from the orphans’ ankles. Three hundred and eighty orphans were collected for the hospital but ‘many of them, taken from the dunghill, when they came to swete and cleane keping and to pure dyett, dyed down righte’.24 Also at this time, the royal palace of Bridewell, which had been built for Henry VIII on the banks of the Fleet river, was made over to the City of London for the reception of vagrants and homeless children and for the punishment of petty offenders and disorderly women.25 And the hospital of St Mary Bethlehem, more commonly known as Bedlam, was re-established as a lunatic asylum. By then St Bartholomew’s had also reopened; in 1549 three surgeons were appointed, and in 1568 Dr Rodrigo Lopez, soon afterwards to be hanged at Tyburn accused of trying to poison Queen Elizabeth I, became the hospital’s first physician.26
The English: A Social History, 1066–1945 (Text Only) Page 22