How far did the sick rely on written communications in looking for remedies in England, 1375-1640

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When someone became sick in England between 1375 and 1640 the number of options they had for seeking remedies depended largely on their illness and their resources. Some of these options centred or relied on written communications, however, others made use of different types. “Lay people moved easily between the medicine provided by a poor old woman, by empirics and by learned medicine” (Wear 2000). For nearly everyone though during this period care began at home and was largely the responsibility of the woman of a household.

The means for women in this position to collect relevant information varied from oral tradition and example, to recipe books and even vernacular texts aimed at their readership. Familial and friendly resources exhausted, a sick person might turn to one of the many unlicensed medical practitioners who frequented towns and the country side. Remedies could be sought from wise old women to mountebanks, and again, the source of their knowledge, and their means of selling their remedies could sometimes rely on written communications. Qualified’ medical practitioners might include apothecaries from whom medicines could be bought, though often physicians tried to limit this trade. Usually a last resort, and only available to a small proportion of the population, was the physician or surgeon. The extent to which written communication was involved in this interaction varied.

Underlying nearly all of these transactions is a religious element too, with prayer or other religious means providing a hope for a remedy. Women were responsible for most of the routine health care on offer in late medieval England” (Rawcliffe 1995) and in this role “were expected to prescribe for and nurse relatives, friends and neighbours” (Beier 1987). All women grew herbs in their gardens or in pots, and were supposed to know when and how to use them to make remedies. For many, health care never went beyond these limits, relying on the knowledge of family and friends for remedies. This system of health care was applicable to all social classes and women from the poorest, completely uneducated to noble women had to learn the skills somewhere.

Most relied upon “an information network consisting of her mother, relatives, neighbours, medical practitioners and books could often be drawn upon” (Wear 2000) depending on her social standing and literacy. In most families “herbal lore [was] customarily passed on by word of mouth and practical demonstration from one generation to the next” (Rawcliffe 1995), and thus bypassed any reliance on written communication. For the literate though there were more options.

In their simplest form, recipe books usually took on the form such as those of families like the Blundells of Crosby who owned books to which visitors were invited to contribute, forming a written collection of family traditions or folk medicine (Wear 2000). As books in the vernacular became more common, larger collections of medical literature could be built up by those who could read and write, and who could afford the books. Indeed, because “the manufacture of remedies was one of the household skills expected of women, [it was] learned by well-to-do women from medical books as well as by word-of-mouth” (Wear 2000).

This was especially true of “Charitable lay-women … [who] often relied on English books to ‘learn up’ medicine” (Wear 2000). A good example of such a person is Lady Margaret Holby of Yorkshire. From the seventeenth century, she provides but one example of someone who took it upon themselves to supply advice and medicine to the poor as an act of Christianity. Gentle women were not the only source outside the family that a community could turn to. There were plenty of other healers who would dispense remedies free of charge or very cheaply.

These included wise old women, or ‘old wives’ who relied on the oral tradition for their secrets and skills, midwives and white witches. Men were active too, as astrologers, herbalists, empirics, quacks and mountebanks. Mountebanks, and most of the others in this large and diverse group, relied on their oral powers to convince and audience sell their remedies. They also employed written means of communication too, such as bills to advertise their arrival in a town, and certificates of approval from past customers.

Another person from whom remedies could be sought was the apothecary. Officially limited to selling only drugs prescribed by a physician, they would often offer other herb or drug based treatments in their shops, or advice. Apothecaries provided another means of seeking a remedy in late medieval England that did not rely on written communications, as though most were literate enough to read a doctor’s prescription, they usually learnt their trade through apprenticeship and experience rather than from books. After seeking help within the family, the more affluent had another option.

Whilst “only the very rich could afford to employ their own personal physician” (Rawcliffe 1995) such men sometimes also did charitable work amongst the poor too. Though the qualification and learning of physicians’ almost certainly involved lengthy study of numerous medical books written in Latin amongst many other things, interaction with a doctor was usually entirely oral, consisting of history taking, diagnosis and prognosis, the remedy lying in the advice they gave at the end of the consultation. Advertisement of their services was normally entirely via recommendations and word-of-mouth, unlike the mountebank.

The relative scarcity of educated physicians in rural locations however, combined with disparate settlements and dangerous travel down poor roads meant that it could frequently be far too expensive for a physician to visit any but the wealthiest of his patients. In these cases, it was necessary for consultation and advice to be given using written correspondence, letters carried by friends or relatives from the sick person to their physician and back. Thus these individuals did rely to a certain extent on written communications.

