1M\EDICAL EXPENSES IN TUDOR extracted from the Household Accounts of Sir by Valentine A. J. Swain, F.R.C.S. THE HOUSEHOLD ACCOUNTS of Sir William Petre (c. 1505-72) of Hall, , Secretary of State to Henry VIII, Edward VI and Mary, contain many items of medical expense which reflect the practice of medicine in the middle of the sixteenth century. The day-to-day entries for the years 1547-62 were made by a John Kyme, "servante unto the saide Sir William Petre " and were signed by his master at the end of the financial year, then on the last day of November. The early items of medical interest reveal that Petre suffered from probably a varicose ulcer of the leg, which was treated from time to time with ointments Jan. 1549. To Forest the Kinges surgeon by way of my masters reward for looking to my masters legge ...... 1 3s. 4d. and To the potycary for a purgacion for my master and for his paynes .. .. 6s. 8d. and to Andrewes the surgeon for dressing my masters leg ...... 6s. 8d. Payments to Vycars, another Royal Surgeon, appear in the accounts: To Vycars the surgeon in rewarde for showing my master to make the plaster called ceres plaster ...... 6s. 8d. and In rewarde to Vycars the serjeant surgeon . . 3s. 4d. It will be recalled that-Thomas Vicary treated Henry VIII's " sorre legge" 20 years previously, after which, in 1528, he was appointed King's surgeon and favourably influenced the royal sanction to the Act of Union of the Barbers and Surgeons in 1540. An early entry shows that Petre suffered also from a rupture: To Yates a surgeon for making a new trusse for my master of lene fustean .. 5s. References are made to his deafness: In rewarde to Mr. Parishe man for bringing a plaster to lay to my masters feete, being good as he said to preserve his hearing .. 3s. 4d. and To the potycary for frankensens and certain oyles delyvered ay Wynchester and Windsor for my masters ears ...... 3s. 4d. and also to his poor vision:- For a case for my masters spectacles .. 6d. Petre, who resigned from the Secretaryship in 1557 owing to ill health, wrote in the previous year to his colleague , then Dean 193 VALENTINE A. J. SWAIN of Canterbury, " I am now so broken through age since my coming hither that you shall not know me, and therefore, it is time for me to get me into a corner and take me to my beads and to remember that we have not here 'permanentem civitatem' and therefore to begin to put on my boots and prepare myself to go to the other place where we look for rest". Thence the accounts become filled with payments to the " poticary for certain stuffs and rewardes to the doctors of physicke and surgeons for their paynes."

*1

SANS DIEU RJEN Fig. 1. The Crest of Sir William Petre (c. 1505-72). It is evident that he suffered from a urinary disorder for which many herbal mixtures and palliative remedies were prescribed; to quote instances of the many such entries: Aprell, 1559. To Ryche the poticarye Wednesday 5th for madenhare 2d., scolopender 2d., a box of unguntum album 8d., Harts tongue ld., Alome Id., for a purgacion and his paines for bringing it, 10th day 6s. 8d.; To hym 16th day for mercury 2d., for honeysockle water 2d., To hym 17th day for barley water with the glas 6d., 3oz. Sirop venegar lld., white suger candye 2d., six urinalls 15d., a skyn of rede leather 6d., To hym 19th day for a glister and for his paines 6s. 8d. A boxe of conserven of cheries 6d., barlie water 4d. A boxe of oyntmente 2s., a lb. of barlie 12d., a quarte glas with