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Lectures review 1-6

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University of Toronto St. George
Dimitri Nakassis

22 June 2011 Tudor Health Reform Introduction Professor Tim Connell Welcome to today’s Symposium on Tudor Hospitals, a fascinating subject which, oddly enough, has certain resonances with NHS reforms today. Let’s begin with an overview of public health in the Tudor period: It is actually quite a popular subject these days, taught at both Key Stage 2 and GCSE. The common view is one of dirt, disease and death, bound down by superstition, quack remedies and bizarre medicines, all of which contains an element of truth, although there are more positive points and good news stories than might at first meet the eye. Childbirth and infancy If we focus on the human condition, a key experience (for all concerned) was childbirth and infancy. The population of The British Isles grows in this period, and nowhere more so than in London, which between the birth of Henry VIII in 1509 and the death of Elizabeth in 1603 grows from 90,000 to a quarter of a million. Inheritance and succession are of critical importance from titles and great estates to even quite ordinary trades. There are few greater examples of this than the redoubtable Elizabeth Pickering Jackson Redman Cholmeley – who in the 1530s and 40s married no fewer than three members of the Stationers’ Company (though not at the same time, of course) and who went on to becime a successful printer in her own right – the first woman in fact known to be a printer. Families were large, though mortality rates were high, even amongst the great families. No fewer than three queens died giving birth to future kings (Henry V, Henry VIII and Edward VI). The service for the Churching of Women in the Book of Common Prayer refers to the “great pain and peril of childbirth” which is reflected in the high death rates to be seen in the lying-in hospitals of the next century and beyond. Even 150 years later in Tristram Shandy, (most of which revolves around the author’s birth) his father Mr Walter Shandy is prone to philosophising, whereas My Uncle Toby (surely one of the kindest figures in English literature) takes a rather more practical view: Of all the riddles of a married life, said my father, crossing the landing in order to set his back against the wall, whilst he propounded it to my uncle Toby—of all the puzzling riddles, said he, in a marriage state,—of which you may trust me, brother Toby, there are more asses loads than all Job's stock of asses could have carried—there is not one that has more intricacies in it than this—that from the very moment the mistress of the house is brought to bed, every female in it, from my lady's gentlewoman down to the cinder-wench, becomes an inch taller 1 | P a g e for it; and give themselves more airs upon that single inch, than all their other inches put together. I think rather, replied my uncle Toby, that 'tis we who sink an inch lower.—If I meet but a woman with child—I do it.—'Tis a heavy tax upon that half of our fellow-creatures, brother Shandy, said my uncle Toby —'Tis a piteous burden upon 'em, continued he, shaking his head—Yes, yes, 'tis a painful thing—said my father, shaking his head too—but certainly since shaking of heads came into fashion, never did twoiiiads shake together, in concert, from two such different springs. In real life, Parson Woodforde’s remarkable diary of Eighteenth century life in Norfolk recounts in some detail the case of the Squire’s lady Mrs Custance. She had eleven children in twelve years, and was left virtually crippled by the last confinement. Three of the children died in infancy, although three lived into their eighties, and two into their ninivies, an interesting reflection on the increase in longevity into the Nineteenth century. The death rate among women of childbearing age seems to have been near epidemic levels, which must have led to other issues such as care of surviving children and disruption to the home economy and indeed whole families. I find it hard to believe that people faced such levels of human tragedy with nothing more than fatal resignation and, pious though people undoubtedly were, the comfort of religion must have been bleak in the face of it. The burial service reminds us that in the midst of life we are in death and people in Tudor times must have been acutely aware of that. If we take the example of Henry VII, he had lost his son and heir Prince Arthur who died in April 1502, his wife died in childbirth less than a year later in February 1503, and the baby did not survive either. Apart from any personal feelings, there were dynastic issues to take into account, although Henry in the end did not re-marry. But if this was the experience of the monarch, how must his subjects have fared, from the lady’s gentlewoman down to the cinder wench? At the other end of the Tudor-Stuart spectrum almost one hundred years later, there is Queen Anne: she went through eighteen pregnancies, of which thirteen were miscarriages or stillbirths; four children died before the age of two, and one died at the age of eleven. Again there were dynastic implications, with the Crown passing subsequently to the German Georges and the Hanoverians, but the constant suffering of the poor Queen can hardly be over-stated. Disease With regard to disease specifically in Tudor times, there was no lack of choice when it came to things to die of, ranging from dysentery and typhoid to malaria, smallpox and leprosy – and that was just the fate of the kings of England. vi There were all sorts of epidemics, not least of which was the sweating sickness, which has never been precisely identified, but which had a devastating effect on the population. It also killed Prince Arthur, heir to Henry VII, and nearly killed his young wife Catherine of Aragon. To quote the Bard: Let us sit upon the ground And tell