The Herbalist: Nicholas Culpeper and the Fight for Medical Freedom

‘The walks in [St] Paul’s are empty,’ observed Thomas Dekker, who having written about the last plague outbreak in 1603 found his fascination revived along with the contagion. Not a ‘rapier or feather [was] worn in London’. The rich were gone, the rest unable to bear the inflating cost of a ticket out. ‘Coachmen ride a cock-horse,’ Dekker wrote, ‘and are so full of jadish tricks, that you cannot be jolted six miles from London [for] under thirty or forty shillings.’ Shops were shut, businesses closed, ‘few woollen drapers sell any cloth, but every churchyard is every day full of linen-drapers’. Cheapside, London’s main market, was empty, ‘a comfortable Garden, where all Physic Herbs grow’.

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Physic herbs may have been plentiful, but not physicians. More Fellows of the College were in attendance to minister to James I during his final illness than in all of London during that deadly spring and summer of 1625. On 21 April, less than a month after the royal medical retinue had returned to the capital, the entire membership of the College was summoned to Amen Corner to undertake a solemn selection procedure to decide who should remain in the capital to deal with the epidemic. They filed into the Comitia room one by one and, before the President, Dr Atkins, named those they thought should stay to represent the College. The names that emerged were Sir William Paddy, John Argent (an ‘Elect’ or senior member of the College and soon to become its president), Simeon Foxe (another future president), and William Harvey. All the others were relieved of their collegiate duties, and most presumably fled.

The official College line for dealing with the plague was set out in a treatise entitled Certaine Rules, Directions, or Advertisements for this Time of Pestilential Contagion, first published in 1603 at the time of the last ‘visitation’, and reissued to deal with the current one. Written by Francis Herring, a College Elect, and dedicated to the King, its first words defined the plague in terms of a Latin dictum taken from the Bible, which translated as: ‘The stroke of God’s wrath for the sins of mankind’. This view of plague as a punishment, in particular for pride, was backed up by ministers like William Attersoll, who pointed out that God sent the first plague to strike the Israelites for ‘rebelliously contending against the high Priest, and the chiefest Magistrate to whom God committed the oversight of all’. ‘This is not only the opinion of Divines,’ Herring continued, ‘but of all learned Physicians … Therefore his [the physician’s] appropriate and special Antidote is Seria paenitentia, & conversio ad Deum: unfeigned and hearty repentance, and conversion to God.’

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The doctors did have some medical advice to offer. ‘Eschew all perturbations of the mind, especially anger and fear’ Herring wrote. ‘Let your exercise be moderate … an hour before dinner or supper, not in the heat of the day, or when the stomach is full. Use seldom familiarity with Venus, for she enfeebleth the body.’ As for remedies, they were various, in particular ‘theriacs’ or treacles of the sort used to treat James in his final illness. Herring did not provide recipes for these – it would break the College statutes to do so, and in any case he expected those educated and rich enough to read his treatise to consult a physician. However, he did provide a set of basic remedies for treating those too poor to afford medical fees. The aim of these was to produce beneficial sweating at various intervals in the illness’s development. They could be made at home and included ingredients that were relatively easy to get hold of, such as radish, caraway seeds, and ‘middle or six-shilling beer’.

Herring also provided advice to the city authorities, in particular relating to the matter of hygiene in public spaces. The College had a low opinion of urban health standards, noting the multitude of ‘annoyances’ that had been allowed to develop and which now aided the epidemic’s spread. Rampant development had produced overcrowding, ‘by which means the air is much offended and provision is made more scarce which are the two prime means of begetting or increasing the plague’; there was ‘neglect of cleansing of Common Sewers and town ditches and the permitting of standing ponds in diverse Inns which are very offensive to the near inhabiting neighbours’. More offensive still were the ‘laystalls’ or dumping and burial grounds accumulating beyond the city’s northern limit. Over the city wall at Bishopsgate or Moorgate lay an unsavoury landscape of fens, shacks, kilns, compost heaps, plantations, ruined abbeys, rubbish piles, firing ranges, laundries, dog houses, and pig stalls. This was the world of Bedlam, the famous hospital for mental patients, and the Finsbury windmills, built atop a vast heap of human remains excavated from a charnel house next to Amen Corner. This would also become the setting for Nicholas Culpeper’s practice, and where he and his comrades would muster for the future fight against the sovereign the physicians now served. As far as the physicians were concerned, the whole area was the brewery of infection. From this wasteland the ‘South Sun’ drew ‘ill vapours cross the City’, polluting the north wind, ‘which should be the best cleanser and purifier of the City’. It was upon these dumps of ‘well rotted’ waste that the city gardens were gorged, ‘making thereby our cabbages and many of our herbs unwholesome’.