water made with barlie and certen other rotes to make almonde 194 MEDICAL EXPENSES IN TUDOR ENGLAND mylke 12d., Allocium to gargle with 12d., a boxe of white lozenges 12d., a spunge 6d., barlie water 6d., Plantaine water and honey- sockle water 6d., To hym 20th day, barlie 6d., harts tongue 2d., To hym 21st day barlie water a boxe ofperfome 2s. Sirop of venegar 2oz. 8d., more for barlie water 4d., To hym 23rd day barlie water 4d., 3oz. sirop of venegar 12d., 24th day barlie water, 25th day barlie water 4d., 27th day halfsticke of cassia 9d., 29th day barlie water 4d., last day barlie water 4d...... 34s. 5d. and again in May, 1559:- To the potecary for barley water 4th day 4d., sugar candy 2d., 4oz. Ceropp fo the rume 12d., more for barley water 4d., To hym 9th day 4oz. of Sokery with Ruberbe 2s. 8d., barley water the glasse 6d. To hym 10th day barley water 6d. 11th day and 12th day barley water 8d., 13th day, 14th and 16th days barley water Is. 20th day a boxe of peppers 20d., a boxe of dia citoniton 2s., a plaster for the stomake 5s., a plaster for the syde 2s. 8d. The 31st day for 3 urinalls 8d. More to the poticary for stuff prepared to carry into Essex with my master viz. 5oz. cerope of sokery with ruberbe 2s. 6d., for 6oz.cerope ofwhitevinegar 16d., two pounds of barley 16d., 4oz. ceny alexandrie 12d., 2oz. galyngale 8d., 2oz. Eryngus drye 8d., jib. of Aniseeds lOd., Ilb. colyander seedes 4d., ilb. lycoras 2d., a glasse bottell 3d., coyker bottell 4d., which said stuff was prepared 3rd June ...... 28s. Id. It is clear that he suffered from urinary lithiasis: for in 1559 payments are entered to " one of Brynford . . . for teaching my master certen medecynes for the stone (lOs.) " and to another " for bringing a powder to my master good to brake the stone (12d.)". Two specific remedies are mentioned:- To Mr. Symons mayde in rewarde for bringing an yerbe called paspere being good for the stone .. .. 6d. and To my ladie for so moche by her given to Mr. E. Tyrelles man for bringing certen rootes called erygus good for the stone . . lOd. The name of the plant " paspere " is derived from " Parsley Piert " which is a corruption of the well-named French remedy Perce Pierre, a dwarf annual herb allied to the Lady's Mantle; the name of the other plant is Eryngus which is the candied root of the Sea Holly. The frequent payments of professional fees appear either as single items or are listed at the end of each period of sickness, the severity of 195 VALENTINE A. J. SWAIN which can be judged by the number of medicaments prescribed and the frequency of the visits of the many medical advisors:- Nov. 17th, 1559. To Cawldwell the physician and to three surgeons being with my master viz. Mr. Cawldwell 6s. 8d. and to each surgeon being 6s. (my master paid the physician) .. 18s. or thus To Clemente, on Sunday 16th die. In consideracion of Mr. Doctor Clemente paines taken with my master £3 6s. 8d. To Mr. Doctor Hills, eodem die, 6s. 8d. 19th die to Mr. Dr. Clemente 6s. 4d. To Mr. Dr. Symons, eodem die, in the forenoone and afternoone 16s. 8d. 21st die to Mr. Dr. Simons 6s. 8d. 22nd die to Mr. Dr. Clemente 6s. 8d. To Mr. Dr. Simons 6s. 8d. 24th die Mr. Dr. Simons 5s. 25th die to Mr. Dr. Simons 5s. 29th die to Mr. Dr. Simons 5s. Accompted and payd 4 Mai 1559 William Petre ...... £6 lls. 4d. Another entry suggests that a retaining fee of 20s. was paid to the surgeon "for hoole yeres fee dewe at Mychelmas".

.~~~~~~~~~~~~~~~~~~...... Sg

w .X~~~~~~~A

W ..