Independent of their resources though, the English people were increasingly touched by written medicine during this period, with education increasing so that by 1640s roughly seventy-eight percent of the adult male population in England were literate (lecture notes). Given that “medicines, especially simples or herbs, were part of the common or public culture of medicine” (Wear 2000) it was initially the remedies from plant animal and mineral principles that “formed a large part of the published medical literature, and they consisted practically the only type of medical information that lay men and women set down on paper” (Wear 2000).

These were the kinds of books used by charitable ladies to advance their knowledge. Gradually though people demanded more. “By the fifteenth century astrological medicine was accessible to the vernacular readership in the form of almanacs” (Furdell 2002). “Long before the arrival of the printing press, vernacular tracts concerning diagnosis, treatment and avoidance of disease enjoyed widespread circulation among educated towns people, the gentry and the baronage” (Rawcliffe 1995).

England had a society where “many would have agreed the ‘All the Nation are already Physitians, If you ayl anything, every one you meet, whether man or woman will prescribe a medicine for it'” (N. Culpeper 1649, cited by Wear 2000) and “self-diagnosis and dosing was for many a daily habit” (Porter 1985). This certainly provided a good market for the “growing corpus of literature [that] was obtainable in English for the guidance of men and women with an interest in medicine” (Rawcliffe 1995).

Wear (2002) argues that because medicine was mostly carried out at home “it made sense for medical knowledge to be accessible to lay people as well as practitioners” and “publishers of vernacular books were responding to the demand of increasingly confident groups such as the gentry, yeomen and merchants” (Wear 2000) who demanded access to specialised information in politics and other areas at the same time. “It was profit … hat drove publishers to spread medical knowledge to an eager readership” (Furdell 2002). This eager readership was wide ranging, including not only the emerging class of merchants but those who required “inexpensive iconoclastic medical literature” besides the “costly tomes” including theory (Furdell 2002). This was a reliable market, and by the beginning of the seventeenth century there had been published in England over 150 different medical works in the vernacular (Furdell 2002).

Although in retrospect it is easy to see that much of what was written in the books relied on folk medicine and remedies anyway, and that the popularisation of a new means of passing information was not going to replace the women centred care system of the home, at the time much concern was expressed by physicians. For example, the “Galenist James Primrose … feared that sick people would employ treatments and recipes not designed specifically for them or that they would ignore well-known astrological prohibitions” (Furdell 2002).

This concern on the part of the learned doctors would suggest that they were worried by a growing reliance on written communications by their clients. More cynically though, it must also be remembered that “English-language books undercut a degreed doctor’s practice, cheapened his investment in his own education, and diminished his potential earnings” (Furdell 2002). Another kind of written communication used at the time that must not be neglected includes the “numerous books and pamphlets which might be called the literature of moral medicine” (Beier 1987).

These manuscript or printed articles in the vernacular were aimed at laymen and remind us of the fact that sickness and health at the time were not separable from religion and God. This was especially true at times of plague when religious pamphlets of advice or instruction sold particularly well. The role or religion in treating disease though cannot be confined to its written communications however. 1375 to 1640 and beyond was a time when prayer was felt by many to be sufficient precaution against and treatment for disease, and certainly most remedies were accompanied by a good degree of praying.

In many cases, especially before the 1530s and the Reformation in England, people might also perform a pilgrimage or visit to the shrine of a saint in search of remedy. At this time also clerics might be a source of more learned medicine and treatment, providing physical as well as spiritual support. The period in question can be seen then to have been a time of multifarious sources of knowledge about medicine and of remedies.

With “the intervention of doctors being only one weapon in the therapeutic arsenal” (Porter 1985), “in the end, medicine could be as simple or as complicated as one wanted to make it; everyone could be a physician by making remedies, diagnosing illnesses and offering advice on regimen. A variety of English medical texts allowed one to do all of this” (Wear 2000). Here Wear is pointing out the support that written communications offered to existing structures.

At the same time the “strength and continuity of active, articulate lay healing cultures” (Porter 1985) must not be forgotten. Certainly during “seventeenth century England the most commonly used kinds of medical therapy were self-treatment and treatment rendered by lay-people – relations, friends and neighbours” (Beier 1987). Remedies were sought from individuals other than learned physicians who rarely relied solely on text for their remedies, and instead used it to bolster the knowledge they already possessed.

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