Medicine in Elizabethan times was all too likely to kill the patient, author SW Perry tells Historia. But it wasn’t necessarily the doctors’ fault. Most of what they believed about curing diseases and healing injuries was based on theories which were spectacularly wrong.

Doctor knows best. It’s an axiom my parents, like most of their generation, always found hard to question. Even in their later years, when Harold Shipman had been exposed and NHS scandals made headline news, they could never quite shake off the belief that a man – it was usually a man – with a doctorate in medicine to his name was all but infallible. Yet my parents weren’t so in awe of physicians that they were never to be heard saying they were off to see the leech, or the quack or the sawbones. These echoes of the fallibility of men of medicine from earlier centuries still lingers.

Dr Nicholas Shelby, the protagonist in my first book, The Angel’s Mark, is a young physician practising during the reign of Elizabeth I. When his knowledge and skill fail to save his wife and the child she carries, his fall is swift, spectacular and brutal. It takes him into a world of murder and conspiracy.

From our vantage point, we know he shouldn’t blame himself. It’s not his fault that most of what he believes about treating disease or healing injury is wrong, spectacularly, stomach-churningly, likely to kill you as soon as cure you, wrong.

Although Leonardo da Vinci had a good understanding of how the blood moved through the heart, Nicholas Shelby would have to wait until 1628 before William Harvey finally published his findings that the heart was the key to the circulation of blood through the body. At the time Nicholas practises medicine, he is relying on textbooks handed down from the ancients: from Asclepius, Hippocrates and perhaps most importantly Galen, a Roman physician who had once treated gladiators. (Given the present controversy over whether people who indulge in risky health-choices should have to chip in for their treatment, I can only speculate on what Dr Galen might have said to his patients when they came to him with yet more injuries sustained in the arena.)

The prevailing view of medical men in Nicholas Shelby’s day was that the body was influenced by four ‘humours’, a system that had coalesced from ancient Greek medical theory via Galen to become an explanation for everything concerning the body’s constitution from character to health. These humours more or less corresponded to the four elements which were thought to make up all matter: earth, water, air and fire.

The Melancholy humour was dry and cold like the earth. The Phlegmatic humour possessed the cold, moist characteristics of water. The Sanguine humour – the blood – was hot and moist like the air (you can tell we’re talking of ancient Aegean islands here and not England). And finally, the Choleric humour: hot and dry, like fire.

These humours were associated with various organs of the body. They could be made to account not only for illness, but also for ageing and temperament. They mirrored the world as people experienced it in its most basic states: hot, cold, dry and wet. And they had to kept in balance. Illness was a result of the humours becoming unbalanced. One of the ways a physician could restore balance was by draining blood from any area of the body where he believed the imbalance lay. This approach only died out in the mid 19th century.

Elizabethan doctors thought they were being rational. What could seem more obvious in a time of superstition than preparing for a course of treatment by casting a horoscope? What caused disease, if not invisible vapours and malignant spirits? And yet, at the time, the first real signs of a modern approach to healing were emerging.

The illustrations in the anatomy books by Andreas Vesalius, born in Brussels in 1514, are astounding. Some of the interventions practised by his contemporary, the Frenchman Ambroise Paré, were still used to treat the wounds of soldiers injured in the First World War. Yet for every Vesalius and Paré there were any number of tricksters and charlatans preying on the desperate. And even Paré himself was convinced that if a pregnant woman sat too long on a stool, it could damage her unborn child.

But despite their ignorance, physicians considered themselves men of great learning, and certainly not to be listed alongside those other practitioners, the barber-surgeons. It was their job to do the actual blood-letting and flesh cutting. And when the barber-surgeons sought professional parity with the physicians, well, voices were more than just raised. The physicians considered the surgeons mere tradesmen, because they used tools, whereas the physicians used intellect and study. The surgeons didn’t get their own guild until 1745.

As for women physicians, Elizabethans – the men, that is – were convinced God hadn’t given the female sex the capacity for such serious study. All Bianca Merton – owner of the Jackdaw tavern on Bankside and the woman who saves Nicholas from his despair – can hope for is to practice as an unlicensed apothecary. While the Muslim world could boast numerous examples of women doctors, and Dorotea Bucca was appointed professor of medicine and philosophy at the University of Bologna in 1390, it wasn’t until 1909 that a woman became a fellow of the Royal College of Physicians. The surgeons caught up two years later.

Amongst the questions I pose in The Angel’s Mark are: what happens when the search for knowledge takes a dark turn? What happens when a man of medicine (and in Elizabethan England that can be amateur as well as professional) loses his conscience?

These are questions I return to in the second of the Nicholas Shelby stories, The Serpent’s Mark. And this time, medicine is hijacked not solely for an individual’s warped ambitions, but to change the entire politics and religion of the State.

The Serpent’s Mark by SW Perry is out in hardback on 6 June.

The Angel’s Mark, published by Corvus Books, came out in paperback on 2 May, 2019. The third and fourth books in the Jackdaw series are under way.

Read more about The Serpent’s Mark by SW Perry.

Images:

A doctor examining urine by Trophime Bigot: via Wikimedia

Dissection scene from frontispiece of Galen’s De anatomicis administrationibus libri novem , 1531: Wellcome Collection (CC BY 4.0)

Illustration of the four humours, 1574: via Wikimedia

‘Tabula’ of musculature from De humani corporis fabrica by Vesalius, 1543: Wellcome Collection (CC BY 4.0)

Chart showing the parts of the body to be bled for different diseases: via Wikimedia