by Ian Mortimer
When it comes to mental illness, it is not the deadliness of the disease that is so distressing: it is the unremitting difficulty of dealing with someone who outwardly has nothing wrong with them and yet cannot behave in an ordinary manner. Classical medicine dictates that there are four varieties of madness: frenzy, mania, melancholy and fatuity, all brought on by different imbalances in the humours. Laymen add lunacy – supposedly caused by the phases of the moon – and ‘distraction’. Culpeper suggests black hellebore for those who are driven mad with melancholy, rosemary flowers as a means to strengthen the brain, and drinking whey to ‘help’ with melancholy and madness, but these are of little real effect.42 Thus families tend to keep their mad relatives at home in a cellar or a barn, locked away from public view.43 There are a few private mad hospitals advertised in the London press from the 1650s, but the costs are high. Most famously there is Bethlehem, popularly known as Bedlam, the London hospital for the mad in Bishopsgate. If you wish to, you can go and watch the patients: the building is open for the curious to enter, like a permanent freak show, in order to raise funds. When it is rebuilt on a magnificent scale, to a design by Robert Hooke in 1676 at Moorfields, just to the north of the city wall, it is given long galleries from which visitors can view the inmates. Sadly, the majority of them will unwittingly entertain the prurient crowds for the rest of their days and never leave these walls.
One final medical problem must be mentioned, namely childbirth. It is a sad fact that for every 1,000 children born in England, 17 mothers are buried. That equates to a 1.7 per cent chance of dying every time you fall pregnant – which means a one-in-twenty chance of death if you have three children and almost a one-in-ten chance if you have six. Overall, 4 per cent of all women die giving birth.44 One of the advantages of living in London at this time is that the Chamberlen family is based in the city. Dr Peter Chamberlen, who heads the family at the beginning of our period, has inherited a secret that enables women who are experiencing a difficult labour to give birth safely. Normally, if a child cannot be born, a surgeon will be called in by the midwives, to pull out the child with hooks and ropes, which invariably kill the child. In extreme cases the child is cut into pieces while still in the womb, for easy extraction. Obviously the use of sharp blades is hugely dangerous to the mother too, and many deaths are actually caused not by the childbirth itself but by frantic attempts to save the mother. The Chamberlens’ secret machine, which they transport in a misleadingly large, elaborately carved wooden case, is actually quite small: a pair of obstetric forceps. Over the years the family has refined these so that the steel blades are curved to fit the head of the infant. No one else in Europe can offer you this service. When the Chamberlens operate, they don’t allow anyone else to be present but the woman in labour. The secret makes the family both rich and envied, so that the College of Physicians in London has an uneasy relationship with Dr Chamberlen, his sons Hugh, Paul and John, and his grandson Hugh, all of whom practise midwifery. Only when the last member of the family dies without an heir in 1728 will the secret be discovered – for the benefit thereafter of every surgeon, midwife and, of course, every anxious expectant mother.45
Medical Practitioners
In Restoration Britain you are your own first medical responder – much more so than in the modern world, where you can simply pop along to see your local GP. A consultation with a physician or a surgeon is expensive, even if he lives nearby, so you don’t want to pay out for medical advice if all you’re suffering from is a cold. In addition, as most people live in the country and most medical practitioners live in towns, you will need to factor in the cost of his travel. Your messenger, who will contact the physician on your behalf, will have to pay his travel expenses in advance if you want to be seen in person, and even a relatively lowly provincial practitioner will charge about 2s 6d per mile.46 Ralph Josselin frequently describes his family’s illnesses as well as his own in his diary, but he almost never consults a physician because he lives at Earls Colne and the nearest doctors are at Braintree (9 miles away) and Colchester (10 miles). Thus, if you can deal with the illness yourself, you will do so.
