The Time Traveler's Guide to Medieval England: A Handbook for Visitors to the Fourteenth Century (33 page)

Your leprous breath will be considered to be of a similar quality as the miasma around a cesspit, and likely to lead to leprosy in others, so no one will tolerate your presence. Perhaps some people will pity you in your ailing condition and look upon your situation charitably. Many will not, seeing your affliction as divine judgment on you for your sinful life and your suffering as nothing more than an opportunity to atone for your sins, and thereby purify your soul, before you die.

Leprosy is not uncommon in 1300. If you catch it you will find that it progresses very slowly through your body, removing first the sensations in your hands and feet, and later paralyzing your extremities, leaving them badly ulcerated. After a few years your fingers and toes will melt off. You will probably bleed from your palms. Your body hair and eyelashes will fall out. You might suffer from claw-foot or claw-hand. Men will see their penises putrefy. At some point the bridge of your nose will collapse and you will be left with a smelly liquid constantly running from the gaping wound where your nose was. The ulcers in your larynx will grow and give your voice a coarse, croaking quality. You will probably lose some teeth, your eyeballs may become ulcerated, and your skin will be marked with large nodules. Ultimately you will be wholly deformed, stinking, repulsive, and blind. That is why it is called the “living death.” That is why people are absolutely terrified of it. And that is why, if you catch it, very few people will dare to come near you.

The good news is that leprosy is on the wane. By 1400 there are very few lepers in leper hospitals, and increasingly the beds are being occupied by tuberculous patients and, in a number of cases, even travelers. When Edward III throws the lepers out of London in 1346, a number of hospitals are set up for them. There is one in Kent Street, Southwark, another between Mile End and Stratford Bow, another at Kingsland (between Shoreditch and Stoke Newington), and another at Knightsbridge. All around the rest of the country leper hospitals are set up on the roads out of towns. Therein, it is supposed, the lepers are fornicating furiously, in line with their supposedly sinful natures, and so most lepers do not actually go to these places until forced to do so. Wearing the cloak and the bell is a preferable alternative. Most communities want nothing to do with those poor souls who suffer from the disease. Given how important it is to an individual to belong somewhere, to throw him or her out of the community is no small
thing. You can understand why the London baker John Mayn repeatedly refuses to leave the city when ordered to do so by the mayor in 1372. That order to abjure the city amounts to his loss of income, possessions, home, protectors, friends, and family. And who is to say he really has leprosy? Perhaps it is just some eczematous skin on his hands and arms, an occupational hazard of medieval baking.
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As leprosy declines, tuberculosis is on the rise. It is a case of out of the frying pan and into the fire. Tuberculosis is an infectious disease which comes in many shapes and sizes, and none of them are pleasant. One common version is scrofula, or the King’s Evil, which is a tuberculous infection of the lymph nodes in the neck. If you catch it, you can expect your neck to swell up until it resembles that of a pig.

The particularly interesting thing about this disease is that it has a supposed cure. The person of the king has the power to alleviate the suffering, or so it is thought, by touching the sufferer or, rather, by touching a coin passed to the unfortunate person. Thousands of people queue up to benefit in this way. Edward I undertakes touching up to two thousand individuals each year. Edward III touches about four hundred individuals every year in the 1330s and 1340s, giving each one Id, only ending the practice in 1344.
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From that date onward he prefers to have all those pennies melted down underneath the Neith Cross (a reliquary holding a piece of the True Cross), which then can be fashioned into cramp rings for the cure of epilepsy. Later monarchs revive the touching for scrofula: it is a good way to demonstrate their divine right.

