As with modern Britain, Elizabethan Britain had many different providers of healthcare – Physicians, Apothecaries, Surgeons, Bonesetters, Midwives, Cunning men/ women, Keepers, Wives and Mothers. Some of these practiced medicine full time and others as a part time business, some were professionally trained and some were not, some charged large fees, some small fees, some for payment in kind and some for nothing at all.
The sick person therefore had a number of options as to their medical provision, and evidence shows that people exercised this choice widely. Nor did the sick person stick to one type or individual through the course of an illness let alone during their life. Rather, people picked and chose different services from different individuals and types of provider as they saw best. Thus a merchant with a fever might initially call a Physician to give him a diagnoses whilst at the same time asking his wife for something from her still room, then send to an Apothecary for medicine prescribed by the Physician. Then finding little relief goes to the cunning woman in the next street who has a good reputation for this kind of ailment and who gives him a charm to wear.
Nor is it just the wealthy town dweller that has access to this variety of practitioner. Whilst Physicians are largely limited to large towns or great households we know that many people were willing to travel in search of their medical help. Apothecaries and Surgeons were common and found in even quite small towns ‘sorcerers are too common; cunning men, wizards and white witches, as they call them, in every village, which if they be sought unto, will help almost any infirmities of body or mind’ Robert Burton 1621. Likewise there were midwives in every community. Every ordinary woman was expected to have some knowledge of simple herbal and traditional remedies and most communities could rely on help from the more sophisticated still rooms of the wealthy woman.
The amount of money a person or their family could afford to spend did of course limit the kind and quantity of medical help a person had access to but perhaps not quite as much as we would imagine. Medical charity remained one of the most socially acceptable and encouraged form of charity in a society which set great store by the idea that much poverty was the result of a wicked unwillingness to work and be under a masters authority. Sickness was an obvious case of genuine need and one in which charitable help could be seen to have a positive result. A second and probably very important motive for giving medical help to the poor was the financial one of returning them to work and thus removing the need to provide further monetary help.
Norwich has exceptionally complete municipal records on this subject which show quite large amounts being spent on medical provision for the poor and utilising all branches of medical practitioner to do so. The city paid for Physicians to treat the poor as well as Surgeons, midwives, bonesetters and keepers ( nurses ) and paid Apothecaries bills. Often they tried to kill two birds with one stone by employing one poor (usually elderly ) person to nurse or ‘keep’ a sick person. The city at various times even had salaried practitioners to medical provide care for the poor and paid retainers to other practitioners. These records also show that practitioners and patients (or in this case the city authorities) would negotiate on the outcome of the treatment and the fee. So for example it might be agreed that a small sum be paid initially to a bonesetter to set a broken leg but the bulk of the fee would only be paid when the patient was able to walk again. Often the practitioner took complete responsibility for the patient during the recovery period including their board and lodgings and the fees Norwich paid often specifically mention this and there value reflect it.
Elizabethan medical theory is an interweaving of several ideas which whilst bearing little resemblance to modern ideas hang together as an intellectually satisfying system. It must be remembered that these ideas predate the discovery of the circulation of the blood, the discovery of bacteria or viruses and stand at the very earliest beginnings of chemistry.
Galen-the four Humors
This the most important of Elizabethan medical theories and explanations of the natural world. Galen was an ancient Greek and his ideas had been the mainstay of medicine throughout Western Europe for many hundreds of years.
Galen says that every living thing be they plant or animal, including ourselves is made of four elements or Humors. These are Blood, Phlegm, yellow bile and black bile. These four Humors have different natures, so blood is both hot and wet, phlegm is cold and wet, yellow bile is hot and dry and black bile is cold and dry. If a person has the correct balance of these four humors in their body they will be healthy but any imbalance will result in illness and health can only be regained by restoring the natural balance of the humors. Each person is of course different and has a slightly different balance this is the nature of the person. Thus a person who has more of the blood humor is more hot and wet in their nature and is said to be sanguine, a person who has more of the phlegm will be cold and wet and is said to be phlegmatic in nature, a person with a preponderance of yellow bile will be hot and dry and is choleric in nature and a person with the black bile dominant will be cold, dry and melancholic in nature.
As all living things are also made of different proportions of these same four humors it is possible to treat any imbalance of a persons humors by eating the right things. Thus a cold is obviously the result of too much phlegm in the body, too much of the cold and wet, so to cure it and restore the balance we must either draw out the excess phlegm or counter act it by drying and heating .We therefore prescribe hot dry food and medicines such as pepper, sugar, ginger, cinnamon, watercress, mustard etc.
A fever may be treated as too much of the blood humor, too much heat ( the patient is very hot ) and too much of the wet (the patient is sweating profusely) thus to bring them back into balance and cure them they must either take cool and dry foods such as chicken or violets or they must have the excess blood drawn off by bleeding, cupping or leaches.