Fig. 2. An Early English Drug Jar (c. 1650) from the Royal College of Surgeons' Collection. DIACATHOLICON, a laxative electuary, was in common use in the sixteenth century. It was customary for the apothecary to supply the various ingredients as ordered by the physician or surgeon, who would in turn make up the compound or application. A payment (3s. 4d.) was made to a surgeon 196 MEDICAL EXPENSES IN TUDOR ENGLAND for " letting Miss Dorothy's bloode " but Sir William seems to have been spared the treatment which his daughter received. It is recorded that Petre was a patron of learning, as was characteristic of the Elizabethan age, for his correspondence with English envoys abroad contain frequent requests for rare books. There is evidence in the accounts of his wide literary taste for the purchase of several books is recorded: To Mr. Delahide for a physicke booke for my master...... 16d. In 1560, a payment, which was registered to "one Toye. a printer for booke of Physicke called Opera Montani bounde in boorde 10s.", reflects that he shared Queen Elizabeth's interest in medicine; but Petre's was also more personal: for one section of this work " de urinis " is devoted to urinary disorders, and the writer, Giovanni Battista da Monte (1498-1551), who has been called the " founder of bedside teaching," also suffered from the " les douleur de pierre." In May, 1555, a payment of 5s. was made " in reward to one Gemy a straunger for bringing two bookes"; this probably refers to Thomas Geminus, the Flemish book printer who lived in England from about 1540 till his death in 1562; he was one of the earliest engravers in this country and published his edition of Vesalius' Anatomy in 1545, the " Compendiosa totius Anatomie delinatio": also he was a maker of maps and instruments. Another item of expense refers to the invalid Sir William being trans- ported to his country seat in Essex: such a journey of 25 miles over rough roads must have been singularly unpleasant for a man suffering from the stone: May 1559. To the lytter man for the hire of himself and Charges carrying my his two horses carying my Mr. to his house Mr. to Ingatestone at Ingatestone, the lytter being my masters in his lytter. viz. one day going down and one day the lytter man going home 12s. In rewarde to his servant 16d. and for his servants dyner at Rumford 4d. .. .. 13s. 8d. Incidental items of medical expense unrelated to Sir William Petre's illness appear throughout the accounts: 1548 Feb. To the surgeon in part of payment lOs., agreed upon for the healing ofBishop's hand 5s. To Bishop for his charges at Kingston after my masters riding from there viz. his surgeon there his meat and drink and for watching with him ...... 3s. 4d. Mar. To the Surgeon in full payment of lOs. for the healing of Bishop's hand .. .. 5s. 197 15 VALENTINE A. J. SWAIN Another entry refers to his nephew:- Aug. 1559. Lent to John Petre, my masters nephewe, Money lent to which he paid over to one Wilton Hall, an be repaid by inkeper and one Jacomym a surgeon £4., Mr. Petre of viz. to W. Hall SOs. for his meals and drink Torbryan in during the time he lay at surgery and to the Devon. surgeon for healing his wounde 30s. to be repaid by Mr. Petre his father. Various " nursing " expenses incurred by illnesses in the Petre household also are recorded: June 1549. Humfrey's wife for nursing Mr. John 13 weeks after lOd. due 24 June...... lOs. lOd. Nov. 1549. Pd. to Clarkes wife that she laid out for ale when little Joan was sick ...... 2d. The surnames of eight physicians and ten surgeons appear in the accounts being mostly in the receipt of fees during the period 1549-62, many were leading members of their profession. All the physicians in attendance were erudite men, the majority being Doctors of Medicine of or Cambridge University and Fellows of the College of Physicians; a number held the office of President of that College, namely, Dr. John Clement in 1544, Dr. John Symings in 1569 and 1572, Dr. Richard Masters in 1561, and Dr. Richard Caldwell in 1570: the last-named was a co-founder with Lord Lumley in 1581 of the Lumleian Surgery Lecture in the College of Physicians; the rest of the physicians mentioned are Dr. Thomas Wendy, Physician to Henry VIII, Queen Mary and Queen Elizabeth ; Dr. Alban Hyll (Hill), Dr. Christopher Langton and a " Mr. Cotton who is called the physician". The ten surgeons named are: Vicary Serjeant Surgeon, Forest " kinges surgeon", Holland, Yates, Crowe, Balthorp, Wright " surgeon of the court", Andrews, Wylde, and Jacomyn; of these Thomas Vicary is well