To the casual modern reader, Tudor medical books, especially herbals, seem an odd jumble of unlikely ingredients with no particular method behind them. In fact, the cures are logical according to the medical theories of the time, even if a modern doctor would not agree with them.
At the very base of Tudor medicine was the idea of the four humours. This was a very old idea, dating back to ancient Greek doctors, particularly Galen and Hippocrates. The idea was that earth, air, fire and water made up all things. Each of these elements had a corresponding quality: earth was cold and dry, air was hot and moist, fire, hot and dry and water, cold and moist. Imbalance of these elements was what caused disease.
The four humours that went to make up the human body were blood, considered to be hot and moist, red choler, which was hot and dry, black choler, which was cold and dry, and phlegm, which was cold and moist. The four basic temperaments which were thought to exist depended upon which of these four humours was dominant in each individual. These temperaments were: phlegmatic (cold and moist), choleric (hot and dry), sanguine (hot and moist) and melancholic (cold and dry). If this all sounds rather confusing, the table below should make matters clearer:
| Element of Earth | Its Qualities | Corresponding Temperament | Dominant Humour |
| Air | Hot and moist | Sanguine | Blood |
| Fire | Hot and dry | Choleric | Red choler |
| Earth | Cold and dry | Melancholic | Black choler |
| Water | Cold and moist | Phlegmatic | Phlegm1 |
Studying a patient’s looks and habits would tell a doctor what his basic constitution was. Here is an example from Sir Thomas Elyot’s Castel of Helth, a best-selling health manual of the sixteenth century. Sir Thomas annoyed the medical establishment of the time by writing the book in English, with the aim of providing medical knowledge to those who couldn’t read Latin. The following is a list of signs of the ‘phlegmatic’ temperament: ‘Fatesse, quavying and soft, vaynes, narrow; heare much, and plaine; colour, white; sleape, superflous; dreams of thynges watrie, or of fyshe; slownesse, dulnesse in learning; cowardice; pulse slowe and lyttell; digestion weake; spittell white, abundant and thicke; urine grosse, white and pale.’2
The appeal of the theory of the four humours becomes obvious from this description. It could be used to explain not only someone’s physical makeup but also psychological problems like ‘dulnesse in learning’. It was such a wonderful, neat theory that the medical establishment were very unwilling to give it up, even when the more scientific approach to medicine that began in the sixteenth century showed that it could not be true. Medical treatment was centred around restoring the balance of the humours, bearing in mind a person’s basic constitution. Everything, including rocks and plants, was considered to be made up of the four elements and to have qualities which could help towards a cure. Here, for example, is how Sir Thomas Elyot describes the qualities of lettuce:
Among al herbes, none hath so good juice as lettice for some men do suppose, that it maketh abundaunce of bloude al be it not verie pure or perfect, it doth let a hot apetite, and eaten in the evening it provoketh slepe albeit it neithr doth losse (loose) nor bynde the bealye of his owne propretye. It increaseth milke in a womans’ brestes but it abateth carnal appetite and much thereof hurteth the eye sight. It is cold and moyst temperately.3
Lettuce, being ‘cold’ was, like other ‘cold’ herbs ideal for treating ‘hot’ complaints, such as fevers. Here is an example from one of the cures given in Markham’s The English Housewife:
Of thirst in fevers
It is to be understood that all fevers of what kind soever they be, and these infectious diseases as the pestilence, plague and such like, are through the inflammation of the blood, incivilly much subject to drought; so that, should the party drink so much as he desired, neither could his body contain it, nor could the great abundance of drink do other than weaken his stomach, and bring his body to a certain destruction. Wherefore, when any man is so overpressed with desire of drink, you shall give him at convenient times, either posset ale made with cold herbs; as sorrel, purslane, violet leaves, lettuce, spinach and such like. . . .4
Certain humours could also change as people aged, or as the seasons changed. For example, the signs of Aries, Leo and Sagittarius were linked with the planet Mars, Fire, the west wind, summer and childhood.
