Part 5

To read a medical dictionary is to marvel that any man should enjoy even brief intervals of health, there are so many delicate organs in the body and so many diseases lying in wait for them. Read the pronouncements of specialists on diet and the dangers which attend the eating of any food or the drinking of any liquid, and the marvel grows. Add the extraordinary facility with which accidents occur, and the margin between life and death becomes surprisingly narrow. The crew of a destroyer are habitually separated from the other world by about a quarter of an inch of steel. With most of us the partition is less obvious, less constant and uniform, but very nearly as thin in places. For any but the most hardened there must always be a feeling of pleased surprise upon emerging safely on the other side of Piccadilly Circus or the Embankment by Blackfriars. (It is true that in the latter case a paternal, not to say grandmotherly, Council has provided the unexciting alternative of a subway, but only leisurely athletes have the time or energy to descend and reascend those stairs.) The average City man is within inches and seconds of death every day, and it is only when the inches and seconds become fractional that he realises for the moment his insecurity of tenure. Which is just as well. Every age has its own dangers: we have the motor car, unwitting apostle of socialism in its brutal, individualistic disregard for the rights of others; mediæval man, I am inclined to think, ran most risk from the quick temper of his fellows.

From time to time, when some undesirable alien is arrested for stabbing an enemy or chance acquaintance who has annoyed him, the police-court magistrate before whom he is brought will comment, with patriotic pride, on the 'un-English' nature of the offence. And it is true that at the present time the Englishman as a rule emphasises his disagreement with his opponent by means of fist or hob-nailed boot rather than with a knife, but this was certainly not so in mediæval times. Call a man 'a boor' nowadays and you may get a black eye, but the results were more disastrous in the thirteenth century, as John Marsh found when he applied that opprobrious term to Richard Fraunkfee as they were walking back from church at Doncaster, for Richard promptly knifed him. Every man in those days carried a knife, dagger, anelace, or baselard, and produced it without hesitation if angered. Needless to say, the knife was much in evidence after harvest feasts, wakes, and especially visits to the tavern, for drunkenness has been an English vice since Fitz Stephen, in the twelfth century, spoke of 'the inordinate drinking of fools' as one of the two plagues of London. How far this failing was common to both sexes I do not know; casual references to women in taverns occur occasionally, but they might have been there as blamelessly as their descendants in a modern tea-shop, and, so far as I can remember, I have only come across one woman who met her death when drunk--a Yorkshire woman who fell down a well. At the same time, seeing that 'the good wyf taugte hir dougter' in the fifteenth century that 'if thou be ofte drunke it falle thee to schame,' it looks as if occasional excess might have been condoned. With the exception of drunkenness, the moving cause of the innumerable murderous assaults is rarely given, and it is rather curious that the only two cases which I have found of men quarrelling, with fatal results, over a woman both occurred at ironworks in Yorkshire in 1266.

Knives were not infrequently responsible for deaths without any evil intent on the part of their owners. In quite a large number of cases when boys were playing together a knife would fall out of its sheath and inflict a mortal wound. And then, if the owner were over twelve, he would have, theoretically, to go to prison and stay there till he received a formal pardon from the king for accidental manslaughter. I say 'theoretically' because in practice the culprit usually 'fled,' which, I suspect, meant that he went round the corner while the village constable carefully looked in the wrong place for him. An unusual incident connected with a knife occurred in Dorset in 1280, when a girl, clearing the table after dinner, picked up the tablecloth with a knife inside, and as she went out of the room tripped and fell so that the knife stuck into her. It was about the same date that a Suffolk peasant, William le Keu, flung a knife against the wall of his house and it bounded off and killed his infant daughter, lying on her mother's lap in front of the fire. Why he should have thrown his knife at the wall does not appear, but people were always throwing things about and hitting inoffensive passers-by. For instance, a man would fling a rake or a flail at some chicken and hit his own child. Children, in fact, had an unhappy knack of coming round the corner with disastrous results to themselves, especially when their elders were playing quoits or pennystone down the village street. One of the most curious cases of what we may call an indirect accident was when two small boys went into an orchard to get apples; one of them threw a stone up into a tree, but instead of bringing down an apple it hit a stone that some one had thrown up long before, and this fell on his cousin's head and killed him. Another case of the unforeseen happened in Nottinghamshire in the thirteenth century, when Richard Palmer was climbing a tree in a churchyard to take a crow's nest. He was standing on a bough when suddenly it broke; but the result was not what might have been expected, for Richard got his arms round a branch and after hanging for a long time came down safely, but the broken bough fell on the head of a man standing down below, and 'the dog it was that died.'