To help you in your self-diagnosis and self-medication there are a great number of medicinal tracts available, such as John Tanner’s The Hidden Treasures of the Art of Physick Fully Discovered, and popular books aimed at women, such as the late countess of Kent’s A Choice Manual or Rare Secrets in Physick and Chirurgery. There are also affordable pharmacopoeias in the stationers’ shops, such as Culpeper’s English translation of the Pharmacopoeia Londinensis, which concentrates on cheap ingredients that are to be found in the fields, woods and hedgerows (hence its later popular name, Culpeper’s Herbal).47 The Ladies Cabinet Enlarged and Opened: Collected and Practised by the Late Right Honourable and Learned Chymist, the Lord Ruthven contains 270 medicinal recipes covering such diverse subjects as how to make artificial spa water, how to cure toothache with oil of cloves and opium (which sounds promising) and how to cure poor hearing with ‘oil of snakes and adders’ (which does not). In case you are wondering, this last recipe begins ‘Take snakes or adders when they are fat, which will be in June or July, cut off their heads and take off their skins and unbowel them and put them into a glass gourd …’ The recommendation for gout in your feet is even more bizarre: ‘Take an ox’s paunch new killed and warm out of the belly, about the latter end of May or beginning of June, make two holes therein and put in your feet …’48 Mind you, it could be worse. When the bishop of Worcester suffers from gout in 1698, the archdeacon of London writes to him with an infallible remedy: ‘drinking fresh urine of a cow, then fasting, a pint every morning’.49 As a gout sufferer myself, I will be sticking to the tried-and-tested old recipe of the colchicum crocus; I don’t hold with these newfangled cow’s paunch and urine-drinking recipes.
Most people will not self-diagnose and self-medicate without talking to someone else about their symptoms. Therefore, unless you happen to have a physician in the family, you would be well advised to seek the advice of the womenfolk in the immediate vicinity. Old women and nurses have a poor reputation as medical practitioners and are often lampooned as careless, drunken hags, but you would be wise to trust their experience, especially with regard to diagnosis. When someone is seriously ill, the poor and old women of the parish are paid to attend them. They have thus seen at first hand a large number of ailments in every stage and have considerable experience of which medicines and healthful broths are effective and which are useless. What’s more, in the 1650s the role of the medical ‘nurse’, as we understand it, suddenly comes to the fore. Before that decade, ‘nursing’ meant just wetnursing; now it also applies to women looking after the sick on a semi-occupational basis, requiring them to have certain skills and experience. Payments for nurses attending infectious illnesses such as smallpox and plague can be relatively high – 8s per week is usual, and higher fees are known. Payments for nursing mentally ill patients can also reach these levels.50 Nurses are not allowed actually to diagnose or prescribe – although you would be wise to pay heed to their wisdom on both accounts. If there are some efficacious pills available from the local apothecary, no one will mind if she sends out for some for you.
If your symptoms leave you in doubt about what is wrong with you, and your family and friends can’t help you, and the old women of the village are shaking their heads, then you have no choice but to seek the advice of a doctor. But what is a ‘doctor’ at this time? And where do you find one?
Before 1660, the term ‘doctor’ was used only in respect of men who had doctoral degrees from a university: you would come across doctors of divinity more often than doctors of medicine. But now the term is used much more loosely in medical contexts. Physicians and surgeons who only have a licence might be called ‘doctor’ by their patients. Thomas Sydenham calls himself ‘Dr Sydenham’ long before he actually obtains a doctorate. Even some apothecaries might use the title. What you need to know is how all these professions work in theory, and
what each one does in practice.