Besides a knowledge of the humours, a Tudor doctor also needed a good knowledge of astrology. The moon was known to control the tides; it was logical that the humours of the body were also controlled by the planets. The stars were thought to dominate the whole of nature to such an extent that outbreaks of plague were even blamed upon their influence, as in the wrong places the stars could bring about infected air. Sir Thomas Elyot explained that ‘the causes whereby the ayr is corrupted be specially four: the influence of sundry stars, stagnant waters, carrion and overcrowding.’5
The position of the stars was also thought to dominate certain parts of the body to such an extent that it was hardly worth attempting the cure if the astrological signs were not good. Arnold of Villanova, a famous medieval doctor, wrote, ‘The planet which acts most on the qualities of a man is the moon. . . . From its phases the crisis of an illness can be foretold and when in conjunction with the constellation Pisces the outlook is always good. The moon’s phase can enhance or interfere with a remedy. So it comes that measures which can be taken otherwise would avail nothing. . . .’6
Astrology was such a vital part of medicine that at the Sorbonne, and other universities, a Chair of Astrology was combined with that of Medicine. It was so much linked with medicine that publication of astrological charts formed a useful sideline for the well-known doctors of the period. Andrew Boorde was one such doctor. In 1537 he published an Almanacke and Prognostigation. The ‘astrological man’ was also a very common illustration in medical books of the time. An example, now in the British Library, is shown here. Blood-letting was a common cure at the time, believed to help balance the humours. At this time, the fact that blood circulated throughout the body was not understood, and so the place from which the blood was taken was considered vital. The ‘astrological man’ shows how each part of the body is governed by the stars, so that you could work out the best time to bleed someone, and from where.
The stars also governed when it was best to sow and pick your herbs. The Gardener’s Labyrinth, the first popular book on gardening to appear in English, was published in 1577. The author, Thomas Hill, goes into great detail as to the correct astrological time to plant the various types of seeds. Here is some of his advice:
The daily experience is to the Gardener, as a Schoolmaster to instruct him, how much it availeth and hindreth, that seeds to be sown, plants to be set, yea Cions to be grafted (in this or that time) having herein regard, not to the time especially of the year, as the Sunne altereth the same but also the Moons increase and wane, yea to the sign she occupieth, and places both above and under the earth. To the aspects also of the other Planets, whose beams and influence both quicken, comfort, preserve, and maintain or else nip, wither, drie, consume, and destroy by sundry means, the tender seeds, plants, yea and grafts . . .7
Running alongside the ‘official’ medical theories of the day there was also an undercurrent of magic. Here is an example, again taken from Markham’s The English Housewife under the heading ‘For teeth that are loose’: ‘First let them blood, then take hartshorn or ivory, and red pimpernel, and bruise them well together, then put it into a linen cloth and lay it to the teeth, and it will fasten them.’8 Hartshorn and ivory would both be associated with teeth, so that to the Tudors it would seem logical that applying hardshorn to teeth would strengthen them.
Another idea was that anything that was especially rare and costly would be a useful cure. The use of ‘unicorn’s horn’ (probably rhinoceros horn) and of ‘Bezoar stone’ (which is found in certain Asiatic goats) are examples of this, but then the Tudors were hardly alone in this belief. Every age considers strange and expensive substances to be either cure-alls or aphrodisiacs.
Such, then, were the basics of Tudor medicine. Before considering what exactly women were expected to do in the world of medicine, there needs to be an explanation of how the medical world worked at the time.
At the top of the Tudor medical tree, at least in their own estimation, were the university-trained doctors. Before even starting your medical training, it was necessary first to complete your Bachelor of Arts. Even when you got as far as being taught actual medicine, you would find your training very academic, and based purely on the writings of the medical masters of the past, especially those of Galen. This was an age, too, when respect for those in authority was drummed into you from your first years, and that respect was extended to academic authority. Questioning the accuracy of these ancient authorities was seen in the same light as questioning the Bible. As late as 1559 Dr John Geynes was cited before the Congregated College of Physicians for questioning Galen and he was forced to sign a humble recantation before being received back into the College. The case of Dr Geynes shows that these beliefs were being questioned, but such harsh opposition to change slowed the advance of medical thought.9
The low standard of English medical training did not help the situation. Most of the better doctors, such as Andrew Boorde, spent time training abroad, especially at the University of Montpellier, although even there medical training was based too much on theory, as the theoretical and practical sides of medicine had become separated over the centuries.