Fire, the second of Fitz Stephen's 'plagues,' played its part in preventing over-population, as might be expected when the framework of the huts was of wood, the roof of thatch and the floor covered with straw or rushes. If a woman went to bed leaving a lighted candle stuck on the wall it was hardly surprising if she paid for her carelessness with her life, but as a rule the victims were children or very old people, and as often as not the immediate cause was some chicken, or pig, or calf getting on to the open hearth and scattering the fire on to the straw-covered floor. For the mediæval peasant shared his hut with his live stock, though it would not be often that a man would be called upon to separate two horses fighting in his kitchen; this did actually happen to a man in Winchester, and as usual the peacemaker got the worst of it. Fire, again, acting indirectly through the medium of water, was another frequent cause of disaster, a most astonishing number of cases occurring of persons, usually children, scalded to death. I can only suppose that the cauldrons were large and insecurely balanced; that they were large may be concluded from the frequency with which people fell into them. But cold water was perhaps as deadly an agent as any. In Yorkshire in particular the coroners' rolls suggest that the number of people that fell off bridges and out of boats into streams and down wells must have seriously interfered with the purity of the water supply; but, fortunately, water was very rarely drunk in those days. The most frequent cause of drowning seems to have been falling off a horse, and the mediæval version of the well-known proverb ought to have been 'One man can ride a horse to the water, but nine out of ten can't stay on when he drinks.' Taking the number of cases in which men watering their horses did get drowned, and allowing that a reasonable percentage of those thrown into the water scrambled out again, the standard of mediæval riding must have been about equal to that of the White Knight, who, when his horse stopped fell over its head, and when it went on again fell over its tail.

Occasionally the propelling agent, so to speak, was human, as in the case of a clothworker of Tadcaster, who, 'being annoyed with his wife,' flung her into the Wharfe and drowned her. The measure seems extreme, and he could not plead peril of shipwreck, the excuse of the Syracusan, who, 'when all ponderous things were to be exonerated out of the ship,' flung his wife into the sea 'because she was the greatest burden.'

In spite of a verdict of 'misadventure,' I cannot help feeling a little sceptical about an incident which took place at Bedford in 1220, when William the miller was driving certain Jews in his cart, and at the bridge the cart fell into the water and three Jews were drowned. As I read the story there came into my mind Sam Weller's conversation with Mr. Pickwick about his father's remarkable accident with the voters: '"Here and there it is a wery bad road," says my father. "'Specially near the canal, I think," says the gentleman.... You wouldn't believe it, sir, but on the wery day as he came down with them woters his coach was upset on that 'ere wery spot and every man on 'em was turned into the canal.'

Occasionally, also, the victim was a voluntary one, as in the case of John Milner, who, with the contempt for consequences which we might expect from one of his name, jumped into the Ouse. The consequence for him was that he became what Mr. Mantalini called 'a demmed, moist, unpleasant corpse,' and the jury decided that he had acted 'by temptation of the Devil.' While they displayed a certain boldness in thus arraigning the Devil for procuring, aiding, and abetting a felony, they showed more discretion in another quarter, for when a man and his wife were found struck by lightning, where a modern jury would have declared it an 'act of God' the mediæval jury preferred the less dogmatic and more reasonable verdict that 'no one is suspected.' It is pleasant to note that in another instance, where the body of a man struck by lightning was first found by his wife, the jury expressly exonerated her, saying 'she is not suspected' (of having done it).

I am not quite certain of the force of a verdict of 'by temptation of the Devil' in a case of suicide, but it seems to have been the half-way house between _felo-de-se_ and madness, to have been, in fact, the mediæval equivalent of that 'temporary insanity' which is the invariable verdict in modern times. The idea that a man must be mad to take his own life, and that therefore all suicides were insane, had not occurred to the mediæval mind, but they evidently felt that there were cases in which the suicide was not himself, although he was not sufficiently outside or beside himself to be considered an absolute lunatic. There are strange and grim little stories of madmen in some of these old records. One of these, not wanting in pathos in its evidence of good intentions diabolically twisted, tells how Robert de Bramwyk, a lunatic who had some lucid intervals (and was, therefore, probably not so closely guarded), in a fit of frenzy took his sister Denise, who had been deformed and hunchbacked from her birth, and, wishing to make her straight, cast her into a cauldron of hot water, and taking her out of this bath trampled upon her with his feet to straighten her limbs.