PHYSICIANS
Physicians deal with the inner workings of the body, diagnosing illnesses and prescribing treatments. The most highly qualified are those who have studied at a university and emerged with a medical degree, either an MB or an MD. The best connected and most respected are also Fellows of the Royal College of Physicians or its Scottish equivalent, which is founded in Edinburgh in 1681. These are the most expensive medical professionals you can employ. Expect to pay a medical bill in the region of £2 per visit – although treatment of a serious disease can easily be ten times as much.51 They will travel long distances for their wealthy clients, which is a good thing, if you are one; on the downside, they will frequently be unable to come to your aid if they are preoccupied with helping someone who is richer than you. Also, such men tend to be based in London and Edinburgh; a 1693 list of physicians printed by John Houghton only notes provincial Fellows in Shrewsbury, Bath, Exeter, Canterbury, Northampton,Gloucester and Bishop’s Stortford.52
If you can’t afford one of the top-flight medical degree-holders, your next best bet is to send for a licensed physician. There are many sorts of medical licences available: some granted by the royal colleges, some by the Lord Chancellor, some by the universities and some by the bishops of England. To qualify for one from the Royal College of Physicians, a candidate has to pass three examinations in anatomy and physiology, pathology and the use of medicine. Needless to say, these require a good deal of knowledge. An easier qualification – and by far the most common at this time – is to apply for a bishop’s licence. The applicant will be examined by a suitably qualified physician, who will then make a recommendation to the bishop’s official as to whether or not to grant a licence. In many cases a petition will be submitted on the applicant’s behalf by former clients, attesting to the effectiveness of his treatments and the purity of his moral life. Expect to pay a licentiate a consultation fee of 2s 6d or more, not including travel. Medicines are extra, too. On this subject, note that wealthy people generally pay twice as much as the poor. The reason is not a discount for the less well off but that physicians will prescribe the best medicines the patient can afford.
The lowest ranks of physicians on the qualification spectrum are self-taught men and women who prescribe and diagnose without any qualifications. These include gentlewomen who feel an obligation to help their tenants and their families; clergymen and their wives who are likewise called to help those whom the Lord has smitten; and apothecaries who take it upon themselves to advise their clients about which medicines are useful against certain diseases (but without any diagnostic training). In addition you will come across many itinerant practitioners, mountebanks and quacks. Sorting out the good from the bad amongst this lot is quite a headache. None of these unqualified practitioners are supposed to charge for their advice, so if they levy a hefty fee, that is one reason to be suspicious. Having said that, a clergyman might not charge you a penny and be full of goodwill, but will yet kill you through sheer medical ignorance. Be particularly cautious of those who stand up in marketplaces shouting about how wonderful their elixir is, or their ointments – especially one ‘Alexander Bendo’ on Tower Hill (it’s actually the rake Lord Rochester in disguise). Likewise, don’t trust men who arrive at your door offering to sell you cure-all pills. As with most things in life, if it sounds too good to be true, it’s neither good nor true.
Will any of these physicians be able to cure you? Obviously it depends on your ailment as well as their experience. Even the best-qualified Fellows of the College are helpless to save their richest clients from time to time. It is salutary to remember the story of Sir Edmund King, MD, FRCP, physician to Charles II. In February 1685 he saves the king’s life by quickly drawing blood during an apoplectic fit. The king is deeply grateful and orders that Sir Edmund be paid a reward of £1,000 – and then promptly dies.
If there is one physician who should be singled out above everyone else as being the best equipped to help you, it is Thomas Sydenham. He studies at Oxford in the 1650s, obtains a Bachelor of Medicine degree and moves to London, where he passes his examinations to obtain a licence from the Royal College of Physicians in 1663 and sets himself up in practice. He is never invited to become a Fellow of the College, and only late in life does he obtain a doctoral degree. What makes him so influential and successful is that he is original and not frightened to follow his own path, and does not feel obliged to stick to medical rules set down in the third century. Rather than seeing humoral imbalance as constructing illnesses, so that one disease can mutate into another, he sees each ailment as specific, caused by particles of morbific matter. He thinks symptoms are indicators of nature’s efforts to rid itself of these morbific particles, and therefore the physician should work with nature, not against it. He is firmly opposed to the process of letting blood, and equally firm in his belief that every patient is unique. As John Locke says of him, ‘you cannot imagine how far a little observation carefully made by a man not tied up to the four humours, or salt, sulphur, and mercury, or to acid and alkali, which had of late prevailed, will carry a man in the curing of diseases’. If a man is wasting away, Sydenham might prescribe him a roast chicken. If a woman has smallpox, he will not wrap her up to make her sweating worse or draw blood and further weaken her, but will get her up and about, making her breathe fresh air. With regard to consumption, he is the first English physician to advocate the use of Jesuit’s bark as a remedy. Richard Talbor’s fame in prescribing this cure for the ague is largely learnt from Sydenham’s book on the subject. Sydenham remarks to John Locke in 1678 (the year Talbor is knighted by Charles II), ‘I never got £10 by it; he has got £5,000.’53 In the end, time will give Sydenham his due reward. Talbor will largely be forgotten, but Sydenham’s fame lives on, in the efficacy of his cures and the originality of his methods, from which he becomes known as ‘the English Hippocrates’.