In the thirteenth century Pope Innocent III at the Council of Tours had forbidden those in holy orders to shed blood. The idea was, of course, to stop them fighting battles, but it was taken to mean also that surgery should not be carried out by such people. Surgery therefore became divorced from the academic study of medicine; physicians became more and more absorbed in the study of abstract theory; and surgery was treated as a craft, without any particular academic study attached to it. The fact that physicians also studied many ancient Arab texts made this situation worse, as the Arabs believed that touching a diseased body made you unclean, so that the doctors tended not to examine their patients themselves.
By the late fifteenth century physicians often did not even meet their patients, especially as apothecaries (the Tudor version of modern pharmacists) tended to act as go-between between patient and doctor. The general belief that the imbalance of the humours caused disease also allowed doctors to merely examine their patient’s urine, so that the urine flask became the symbol of a doctor’s profession, as can be seen from plate 21, showing an Elizabethan doctor as depicted on a painted platter. This obviously laid the physician open to practical jokes, leading to this heartfelt plea from Robert Recorde, in his Urinall of Physicke published in 1559: ‘. . . likewise, I shall enjoin all men not to mock and jest with any physician (as some light-wits do), tempting them with beastes stale instead of man’s urine . . . and much other fowle things.’10
A doctor’s training was so academic that it often did not even include dissecting a human body. Where dissections were carried out, the professor of surgery sat on a high chair reading his lecture whilst a menial known as a ‘demonstrator’ did the actual dissection.
It was not surprising that medical ideas stagnated in such a climate. However in the sixteenth century new ideas came flooding into medicine, just as they did in other areas. The best example is the attitude to dissection, which gradually became part of medical training, with student doctors actually dissecting bodies themselves so that they could learn firsthand how the body was really made up. Text books such as Vesalius’s De Humani Corporis Fabrica became available, based upon the author’s own experience and observations of dissection.
This did not mean that Tudor medical treatment was vastly different from that of the Middle Ages. The practical effects of the new thinking were not really felt at the time; rather it laid the foundations for the discoveries of the seventeenth century. The main advance was that doctors began to come out of their ivory towers and to take a more practical attitude to medicine. It did not change the fact that university-trained doctors, whether highly respected or not, were very expensive, and well beyond the price of most people.
Ordinary people were more likely to go to the second important body of men in Tudor medicine, the apothecaries. They were supposed to give free advice, and only charge for the remedies they sold as a result. They did not get as far as becoming a separate company in the sixteenth century, but their social status did rise during the period, and they become increasingly reputable.
The barber-surgeons were the third great force in the Tudor medical establishment. They did everything from pulling teeth to the removal of tumours, the setting of broken limbs and the amputations of those limbs too badly damaged to be saved. It was barber-surgeons, rather than doctors, who would accompany armies and sail on ships like the Mary Rose to look after the illnesses and injuries of the fighting men. The standard of training for the barber-surgeons seems to have been raised in Tudor times. They were incorporated into a company in London in 1540, and had a portrait painted by Holbein to celebrate the event. Their training was mostly practical, but by the later sixteenth century there were examinations for the apprentices (although how many actually took them is unknown). The London apprentices served seven years, and had to attend a weekly lecture on surgery, and those in other cities such as York, Norwich and Bristol seem to have had a similar education. However, those in Newcastle and Oxford were not so strictly trained, which highlights the constant problem with Tudor medicine.11 Where you lived determined what help was available to you.