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In response to such complaints, the authorities drew up a series of emergency ‘Orders to be used in the time of the infection of the plague within the City and Liberties of London’. The aim was to deal with the situation ‘till further charitable provision may be had for places of receipt for the visited with infection’ – in other words, in anticipation of an evacuation of plague victims to surrounding pest hospitals, a monumental undertaking which the authorities were not prepared to pay for out of city funds. The orders focused primarily on identifying sites of infection and sealing them off. Any house or shop in which a resident had died of, or become infected with, the plague was to be shut up for twenty-eight days, and over the door ‘in a place notorious and plain for them that pass to see it, the Clerk or sexton of the parish shall cause to be set on Paper printed with these words: “Lord have mercy upon us”, in such large form as shall be appointed’. One person appointed by official parish ‘surveyors’ would be allowed out to ‘go abroad’ to buy provisions for the incarcerated residents, at all times carrying ‘in their hand openly upright in the plainest manner to be seen, one red wand of the length iii foot … without carrying it closely, or covering any part of it with their cloak or garment, or otherwise’. They were further required to always walk next to the gutter, ‘shunning as much as may be, the meeting and usual way of other people’. Those who failed to do this faced eight days locked up in a cage set beside their home.

As to the ‘annoyances’ pointed out by the physicians, the orders called for the streets to be cleaned daily by the parish Scavenger and Raker, for dunghills to be cleared, for pavements to be mended ‘where any holes be wherein any water or filth may stand to increase corruption’, and for the owners of pumps and wells to draw each night between 8 p.m. and 6 a.m. at least ten pails of water to sluice out the street gutters. On the matter of treating the sick, the orders were much less specific. They simply mentioned that a ‘treaty’ should be agreed with the College ‘that some certain and convenient number of physicians and surgeons be appointed and notified to attend for the counsel and cure of persons infected’.

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The Mayor and Aldermen published a further set of orders, hard to date, but probably in the summer of 1625. These show that the College was no longer involved in the city’s increasingly desperate measures to control the crisis. Only surgeons are mentioned, six to accompany the searchers and identify cases of plague, there having been ‘heretofore great abuse in misreporting the diseases, to the further spreading of the infection’. These new orders were more draconian than the previous ones. The surgeons were offered 12d. per body examined, ‘to be paid out of the goods of the party searched, if he be able, or otherwise by the parish’. Infected properties were to be identified, not just with a sign, but with a large red cross painted in the middle of the front door – the first appearance of what became the universal mark of contamination. No longer were appointed residents allowed out to buy necessities. Instead, everyone was to be confined indoors for a month, with a day- and a night-watchman to stand guard and fetch provisions as required, locking up the house and taking the key while away from his post.

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The physicians were left out of these orders because they had fallen out with the city authorities. This is confirmed by a meeting held at the College in 1630 to discuss a less serious outbreak, during which Harvey pointed out that there was no point in selecting a team of practitioners to advise and help city officials because during 1625 he and his colleagues had been ignored. The exact cause of the dispute is unknown, but the very fact that it had come at a time of such intense medical need shows that, on the streets at least, the physicians had become an irrelevance. Those who had disappeared became resentfully numbered among the rich ‘runaways’ attacked by Dekker, so much so that when they returned many stopped wearing their official robes in public to prevent being identified, despite reprimands from the College President. Harvey and the three lone colleagues who remained presumably treated their own patients, but they had no documented involvement in dealing with the escalating number of cases that arose among the mass of the population, which produced 593 deaths in the first week of July, 1,004 in the second, 1,819 in the third, 2,471 in the fourth, peaking at 4,463 in the third week of August.

(#litres_trial_promo) Throughout these desperate months, Amen Corner remained empty, the Censors inactive. The only meeting to be called was convened at the house of the President, Dr Atkins, to appoint his successor.

The inaction of the doctors left the market for medicine wide open, and the apothecaries, no longer mere Grocers but now enjoying the dignity of a Society of their own, stepped into the gaping breach. As the number of cases mounted, it was they who visited the sick and distributed the medicine. They began mass-producing Theriaca Andromache, Mithridate, and London Treacle, the physicians’ favourite antidotes. One particularly industrious apothecary managed to produce 160 lb of Mithridate in one month, enough for 15,360 doses.

(#litres_trial_promo) These medicines included an enormous number of ingredients: animal derivatives such as deer antler and viper flesh, spices such as nutmeg and saffron, flowers such as roses and marigolds, herbs such as dittany and St John’s wort, anodynes such as opium and Malaga wine. By June, supplies of some key ingredients had run out. As required by its charter, the Society of Apothecaries consulted Harvey and his three colleagues, as the College’s official representatives, on the use of substitutes. At other times, the College insisted on the recipes in the Pharmacopoeia Londinensis being rigidly followed, but on this occasion no resistance was offered.

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The physicians had in any case tacitly accepted that the apothecaries were in charge, as they had apparently let them prescribe as well as dispense medicines on a routine basis, breaking the cardinal rule of the College’s as well as the Society’s charter. It was impractical for a handful of physicians to write bills for the thousands of patients clamouring for medical help. In Harvey’s tiny parish of St Martin’s in Ludgate, one of the worst affected, there were over 250 deaths and an unrecorded number of infections, among a population unlikely to have been much more than a thousand.

(#litres_trial_promo) No lone physician could be expected to cope with such levels of sickness, even if the victims were able to afford his fees.