sad stories of the death of kings; How some have been deposed; some slain in war, Some haunted by the ghosts they have deposed; Some poison'd by their wives: some sleeping kill'd; All murder'd: for within the hollow crown That rounds the mortal temples of a king Keeps Death his court. vii Or to put it more prosaically, two English monarchs died of dysentery (Edward I and Henry V) and two of TB (Edward VI and possibly James I); Henry IV Part I may have had leprosy (though some people think that Henry IV Part II had psoriasis and actually died of something else); 2 | P a g e Edward III had a stroke; Mary died of ovarian cancer, and only Henry VII and Elizabeth appear to have died from natural causes and old age. And curiously enough, relatively few princes succeeded their father to the throne: the Black Prince may have had multiple sclerosis; Henry VIII’s illegitimate son Henry Fitzroy had TB; and Prince Henry, the highly promising son of James I, died of typhoid. viiThe course of history would undoubtedly have been different had any of these survived to take the crown. Leprosy, as we shall hear, was a sufficient threat for dedicated hospitals to be set up. And it had a high enough profile for some lazar hospitals to achieve notoriety, such as the one at Harbledown that pilgrims to Canterbury had to pass – and run the gauntlet of the inmates who wanted them to kiss a relic of St Thomas à Becket. (Erasmus himself commented on this practice with some disgust.) ix Then there was the plague, which hit London in 1563, 1593, 1597 and 1603, killing tens of thousands of people in the process. It affected all levels of society (Shakespeare actually lost xi three sisters and a brother to the disease) and caused a great deal of upheaval as people left London for lengthy periods of time if they could (or were allowed to). For ordinary people and lesser afflictions, there were the folk remedies, the wise woman with her knowledge of herbs, and housewives would have had their own remedies for family ailments. Many houses would have had a physic garden of the sort that the Barber Surgeons’ Company has today at xii their hall just near here. Accidents and infirmity Transport and travel were hazardous (Sir Thomas Gresham broke a leg by fallinxiiif a horse, and his only son, a promising youth aged 20, died in a similar way.) Industrial accidents, not to mention occupational hazards, must have been common, with risks ranging from tetanus to septicaemia. There was only the vaguest notion of hygiene and public health was xiv rudimentary, even though the City authorities did take the matter seriously. A great deal of human suffering lies behind all of the above. I am something of a renegade in all this. Did people really tolerate such apparent helplessness in the run-up to the Age of Reason? When Prince Octavius died in 1783 at the age of 4, King George III was soxvffected that he cried, “There will be no heaven for me if Octavius is not there”, echoing perhaps the great lament of King David, “would God I had died for thee, O Absalom, my son, my son!” And Absalom was far from being the perfect son… xvi The elderly wealthy would not have been prepared to accept infirmity – and plenty of medical men (and especially the quacks and mountebanks) would not have wanted them to! There is ample evidence of bequests, legacies and endowments for hospitals or for the relief of suffering to show that people cared as much then as we do today with our donations to cancer or heart charities. Some of these early bequests have survived to this day, such as Trinity Hospital, which was founded by the Earl of Northampton in 1614, and is still managed by the Mercers Company. xvii I would prefer to think that two key human characteristics came to the fore in the face of constant ongoing pain and personal tragedy: one is human compassion; the other is human ingenuity. Not all at sea I would like to take Medicine at Sea as an example. In the introduction to some symposia previously, I have unwittingly stolen the speakers’ thunder by inadvertently using the examples they were already going to draw on, so I hope that this topic will widen our perspectives without treading on anyone’s toes! Ships’ logs, memoirs and reports and the needs of a growing navy provide us with a fair amount of data; xviithere is an interesting literature as growing literacy leads to an increasing number of manuals and textbooks; and 3 | P a g e we even have the medicine chest that belonged to the surgeon on board the Mary Rose, not to mention sackfuls of bones belonging to many of his patients. Also of interest is the Giustiniani Medicine Chest, made in Genoa in c.1565. It holds 126 bottles and pots, some with traces of their original contents. xix As England’s maritime power expanded and navigational skills grew, exploration began to spread across the globe, ranging from Sir Hugh Willoughby’s voyage to the North Cape and beyond in the 1550s, to Sir Martin Frobisher’s searches for the North-West Passage in the 1570s xxand Drake’s circumnavigation of the globe in 1577-1580. The problem lay not with the ships or navigational instruments (though measuring longitude was still a couple of centuries off) but the health of the crew, and scurvy in particular. An early voyage to the Spice Islands in 1610 saw four ships out of five stricken with scurvy, leaving the men too weak to work the ship. xxiThe one exception was the ship whose crew had been issued with lemon juice. This might have been seen as the perfect Baconian experiment, only other remedies (including mustard) were still being tried and it was not until the Eighteenth Century that the scurvy was really brought under control. Both sides during the Spanish Armada were seriously debilitated by disease, and the Spanish commander, the Duke of Medina Sidonia, was convinced that this was because of unhygienic conditions on board ship and th
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