The above list of medical practitioners suggests that there was plenty of skilled medical help available in sixteenth-century England, but unfortunately this was not the case. For one thing, the number of formally-trained practitioners was never high enough to meet the need. This was something that was recognized even in government circles. In 1512 an act had been passed laying down that nobody should practise physic or surgery, except graduates of Oxford or Cambridge, unless licensed by the bishop of his diocese. The fee for unlicensed practice was set at the high price of £5 per month. The preamble to the act gave a list of those to whom the act was aimed, who included ‘common artificers, as smiths, weavers, and women that boldly and customarily take upon them great cures and things of great difficulty, in which they partly use sorcery and witchcraft . . . to the . . . grevious hurt, damage and destruction of the king’s liege people.’ The setting up of the Royal College of Physicians in 1518 also limited those allowed to practise medicine.
In 1542, however, this act was amended, exempting from the penalties ‘divers honest persons, as well men as women, whom God hath endowed with the knowledge of the nature kind and operation of certain herbs, roots and waters, and the using and ministering to them to such as be pained with customable disease’. They were only allowed to practise on the understanding that they did so without fee. The licensed doctors did not want these people interfering with their livelihood, but they also recognized that they were unable to meet public demand on their own.
The fact that women are singled out for mention in both acts gives us a clue as to how central the role of women was to Tudor medicine. The housewife was responsible for the comfort and well-being of her family, which naturally included an understanding of how to look after them when they were ill. Markham rather plays down her role, saying that ‘we must confess that the depth and secrets of this most excellent art of physic is far beyond the capacity of the most skilful women, as lodging only in the breast of the learned professors . . .’12
However, his own book supplies cures for ailments ranging from a headache to the plague, broken bones and coping with serious bleeding, which suggests that women were expected to deal with most medical problems. At this time most people lived in the country where there was highly unlikely to be an apothecary, let alone a barber-surgeon or a doctor. The women just had to be able to cope.
It is very difficult to get an accurate picture of women practising professional medicine at this time. We get glimpses of them at work through letters and literature, and through court records when their work offended the establishment, but that is all. Most information is available concerning their work as midwives, which is discussed in Chapter Two. The lower-class women are the most elusive as even by the sixteenth century many of them were not literate, and their cures and ideas were passed down from mother to daughter by word of mouth. Most of these women only appear in records when on trial for witchcraft.
The local witch or wise woman would have been the only general practitioner available to most people. Many of the cures used by them must have been based on years of trial and error by generations of women, so that it is not surprising that they made some useful discoveries and must often have been more successful than the professional university-trained doctors. Wise women, for example, used ergot for labour pains, and ergot derivatives are still used to hasten labour. They also used belladonna to inhibit uterine contractions when a miscarriage threatened. Belladonna is still used as an anti-spasmodic today.13 Witches also used charms and other magic, so doubtless not all their cures were successful but their skills were much in demand.
Wise women, despite their popularity with the poor people who were their patients, were despised and even feared by those in authority. Perhaps the fact that they were obviously sometimes more successful than doctors stung professional pride. Paracelsus, the sixteenth-century doctor who pioneered the use of pharmaceutical drugs, was impressed by them and even maintained that he had learnt all he knew from witches, but he was a very controversial figure who even went as far as to burn the works of the accepted medical authorities of the time, Galen and Avicenna, in the public square at Strasbourg. Sadly, most of the information we have about wise women comes from accounts of witch trials.
Witch-hunting took place between the fourteenth and seventeenth centuries and was carried out with varying ferocity in different countries at different times. It was always aimed at the female peasant population and had sinister undercurrents, which mostly had very little to do with whether or not the women were effective doctors. It is interesting that even the persecutors of witches often testify to the success of some of these women. Here is a quote from a leading seventeenth-century English witch-hunter:
For this must always be remembered, as a conclusion, that by witches we understand not only those which kill and torment, but all Diviners, Charmers, Jugglers, all Wizards commonly called wise men and women . . . and in the same number we reckon all Witches which do no hurt but good, which do not spoil and destroy, but save and deliver . . . It were a thousand times better for the land if all Witches, but especially the blessing Witch, might suffer death.14
Even a violent opponent of ‘witches’ had to admit that some of them could ‘save and deliver’.