The most obvious sign that the physicians had relinquished responsibility for dealing with the plague came in early 1626, when it had passed its height. Harvey had once more been elected a Censor, and at a meeting he attended in 1626 one John Antony appeared accused of having practised without a licence for over two years. A month later Antony returned with 8 lb of a medicine he was prescribing ‘which he handed over to the President and asked that he might be allowed to practise and connived at: which was granted to him by those present’ – an unprecedented display of tolerance.

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Nehemiah Wallington the wood turner had a small shop in Little Eastcheap, between Pudding Lane and Fish Street Hill. Standing upon the doorstep in early 1625, he surveyed ‘this doleful city’, listened to the ‘bells tolling and ringing out continually’, and wondered what would become of him and his family.

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If the courtiers, the physicians, the rich merchants with royal monopolies, the ‘great Masters of Riches’, as Dekker called them, were the runaways, Wallington was typical of those left behind.

(#litres_trial_promo) Figures are imprecise, but by the 1620s crafts- and tradesmen like him made up the bulk of London’s householders.

(#litres_trial_promo) Their standard of living was modest, and for some barely distinguishable from poverty in bad years; but they had something few of their sort enjoyed outside London – political influence. The City could not be called democratic, but it was closer to that ideal than most other institutions of the era. Wallington and his ‘middling sort’ were ‘freemen’, citizens, with a say in the running of their livery companies (the Turners, in Wallington’s case). These companies in turn not only ran London’s government, but were bankrolling the debts James, and now Charles, had run up in their attempts to avoid having to go cap-in-hand to Parliament.

Nehemiah’s neighbourhood. Little Eastcheap is the lane at the top of the map, here identified as ‘St Margarets patens’.

Nehemiah Wallington shared another feature common to many Londoners of his class: he was a Puritan, and an avid reader of the Bible and biblical exegeses, such as William Attersoll’s analysis of the Book of Numbers. But where Attersoll’s rural congregation rejected theological innovation, that to which Wallington belonged thrived on it. They lapped up lectures on predestination, the role of Church government and the meaning of divine election.

Wallington also believed in divine providence – that events on earth somehow expressed God’s will. From the moment he ‘came forth polluted into this wicked world’ in 1598, every event, from the tiniest domestic incident to the greatest international affairs, was to be investigated to see how it fitted in with God’s plan. Most Puritans understood events in this way, but Wallington took it a step further: he wrote all his deliberations down, creating a journal of human struggle amounting to over two and a half thousand pages.

The plague of 1625 represented one of the first major episodes to be examined by Wallington in this way, and his account of it provides a vivid street-level view of what it was like for the ordinary citizens of London left behind and how they dealt with it – not just medically, but philosophically and emotionally.

Like the College of Physicians, Wallington assumed that the plague must have been sent by God. But where the College, taking its line from the religious establishment, saw it as a ‘general humiliation of the people’, Wallington believed it was a sign of how ‘idolatry crept in by little and little’ and how ‘cunningly and craftily hath the enemies of God’s free grace brought in superstition’.

(#litres_trial_promo) In other words, it was a divine reaction to the established Church of England being drawn dangerously back towards the idolatrous rites and doctrinaire attitudes of Catholicism. Charles I had already revealed himself to be an enemy of Puritan reform, having chosen the controversial religious conservative Robert Montagu as his theological adviser. In a book ostentatiously dedicated to Charles that appeared in 1625, Montagu had attacked ‘those Classical Puritans who were wont to pass all their Strange Determinations, Sabbatarian Paradoxes, and Apocalyptical Frenzies under the Name and Covert of the True Professors of Protestant Doctrine’.

(#litres_trial_promo) Puritans such as Nehemiah Wallington would have found it hard not to see the distorted reflection of themselves in Montagu’s caricature and to conclude that their beliefs were under threat.

Thus the plague could not have descended on London at a more significant or sensitive time: it was part of the unfolding struggle between the Puritan saints and the courtly sinners. Wallington had already noted, a few years before, a ‘poor man of Buckinghamshire, that went all in black clothes, with his hat commonly under his arm’ and who for the space of a year stood before the palace gates at Whitehall calling to the King ‘for woe and vengeance on all Papists’. ‘I myself have seen and heard him,’ Wallington wrote, ‘crying, Woe to London, woe to the inhabitants of London.’

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Woe indeed. In the summer months of 1625, the tolling of the bells was ceaseless, and ‘could not but make us wonder at the hand of God to be so hot round about us’. Would even Nehemiah’s godly family be touched? He certainly did not regard himself as immune. He was a sinner too, all his efforts at saintliness, set out in a list of seventy-seven articles drawn up on his twenty-first birthday, proving paltry in the face of temptation. ‘I have many sorrows and am weak,’ he admitted to his journal.

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Through the summer weeks of 1625, all he could do was study the Bills of Mortality nailed to the door of his local church, St Margaret’s in New Fish Street: 5,205 dead in August, 43,265 in the year up to 27 October. He heard gossip about whole families – fifteen or sixteen in a single household – being wiped out, or perhaps leaving a lone survivor to endure a life of isolation, ‘a torment which is not threatened in hell itself, as the poet and preacher John Donne observed at the time.

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