With the exception of this madman's empiric bone-setting I only remember to have come across one instance of an operation being mentioned in this particular class of coroner's records. This was in 1330, when Richard de Berneston, a surgeon of Nottingham, cut a 'wenne' on the arm of William de Brunnesley and William afterwards died of heart failure. It is rather remarkable that doctors seem hardly ever to have been held responsible for the death of their patients, though in 1350 we do find Thomas Rasyn, leech, and Pernel, his wife, pardoned for the death of John Panyers, miller, of Sidmouth, whom they were said to have killed through ignorance of their art; the inclusion of the wife seems to point to a mediæval nursing home. As a rule, probably, when a patient died under a doctor's care, his relations took the matter philosophically and assumed that the treatment had been correct and that he would have died in any case. It was the patients who survived that made all the fuss. For instance, there was Thomas Medewe, the vicar of a Hertfordshire parish in the fifteenth century, who 'by goddys visitacion had an infirmyte in his throte.' The local practitioner, or his equivalent, who would probably have been a 'wise woman,' being unable to deal with it, the vicar came up to London and consulted John Dayvyle, surgeon, who gave him a plaster for his throat which did him much good and only cost 4_d._ Unfortunately for both parties, the surgeon finding that his patient was 'nygh hole' as a result of his first experiment insisted upon his having another plaster, for which he charged 20_d._ to make him 'thurgh hole.' The result was disastrous, as the patient 'felle in suche infirmitye that he might not speke and was like therby to have dyed' if he had not called in another doctor. It was, in the circumstances, perhaps natural that the vicar expressed his feelings strongly when Dayvyle sent in a bill for 20_s._ for attendance. There was the case also of Edmund Broke, of Southampton, who came up to London to undergo an operation, and put himself in the hands of Nicholas Sax, who stipulated for a fee of 33_s._ 4_d._, of which 13_s._ 4_d._ was paid in advance. The patient, according to his own account, was in jeopardy of his life through the 'defaute and unkunnyng' of Dr. Sax, and had to call in John Surgeon, 'dwelling at Powlez cheyn,' who cured him and to whom he paid the 20_s._ which his incompetent attendant claimed was due to him.

Of course there was another side to the question, patients then as now being more ready with promises when ill than with fees when well. There was William Robinson, for instance, a haberdasher of Lombard Street, who fell ill with pestilence and sent for William Paronus, promising that if he would only save him 'he would reward him as well as ever he was rewarded for any cure'; but when, after a month's attendance, he was well again, he declined even to pay the doctor's out-of-pocket expenses incurred for drugs. And sometimes there were cases in which it was difficult to decide who was in the right. One such case came into court in 1292. Mauger le Vavassour, a member of a leading Yorkshire family, fell ill; his wife, Agnes, and other friends, including his uncle, Henry le Chapeleyn, sent for Master Otto of Germany, evidently a doctor of repute, promising him one mark to come and see the invalid, and further six marks if he would undertake his treatment. So Master Otto paid his visit and then went off to York to the apothecary's and compounded various medicines and healing drinks, which he gave to Mauger, with excellent effect. When the patient was convalescent Master Otto put him on a very strict diet, so strict that Mauger grew restive, and his wife, who sympathised with his feelings, gave him various forbidden foods. The doctor, finding his orders disobeyed, declined to accept responsibility, washed his hands of the case and withdrew. The question then arose whether he was entitled to his fees or whether he had shown neglect by leaving his patient before he was fully cured. The jury decided that Master Otto ordered the strict diet for Mauger's good, and not, as had been suggested, with the object of keeping him weak, and so increasing the bill for attendance, but they also found that as a matter of fact the extra food did the patient good and not harm. The verdict being thus for both parties the judges were puzzled and reserved their decision.

Another rather curious point cropped up about the middle of the fifteenth century. Eryk de Vedica, one of the brethren of the Grey Friars of London, was a physician of skill and reputation, and was sent for by Alice, wife of William Stede, a vintner. She seems to have been in a very bad way, and when Brother Eryk saw her and understood her 'grete age and jubertous sikeness' he was with difficulty persuaded to attempt her cure. However, after five weeks' attention he 'had soo doon hys parte vnto her that she thought herself wele amended in her body, she cowde hym grete thancke and gave hym 20_s._ for his labour.' And then her curmudgeon of a husband, who was possibly not particularly pleased at her recovery, sued Brother Eryk for taking the money, and technically the unfortunate friar had no defence, as 'the common law supposeth every receiving of the husband's goods or money by the hands of his wife without his licence or command to be a wrongful taking away of the same from him.' We will hope that the Court of Chancery, whose assistance was invoked, over-ruled the Common Law and did the friar justice.