As this theory also takes account of people’s natures or mental outlook upon the world (sanguine, phlegmatic, choleric and melancholic) t can also be used to treat mental illness as well as physical.
The Doctrine of Signatures
This wonderful idea is based on God’s bounty. Every living thing was put on this earth for man to use, for god gave us dominion over all the plants and all the beasts of the air and the land and all the fishes in the sea. Many of these plants and animals were created for us to eat, thus God’s purpose for the cow was as meat and milk provider for us and God’s reason for creating wheat was to provide us with bread. Other plants and animals are obviously not for us to eat but they still have their purpose as medicines for us. The deadly nightshade was not put on earth by God as food but as help against great pain. God gives us clues as to the use if these things by their outward appearance. So lungwort, which has a leaf that resembles a lung, is good for illnesses of the lungs and heartsease will relieve the heart and eyebright will clear the eyesight.
This was not considered to be quack pseudo medicine but was a mainstream and highly respected medical theory taught at the universities. The stars, planets and the moon were felt to exercise an influence over every living thing as they so obviously do on the tides the mating times of certain beasts and the growth and flowering of many plants. If therefore you were to go to a physician for help he might well begin by asking for your date of birth from which he would cast your horoscope. Next he would need to know exactly when the illness began so that he could cast the horoscope of the illness and relate it to that of the patient. In prescribing he would also wish too know which parts of the body was affected as each area of the body comes under the influence of different star signs and he would bear in mind which star sign and planet each ingredient of any medicine came under. Those growing plants for medical would also have to be careful to plant seeds at the new moon and harvest at the full moon to gain maximum potency from them.
There was a thriving array of ideas that often did not fit with the three main academic lines of thought given above but were none the less respected and widely used. A belief for example that disease was a foreign presence in the body, which could be driven out thus exorcism, was an accepted response to mental illness; that the King or Queen’s touch could cure scrofula; and the power of toads to cure warts are all examples.
This really marks the very beginnings of chemistry with a whole host of newly discovered substances and non-organic materials being pressed into medical service. Tobacco and mercury being two of the best well known.
The dividing line between magic and legitimate medical practice was extremely blurred. Much that we may se as magic seemed perfectly logical and even scientific to an Elizabethan .Sir Kenelm Digby, an educated and respectable man often at court in the next reign wrote an entire book explaining how ‘weapon salve’ worked and why it was an effective cure working ’naturally and without any magic’. Weapon salve is when you put the healing lotion on the weapon which caused the wound and though the victim be many miles away the wound shall be healed.
Magic often contained ideas which were widely accepted and people from all walks of life patronised people who could be said to practice magic. In 1604 Goodwife Veazy was recommended to Cecil as an expert in curing cases of ringworm, tetterworm, and cankerworm. Her cure is reported to have consisted of saying ’In the name of god I begin and in the name of God I do end. Thou tetterworm begone from hence in the name of the Father of the Son and of the Holy Ghost’. Three times and then putting on a poultice of honey and pepper.
James Sykes of Guisley in 1597 was curing horses by writing on papers which he hung about their necks.
William Lilly had his patients write ‘Jesus Christ for mercy’s sake, take away this toothache’ three times before saying the same words aloud and then burning the paper.
Another reported cure for an ague was for the cunning man or woman to write ‘Arataly, Rataly, Ataly, Taly, aly, Ly’ and bind the paper it was written on around the patients arm for nine days and every day say three paternosters to St Peter and St Paul and then take off the paper and burn it.
A cure for pains in the head consists of taking a lock of the patient’s hair, boiling it in the patient’s own urine then throwing the mixture into the fire.
How effective any of the medicine arising from any of these ideas was is very open to question, but we mustn’t assume that they were totally useless. After all many long proven remedies discovered empirically over the centuries are incorporated in the actual practice of Elizabethan medicine and then ways found to fit them into the theoretical structure. It is easy knowing that digitalis, the common foxglove, can be successfully used to treat heart attacks, in the right dosages, to then say that it must be a plant with a lot of the blood humor in it which can strengthen the heart and obviously it must be under the astrological influence of the star sign relating to the heart. I n this way much useful herbal knowledge of a genuine helpful nature is present in Elizabethan medicine. After all digitalis remains a useful modern drug in the treatment of heart complaints as does willow bark for pain (it the natural source if aspirin) and there are many more examples.
The other important benefit that all Elizabethan medicine conferred on it’s patients was that of the placebo effect, trial after trial has proved that believing that you are taking an effective treatment has very significant effects upon patients, with large numbers reporting complete cures or significant improvement in their conditions. Belief in ones treatment has been shown to add several years onto the life expectancy of cancer patients.
Some useful books
The Common Lot – Margaret Pelling
Religion and the Decline of Magic – Keith Thomas
Herbal – Culpepper
Herbal – Gerard
A Dietry of Health – Andrew Boorde
Lady Mildmays Diary;
The English Housewife – Gervaise Markham
Written by Ruth Goodman, 1998