known; Forest is perhaps Richard Ferris serjeant surgeon to the Queen; George Holland, John Yates, and William Crowe all held offices of distinction in the Company of Barber Surgeons; it is of interest to recall that the notable Elizabethan surgeons William Clowes in 1580 and William Gale in 1583 were examined by Yates and Crowe before their admission to that Company ; also, that Mr. Balthorp, while a surgeon at the Court, attended at the Queen's request " Doctor" John Dee, the mathematician and royal astrologer, during his illness in 1571. No biographical records can be found about the remaining surgeons, namely, Wright, Andrews, Wylde, and Jacomyn. Rich (Ryche) is the most frequently named apothecary; he supplied the many ingredients, herbs, oils, ointments, purges, etc.,which were prescribed for the numerous concoctions and plasters; lists of these remedies which abound in the accounts reflect the polypharmacy of that period. During the last ten years of his life, Sir William Petre led a life of retirement except for an occasional attendance as Privy Councillor; he died in 1572 and was buried in Ingatestone Church. It is unfortunate 198 MEDICAL EXPENSES IN TUDOR ENGLAND that this last decade is not accounted for in the household ledgers but the records which exist give an interesting glimpse of Tudor England and reflect the practice of medicine of that time. The archives of the Petre family have been entrusted to the Essex Record Office and I am indebted to Mr. F. G. Emmison, the County Archivist, for access to the transcripts of the Household Accounts; and to him and his staff for their kind assistance; also to the Rt. Hon. Lord Petre for his consent to this publication. REFERENCES BLOOM, J. H. and JAMES, R. R. (1935) Medical practitioners in the diocese of - 1529-1725. Cambridge University Press. ELOY, N. F. J. (1778) Dictionnaire historique de la Medecine ancienne et moderne. Mons. Introduction to (1953) Essex Record Publication No. 20. MACNALTY, SIR A. S. (1953) Medicine in the time of Queen Elizabeth the First. Brit. Med. J. 1, 1179. MUNK, W. (1878) The roll of the Royal College of Physicians of London. Vol. 1. R.C.P., London. SINGER, CHAS. (1953) Medicine in the reign of . Medical Annual. Bristol. UNDERWOOD, E. A. (1953) Medicine and the Crown. Brit. Med. J. 1, 1185. PRIMARY FELLOWSHIP EXAMINATION OVERSEAS It may be of interest to recall that it is just twenty-five years ago-in August, 1929-that the Primary Examination for the Fellowship was for the first time conducted overseas. This was held in Toronto, and preliminary negotiations lasted for more than two years before final arrangements could be completed. In October, 1925, the Canadian Medical Association had expressed "its unanimous desire and approval of establishing such means as may be necessary for the purpose of facilitating for our Canadians, by post-graduate study and examination, the obtaining of the Fellowship of the Royal College of Surgeons of England." In May, 1927, the Council of the College adopted a recommendation of the Nomination Committee " that it is desirable to send Examiners to the Dominions to conduct a Primary Examination for the Fellowship of the same standard as the examination in this country.... This decision was largely due to the enthusiasm of Lord Moynihan, then President of the College. The Secretary of the College and the Director of Examinations were then authorised to enter into negotiations with the proper authorities in Canada, and these negotiations were carried on with Dr. Alexander Primrose, C.B., Chairman of Council of the Canadian Medical Association, who had been elected to the Fellowship of the College in July, 1925, as a Member of twenty years' standing. Four Examiners were invited to go to Toronto-Professor William Wright (Chairman) and Professor W. E. Le Gros Clark in Anatomy: Professor C. Lovatt Evans and Professor John Mellanby in Physiology. Sir Holburt Waring, then the second senior Member of Council, led the team of examiners in the capacity of visitor. Thirty-five candidates presented themselves for examination on payment of a fee of one hundred dollars each, and nine of these satisfied the Examiners, among them a distinguished member of the present Court of Examiners. Since that date examinations have been held in Montreal, Melbourne, Sydney, Dunedin, Bombay, Calcutta, Madras, Lahore, Colombo, and Cairo, and have been enthusiastically welcomed everywhere as providing one of the most important links between surgeons in Great Britain and their colleagues in the Commonwealth countries. 199 15-2