As long as women did not try to become professional healers, their medical skills were valued even by those in authority. The Paston Letters, everyday correspondence of the wealthy Paston family covering most of the fifteenth century, make numerous references to medical matters, as the women of the family exchange cures and fuss over the health of the men. One example is a letter written from John Paston III to his wife, Margery:
Mistress Margery
I recommend me to you. And I pray you in all haste possible to send me by the next sure messenger that you can get a large poultice of your flos unguentorum [flower of ointments] for the King’s Attorney, James Hobart, for his disease is but an ache in the knee. He is the man who brought you and me together, and I would give £40 that you could with your plaster part him from his pain. But when you send me the poultice, you must send me writing how it should be laid to and taken from his knee, and how long it should abide on his knee without removal, and how long the plaster will last and whether or not he must wrap any more clothes about the plaster to keep it warm. And God be with you.15
It is interesting that the Paston women did not have much faith in professional doctors. Margaret Paston made the following pithy observation to her husband, after having seen doctors do little good in other family cases: ‘Also for Goddys sake be war what medesyyns ye take of any fysissyans of London: I schal never trust to hem because of your fadir and my onkyl, whoys sowlys God asoyle.’16 The wealthy lady was still supposed to call in a doctor to deal with really serious cases, but as Margaret’s words suggest, many women must have wondered if it was worth the fee.
Fiction is a good reflection of the feelings of any age and in the fiction of the Middle Ages great faith is set in the medical skills of women. In Malory’s Morte Darthur the King of Ireland happily places Tristan in the care of his daughter, La Belle Iseult, ‘because she was a noble surgion.’ King Mark also sends for ‘alle maner of leches and surgeons bothe unto men and wymmen . . .’. In the earlier Middle Ages, Nicolette, a Saracen slave, puts her lover’s dislocated shoulder back in place after he falls from his horse whilst distracted with thoughts of love for her.17
Having established that women were expected to be skilled in medicine, what sort of training and knowledge would a woman have? It is difficult to know as not many women wrote down either their thoughts or knowledge about medicine or what they knew. In the sixteenth century we begin to get more of an idea with the publication of books on housewifery but it is difficult to know to what extent these books give the full picture. The books are aimed mostly at the middle-class market, and make assumptions such as the ability to afford some of the more expensive ingredients from the apothecary, and the possession of the still room and all the equipment that was needed. The arts and cures of wise women, for example, are difficult to pin down. Women were, of course, excluded from universities and so from the forefront of medicine but the bulk of the work of caring for the sick still fell to them.
The most obvious job that fell to them was nursing. At this time the vast majority of people would have been cared for at home even when seriously ill. Hospitals did exist, but they were not always designed for the care of the sick – Christ’s Hospital in London was set up for the care of orphans, for example. Even those hospitals which did care for the sick usually cared for the very poor who simply had no-one to look after them. St Bartholomew’s and St Thomas’s Hospitals in London both looked after sick, aged or otherwise infirm beggars at this time, but even so most nursing was done at home. In the parish of Aldgate in London in the late sixteenth century many poor people found sick on the street were carried not to one of the hospitals but to local people’s houses. Their stories are still to be found in the parish registers. Here is the story of Peter Nicholson who died on 19 December 1594:
Peter Nycholson a singleman or batcheler and as was sayd he was a sayler being borne at Barking in Essex who being verie sicke in the striete before the signe of the harshorne a brewhouse was caried by the head borowe [one of the parish officers] to the house of William Landie a lyghterman dwelling in morlyes rentte . . . where he dyed.18
The sheer amount of work involved in nursing a seriously ill person, who would today be taken to hospital to be cared for by specialist nurses, must have been enormous, especially when all the normal burdens of keeping house were added to it. People today, with all the benefits of modern medicine, not only generally recover much faster than their sixteenth-century ancestors, but are ill much less often. A far greater percentage of women’s time must have been taken up with nursing her family than we would expect today.