It was not unusual for friars to have a knowledge of science and medicine, but a statement that I read the other day in a book recently published, that most (I believe my author said 'all') mediæval doctors 'were, of course, monks' is singularly wide of the truth. On the contrary, in even the largest monasteries it was customary to call in a doctor from outside in any case of serious illness, and the greater houses frequently retained the services of a secular physician. The cathedral monastery of Winchester, for instance, in the fourteenth century, made an agreement with Master Thomas of Shaftesbury that he should attend the convent in return for his board and lodging, the board, it may be noticed, including a daily allowance of one and a half gallons of the best ale and a gallon of a smaller brew. It is probable also that Master Adam of St. Albans, surgeon, who came from the priory of Ely to attend King Edward I. in his last illness at Lanercost, was the cathedral doctor. There were, of course, medical attendants attached to the court; their salaries were not large, the surgeons of the first two Edwards being paid only from one to two pounds a year, but there were perquisites in the shape of furred robes, gifts of money, or silver goblets from grateful patients, and substantial pickings in the shape of ecclesiastical benefices--the favourite way of pensioning a court physician being to give him one or more prebends or rectories. Occasionally the pension took the form of landed estate, as when Edward III. gave land in Kildare to his surgeon, John Leche, a grant which proved rather a white elephant, for early in the next reign Parliament, seeing the evils of absenteeism, ordered that all owners of estates in Ireland should reside on them in person or else pay for an able-bodied man to assist in policing the country, two alternatives equally trying to the old surgeon's feelings. With such slender and precarious remuneration it was excusable that the royal doctors should sometimes have an eye to the main chance, and Fabyan tells a story against one Master Dominic, physician (very much) in waiting to Elizabeth, Queen of Edward IV. Before the birth of her first child (the Princess Elizabeth) Master Dominic had been very positive that it would be a boy, and so, when the time came, he stood outside the queen's room 'that he myght be the firste that shulde brynge tydynges to the kynge of the byrth of the prynce to the entent to have greate thanke and rewarde of the kynge; and lastly when he harde the childe crye, he knockyd or called secretly at the chamber dore, and frayned what the quene had. To whom it was answeryd by one of the ladyes, "what so ever the quenes grace hath here wythin, suer it is that a fole standithe there withoute." And so confused with thys answere, he deperted wythoute seynge of the kynge for that tyme.'

The position of the medical man who was not attached to the court or to some nobleman's suite is rather obscure. In London during the fourteenth and fifteenth centuries the surgeons of the city were under the control of two or more master surgeons who acted as universal consultants; any surgeon undertaking a case involving risk to life or limb being obliged to call in one of the masters to see that his treatment was correct. In the same way the veterinary surgeons were at liberty to call in the advice of a master farrier, and if through conceit or negligence they did not do so and the horse they were treating died, then they would be responsible to the owner for its value. As to the country practitioner, it is not quite clear who licensed him to take the title of 'leech' or whether he merely assumed it. There were, no doubt, a certain number of men of learning in the provinces, and in 1478 Sir John Savage was able to find a 'connyng fisission' for Robert Pilkington in Macclesfield. He certainly required such a one, for, as a result of eating a mess of 'grene potage' containing poison he was 'swolne so grete that he was gyrd abowte his bodye in iij places with towells and gyrdylls' to prevent him bursting. When a man is in such a state it is 'a thousand to one if he lives the age of a little fish,' as Nicholas Culpeper would say, but the physician 'dyd grete cures to hym' and he recovered. As a rule, however, it is probable that the country leech had little more knowledge of the healing art than many of his patients. It must be remembered that a knowledge of simple herbal remedies was pretty widely diffused, and an acquaintance with more elaborate preparations formed part of the education of the upper classes. Did not the lady of the manor almost to our own days dispense home-made medicines with moral stimulants to her tenants, whose simple minds and _dura ilia_ received therefrom much benefit? Yea, 'kynges and kynges sones and other noble men hath ben eximious phisicions,' and there is in the British Museum a book full of recipes for plasters and ointments, composed by Henry VIII. Half a century before that bluff but gouty monarch 'the gude Erl of Herforth was holden a gud surgen,' though he seems to have had a tendency towards extravagant multiplication of ingredients in his prescriptions. In humbler ranks of life every monastery had an Infirmarian who, though dependent on outside assistance in serious cases, was expected to treat the ordinary illnesses of his brethren, and at least to see that there was always ginger, cinnamon, and peony (this last most effectual for the incubus or nightmare) in his cupboard. It is noteworthy that in all the hundreds of hospitals founded prior to the Reformation, from St. Leonard's at York with its two hundred beds downwards, there appears to have been no provision for medical attendance. The wardens were rarely medical men; Master Thomas Goldington, one of the surgeons of Edward III. was made warden of two hospitals, at Derby and Carlisle, but the only result was that he attended to his private practice and neglected the hospitals. Clearly the rudiments of nursing were assumed to be known to the resident chaplain or some of the inmates--more particularly the women. Wise women have doctored the country-side time out of mind, and in the reign of Elizabeth we even find one, Isabel Warick, practising surgery in York and requiring protection from her male rivals. A century earlier Alice Shevington, servant to William Gregory of London, 'pretendyng hirself to have had connyng in helyng of sore ighen,' spent much of her time attending to her neighbours' eyes instead of her master's house, wherefore he docked her of part of her munificent wages of 16_s._ a year.