Although you can get tuberculosis from drinking infected cows’ milk—many children get it this way, with fatal results—most adults are infected by human-to-human contact. This does not require them to touch or even be in the same room as one another. Aerial transmission of the bacillus can take place as a result of talking, coughing, spitting, sneezing, breathing, or just singing. Once the droplets containing the bacilli have dried out, they can rest in the dust of the house or the parish church (an important place for spreading disease) and remain infectious for up to eight weeks. Once in the body, the bacillus remains dormant until the body’s resistance fails, but further bacilli may be
spat or breathed out, spreading the disease further. Of course, medieval people do not know this. They just see the results. If you catch pulmonary tuberculosis you will find you are affected by an increasingly frequent and violent cough. After a short while your sputum will be flecked with blood. In addition you may experience fatigue, anorexia, weight loss, lethargy, anxiety, chills, muscular aches, irregular periods, sweating, and fever; ultimately you will die. Given that hundreds of men and women suffering from this infectious disease are brought before the king each year, it is a wonder that the royal family survives.

As you may imagine from these sources of infection, tuberculosis is a particularly urban problem. This is another reason why living with monks in a dormitory is a dangerous thing to do. Once one monk is infected, the whole dormitory goes down. Sufferers need to be taken to a hospital—or a monastic infirmary, in the case of monks—to be given good food and fresh water and allowed to rest. Keeping up your strength is about the only effective remedy, unless you include the psychosomatic value of going to see the king. Other remedies have a certain antiquarian charm but you would not want to undergo them. John Mirfield’s handbook for physicians at St. Bartholomew’s Hospital recommends that women’s milk should be used as a cure, and that it should be sucked directly from the breast. However, before any tuberculous men rush off to St. Bartholomew’s, they should note that Mirfield adds that if no lactating women are available, then asses’ or goats’ milk should be used, and this too should be taken directly from the udder. In addition, the patient should take a medicinal bath. For this the physician’s assistant should “take blind puppies, remove the viscera and cut off the extremities, then boil them in water, and bathe the patient in this water four hours after he has eaten.” While he is in this bath, he needs to keep his head entirely covered and his chest completely wrapped in the skin of a small goat, as a preservation against a sudden chill.

There are myriad other diseases in medieval England which you may end up catching. Many of them will cease to exist before the advent of the modern world. Several ailments described by the chronicler Henry
Knighton do not correspond with anything known to modern medical science. Similarly there are afflictions such as “styche” and “ipydyme” which have no modern equivalent.
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Some diseases have simply become less common: malaria is endemic in marshy areas, such as Romney Marsh in Kent and the Fens of Lincolnshire and Norfolk. On the other hand, fourteenth-century England is free from a number of diseases which affect us in later centuries: you will not find cholera or syphilis.
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In some cases this is due to barriers of travel. In others, it is because our vulnerability to specific infections alters with our living conditions. Diseases change as they circulate around the pool of humanity. Rodent carriers of diseases are replaced by different rodents carrying different diseases. Certain illnesses which are initially lethal grow progressively less dangerous as the decades go by. The entire medical landscape is slightly different—the diseases being as changeable as the remedies.

Childbirth is an exception. The problems of babies presenting themselves the wrong way up, or with umbilical cords wrapped around their necks, or developing within mothers whose pelvises are too small to give birth to them, are timeless. What alters is the level of medical help available. There are no forceps in fourteenth-century England. There is no vacuum extraction. A Cesarean birth is a last resort, as it is always fatal for the mother. In fact, giving birth is often fatal, whether or not it ends with a Cesarean: 2 percent of all confinements result in the mother’s death.
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That statistic—one in fifty—does not sound a high proportion, but most married women give birth more than once, and many loyal wives do so more than a dozen times. Every single pregnancy is thus like a game of Russian roulette, played with a fifty-barrel gun. A dozen children is like firing that fifty-barrel gun a dozen times. Twenty-two percent of women will not survive that number of pregnancies. Often it is not the birth itself which is fatal but the blood loss afterwards. As for the babies, a much greater proportion do not survive the ordeal. The exact rate is unknown but more than 10 percent are stillborn. Of those who do survive the birth, and live long enough to be baptized, one in six will be dead before their first birthday
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Typhoid fever is another exception to the strangeness of the medical landscape. Whenever you have armies on the move, you have a wide variety of enteric diseases moving with them. The idea that a
siege is always weighted in favor of the besieging force fails on this point: any army attacking a castle has to remain in the same place for a long time, and, as a result of poor sanitation, they tend to suffer very heavy casualties to typhoid, or “camp fever” as it is sometimes known. The same goes for dysentery. Even royalty may suffer when in the field. For all his glory at the battles of Poitiers and at Nájera, Prince Edward (the Black Prince) suffers from dysentery in the course of his long, wasting disease.
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A later warrior king, Henry V will die from it.