APOTHECARIES
Apothecaries make up and sell the medicines that are prescribed by physicians – thus their businesses lie at the very heart of the medicalisation of society. Consider this fact: back in 1600, if people were suffering from a sickness that would eventually kill them, only about 5 per cent would seek professional medical help, even in the relatively prosperous south-east of England. The vast majority would either accept their lot or consult amateurs, such as clergymen’s wives. Now, in the period from 1660 to 1689, about one-third of all seriously ill people in the south-east seek professional medical help when facing death; from 1690 on, half do. Other parts of England are only a little way behind. And the single factor that has changed this attitude to medicine more than any other is the availability of new medicinal substances. The value of the medicinal drugs imported in 1700 is roughly fifty times greater than it was in 1600.54
The ever-increasing demand for drugs and medicaments is what underlies the changes in attitudes to medicine; it also explains why the medical profession is expanding and changing so rapidly. In Canterbury, the number of apothecaries who are freemen of the city doubles over the course of the century – from thirteen in 1610 to twenty-seven in 1700. In Exeter, the number quadruples, to twenty-five.55 Moreover, the volume and variety of medicines that they purvey are greater than ever before. In 1685, about a ton of Jesuit’s bark arrives in London, along with half a ton of bezoar stones, ten tons of senna and a ton of opium. Many of these go straight into pre-ordered pills and potions, made up by apothecaries and sold over the counter. And this is where the apothecaries come into conflict with the physicians. The physicians realise the apothecaries are giving advice to their customers and think they are trespassing on ground that is rightly theirs, thereby doing them out of money. But is it an apothecary’s fault if a woman enters his shop asking for Gascoyne powder? Why should he not sell it to her? After all, it is the cure that matters. By 1700 towns and cities are awash with apothecaries giving you advice about their wares.
Entering an apothecary’s shop is quite a striking experience.
The walls are lined from ground to ceiling with shelves on which row above row of chemists’ blue-and-white ceramic jars are stored. You can read the names of all the exotic substances on the jars: agaric, aloes, ambergris, aniseed, bezoar stone, dragon’s blood, gum traganth, Jesuit’s bark, lignum vitae, opium, rhubarb, sarsaparilla, sassafras, senna, sulphur and wormwood, to name just a few. Among these you will also find bottles of distillations such as aquavitae and jars of herbs and ground spices (cinnamon, cumin, cloves, pepper, and so forth). Apothecaries also sell luxury consumables like chocolate, tea and coffee. There is a long table running down the middle of the room where the apothecary grinds roots to powder in a pestle and mortar, weighs out his wares on a set of scales, and bottles them up for the customer. Note also the spatulas and sets of ladles hanging on the walls, and the order book on the work surface. Above your head you may well see exotic trophies suspended from the ceiling, such as the skull of a shark or a stuffed crocodile. Nearby are his moulds for making pills, which, once prepared, are kept in drawers ready to be offered to customers. Among the medicines you’ll also come across less desirable things: processed millipedes ground up and dissolved in wine (to provoke urine), woodlice boiled in oil (to be dropped into the ears), snakes’ flesh (for the eyes), powdered burnt crab (for the bites of rabid dogs), sparrows’ brains (to provoke lust) and the ashes of the head of a coal-black cat (for better eyesight).56 To be fair, only about 10 per cent of medical recipes involve the body parts of animals. But even this small percentage is significant, for there is something fundamentally different from modern medicine in their grinding up animals and dissolving them in wine or oil for health reasons. It is reminiscent of people’s attitude to food: that every creature has been put on Earth by God for mankind’s benefit.