In my piece on the Pilgrim Fathers, I speculated upon the causes of the deaths of some of those people soon after their landing in the New World. I thought it might be useful to attempt a study of the whole issue of medical and "healing" practices during the period we call the Early Modern Age. This is a synthetic historiographical term which arbitrarily covers the period 1550 - 1750. This period in history does incorporate the lifespan of the Pilgrim Fathers and that of their offspring.

Medical practitioners in Early Modern England came from a variety of backgrounds. At the top of this hierarchical "tree" was the university trained physician. Typically, the physician made a diagnosis of the condition of a particular patient and prescribed a course of treatment which the apothecary, under the auspices of the physician, would dispense. Below the physician came the barber-surgeon. This was strictly a manual and comparatively non-academic branch of medical practice which resulted from a period of apprenticeship. In the period under review, the barber-surgeon could set broken bones,lance boils, pull teeth etc. - and the universal panacea of "cupping" (blood-letting). More ambitious practioners in that category might seek to perform the rather precarious operational procedure of lithotomy (surgical removal of kidney stones) once they had passed into the bladder. This was a common ailment of this period.

As both surgeons and barbers were reliant on the "art of the knife", they were "yoked" together within the Guild of the Barber- Surgeons of London. Below the barber-surgeon was the apothocary (already mentioned above). The apothocary was, of course, very knowledgeable in regard to drugs etc. and this sometimes led to rivalry between him and the other two professions above him.

In the more remote areas of the country where there was a lack of the established practitioners, an individual with some training might combine the disciplines cited above. This eventually gave birth to the modern General Practioner now known to all of us. Additionally some university educated men, such as clergymen, might turn their skills to the art of healing. The university curriculum of the period was "hidebound" in specific subjects such as natural sciences.

There was never ever any shortage of other individuals experienced in one form of healing or another. We should mention midwives here - female midwives until the proliferation of the forceps with its strict male practitioner limitation, in England in c1735. In this period though, one in five of women and infants did not survive childbirth.

Regarding childbirth, a physician or surgeon would only be summoned when the birth developed complications, at least in theory. Other than that, the midwife would reign supreme with the help of the women - usually older women who had had children themselves. These women were called "gossips" and their constant "tittle-tattle" "gave birth" to the modern colloquial term ! The birth-room would be sealed - windows firmly closed and even keyholes blocked in order to prevent any harmful drafts accessing the room.

Further down the hierarchy were the "healers" selling "empirics", often at fairs and suchlike. Although some of these had a sense of duty to the communities they were a part of, some peddled their "nostrums" for remuneration only. Grocers and peddlars sold drugs. Blacksmiths and farriers drew teeth - the latter in particular, as he was adept at pulling horses' teeth !

Every village had its nurses and "wisewomen" - these often suffered during the witchcraft persecutions, particularly during the middle of the 17th Century (see the Witchcraft Persecutions article on this site). These women were well-versed in herb-lore with secret brews and various potions. These remedies were typically passed down through generations of families. There were recipe books published with home-made remedies.

We have faith in our medical practitioners nowadays as modern medical science is so advanced. Not so then. There were quite often doubts about diagnoses and treatments then however. Physicians based their knowledge upon the texts they had been taught - those of antiquity, predominantly Hippocrates and Galen - with all the misconceptions they engendered.

Such universal remedies including purging, sweating, vomiting and blood-letting were ubiquitous. These were based on the misconceived ancient theory of the humours and their effect on the body's health. Too much of one humour - black bile, yellow bile, phlegm, blood, for example - could cause an imbalance and subsequent ill health.

Certain chemicals were administered, such as antimony and mercury, advocated as cures for venereal conditions. These were introduced by the medical iconoclast Paracelsus in the 16th Century. So these were well established by 1620, the year The Mayflower set sail.

In this period some people tended to treat themselves with the aid of nurses etc. cited above. As in the case of the Josselin family in the mid to late 17th Century, families rarely consulted and in some cases were unable to pay physicians and surgeons high fees unless it was absolutely necessary. Although five of the Josselin family children died between February 1648 and July 1673, only on one occasion was a physician summoned. Indeed, at birth and death physicians and surgeons were conspicuous by their absence. The Rev. Ralph Josselin was typical in that people of the time could either not afford the fees or just simply did not believe the physicians and surgeons were able to cure illness successfully. "Trust in God" prevailed.

Removing the Stone of Madness

Samuel Pepys too seemed to distrust the professions unless it became absolutely imperative to summon one of them, as was the case with his troublesome bladder stone. This was a precarious operation, as surgeons could only utilise the perineal route to the bladder. The procedure is worth recounting here as an example of 17th Century surgery. Pepys speaks in the third person.

"The surgeon got to work. First he inserted a thin silver instrument, the itinerarium, through the penis into the bladder to help position the stone. Then he made the incision, about three inches long and a finger's breadth from the line running between scrotum and anus, and into the neck of the bladder, or just below it. The patient's face was sponged as the incision was made. The stone was sought, found and grasped with pincers; the more speedily it could be got out the better. Once out, the wound was not stitched - it was thought best to let it drain and cicatrize [sic] itself - but simply washed and covered with a dressing, or even kept open at first with a small roll of soft cloth known as a tent, dipped in egg white. A plaster of egg yolk, rose vinegar and anointing oils was then applied".

Madness in this period was, of course, fundamentally misunderstood. Incarceration was the only real effective means of combating the condition - more for protection of the public than the benefit of patient him or herself. "The stone of folly" (see the Bosch painting here) was thought by some to be the cause of madness. Quite what the "stone" itself actually was is obscure. Perhaps the "stone of madness" was merely a convenient euphemism (derived from the term bladder stone) for the disease of the mind. Trepanning or trephining (drilling a hole in the skull to relieve pressure, or "evil spirits") was a well-known procedure practised as far back as prehistory.

Another consideration is distance and the need to travel to see a physician or surgeon. Quite often the lowly and humble village healer was trusted - rightly or wrongly.

Hospitals were not a feature of the period under review. It was not until the 18th Century that hospitals as we know them began to appear. Patients were treated in their homes or in the houses of the practitioners.

Medicine at sea was an exception in the strict practitioner hierarchy. On land physicians jealously protected their profession from surgeons and apothecaries and were backed by law. Although surgeons did on occasion prescribe and administer medicines, they did so at their own peril. And as cited above, in remote areas of the country skills did converge. In such areas the professions "turned a blind eye".

At sea no such niceties could ever exist. The seagoing community was often served by a physician or surgeon who could not find work at home. So at sea, certain concessions were allowed. In any case the influence of the great and noble edifices of the physicians' and surgeons' companies did not extend beyond the shores of this country. That wider expertise, demanded by the nature of the work that ships' surgeons had to perform, was ultimately transferred to the New World where physicians/surgeons were more common.


Martin Wakley (copyright)