A third exception is poisons. Although ergotism—poisoning from rotting rye bread—is rare in England (it is not documented here before the eighteenth century) there are other natural and man-made poisons.
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The occupational hazards of working in a mine, such as lung diseases and ankylostomiasis (an infestation of parasite worms), are well known. Gongfermors are particularly at risk. Sometimes they die from the fumes in the cesspits; sometimes they die from the diseases suppurating in the pools of rotting excrement and urine. When you think that a city latrine pit may contain a thousand gallons of sewage to be cleared—at a cost of 6s 8d—you can appreciate that the danger is ever present.
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Add in the public health issue of the cleanliness of the water supply, and you can see that even having a wash after work may lead to illness. Pipes might be made of wood—elm or oak—but often they are made of lead, as in the case of Exeter’s urban water supply. The lead poisoning is not so acute that it leads to widespread nervous disorders but over the course of a lifetime of drinking lead-polluted water you can expect to see the early stage symptoms: constipation, muscular weakness, blue gums, and, discolored skin. Those workers who specialize in making lead pipes (plumbers) and laying lead roofs can expect a heavy dose of lead poisoning over the course of their career, possibly ending in nervous disorders, tremors, paralysis, and blindness.

Although they have to cope with the basic problem of crop failure, the English manage to avoid many nutrition-related diseases. Scurvy is prevented in the diets of the rich by eating plenty of cultivated and preserved fruit. It is prevented in the diets of the poor by the reliance on cabbages and root vegetables, and the storage of apples and pears through the year. Pellagra is not a problem in England, as there is no reliance on corn. Rickets—a disease in which children’s bones do not harden and are bent with muscle use, resulting in bowlegs and curved
arms—is rare, for vitamin D deficiency is offset naturally as a result of sunlight acting on the skin, and children spend much of their time out of doors. So, as long as you can get enough to eat, and can avoid all the various lethal infections, the dangers of childbirth, lead poisoning, and the extreme violence, you should live a long time.

All you have to worry about are the doctors.

As you will realize from humoral theory and the astrological basis for miasma theory noted above, medicine and religion are uneasy bedfellows. If you add the popular magic applied by ordinary people in desperate situations, you can see that it is difficult for the Church to stop people straying from religious faith and veering into the occult in search of medical relief. Besides, if the Church allows astrological means to explain a plague, why not use the same means to predict when the next plague will be? That logic leads to fortune-telling and sorcery. Thus the Church increasingly denounces medicine. As a result of the Fourth Lateran Council (1215), the Church forbids priests of the rank of subdeacon or above from engaging in any activity likely to draw blood. They are forbidden to cut into the skin, and anatomy is regarded as unholy (the Church refuses to permit Christians to dissect corpses until the late fifteenth century). The division leads to the growing separation of the professions of physic (medicine) and surgery.

If you feel ill you will need to seek out a physician or doctor of medicine. (The term “doctor” does not become interchangeable with “physician” until the end of the seventeenth century.) This is not a straightforward matter: qualified physicians are rare. There are probably fewer than a hundred medical degree holders in the whole of England, and only the very largest cities and towns have a medical doctor in residence. Moreover, many of these highly qualified men are contracted to serve a particular household, for instance a monastery or a great lord. Their capacity for doing extra work is relatively limited. No
matter how far a physician is from his lord, if the lord needs him he must attend when summoned. Because his fees are so high, he rarely refuses. When Queen Isabella is dying in 1358 she sends a horse for her physician, Master Lawrence, to come to her immediately at Hertford Castle. When her health worsens, she sends for him again, even though he is at Canterbury, seventy miles away
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As her situation is desperate, she also summons other physicians from London, twenty-one miles away. Even if you are a queen at death’s door you may have to wait a day or more for a qualified physician to come to you.