Most women would have learnt their medicine from their mothers, but the development of printing meant that, for middle and upper class women at least, they could add to their knowledge by reading. Medical books written in English began to appear, aimed at the general reader, but not without objection from the medical establishment. Real ‘academic’ books were still written in Latin and even Sir Thomas Elyot, a rich and well-connected courtier, had to include a defence for writing his Castel of Helth in English in the preface of its second edition. Such books, however, remained firmly based on the principles of the four humours so women were better served by the increasing range of herbals which were slowly becoming available.
Today we imagine herbals to be books of botanical illustrations of herbs with a description of the herb and a discussion of its various uses. This was something that was only just beginning to evolve in the sixteenth century. Banckes Herbal, the first book printed in England to deal only with herbs and published in 1525, was not even illustrated. The Grete Herball or Arbolayre translated out of ye Frensshe into Englysshe, one of the most influential herbals to be published in England in the sixteenth century, had illustrations, but these were so vague that they did little to help identify the plants. A wonderful example of this is that the same illustration was used to identify the cherry as the deadly nightshade! Fortunately, the figure looks little like either plant so probably there were no very serious results.19
The most famous herbal of the time is Gerard’s Herbal, published in 1597. Despite its influence, it was not quite all it seemed. It is really a herbal written by a doctor named Dodeous early in the century, and largely translated by a Dr Prest who died before his work was completed. Gerard, himself a barber-surgeon, took the work over but really took over more than he could cope with. Norton, the publisher who produced the work, rented around 1,800 woodcuts to illustrate the volume and poor Gerard found he could not even match many of them to the text, although, of course, he didn’t admit this in print; and from the magnificent coloured frontispiece in the Bodleian Library’s edition he seems quite the master of his subject. Fortunately his work was later edited by a London apothecary called Thomas Johnson, and the ‘Johnson Gerard’, first published in 1633, was not only full of new entries, so that it was half as long again as the original version, but was also much more accurate. Even so, the full volume cost forty two shillings and sixpence unbound or forty eight shillings bound. At that price it would have been well out of the reach of most women.20
Having correctly identified her herbs, the housewife’s job was far from over. Fresh herbs were only available in season, and so they had to be preserved in some way for use over the rest of the year. The housewife also had to make up salves, syrups, candies (which were used in medicine and not only as sweets) and sweet waters for use as medicines. The latter in particular were a great fashion in the sixteenth century. These were distilled waters and every lady who could have afforded one would have had a still room.
The idea of distilling was to preserve the essence of various herbs all year round. Distilled waters were also a very convenient form of medicine, being easily added to anything from salves to candies. The still room would be used generally for the production of medicines but the great pride of the Tudor lady, judging from the housewifery books of the time, was her still. There are often separate sections on distilling in the books. Sir Hugh Plat’s Delightes for Ladies includes twenty-five such recipes in his ‘Secrets in Distillation’ section, and Gervase Markham, thirty-eight.
The uses of the recipes are not all medicinal; Sir Hugh, for example, provides a recipe for ‘A Scottish Handwater’21 designed to be added to ordinary water to make ‘a very sweet washing water’. There are also some waters, such as rosewater, which are used both medicinally and for everything from cosmetics to cooking. Ladies seem to have used so much rosewater that Sir Hugh even provides a way of preserving roses in order ‘to distill rosewater at Michaelmas and to have a good yeeld as at any other time of the yeare’. Ladies were making so much rosewater that they were buying the roses in and obviously they were cheapest, ‘7. pence or 8. pence the bushell’ according to Sir Hugh, when the roses were in season.22
Sixteenth-century women, though not allowed to be at the forefront of Tudor medicine, were certainly the backbone of the science. Certainly many a man must have agreed with Chaucer’s sentiments as quoted from the ‘Merchant’s Tale’:
Wel may the sike man biwaille and wepe
Ther as ther nys no wyf the house to kepe.