A Bill of Mortality (and a peck of snails)

Bill_of_Mortality

Wikimedia Commons.

This Bill of Mortality is a dense document, crammed with facts and figures on death and disease in seventeenth-century England. The English started collecting data on numbers of births and deaths and causes of death in the sixteenth century as a way of tracking potential plague epidemics. This particular Bill is much reproduced because it is the total Bill of Mortality for the year 1665, which was the year London experienced a devastating plague epidemic. According to the Bill, 68,596 people in London died of the plague. For more on this plague see here and here.  I like to use this Bill in class to discuss some more general issues about morbidity and mortality in the early modern world.

The top two thirds of the Bill list numbers of people buried in each parish in London and its immediate surroundings. You can see (if you look carefully at the numbers) the huge differences in numbers of deaths between parishes. The two parishes with the biggest body counts are Stepney parish, where 8595 people were buried, and St. Giles Cripplegate, where 8,069 people were buried. On the other end of the spectrum, we see Allhallows, where ten people were buried and St. John the Evangelist, where only nine people died. This reflects in part the widely varying sizes of London parishes (the parish of St. John the Evangelist was only one acre), but it also reflects the varying economic levels. Poorer parishes were much harder hit, something that did not escape contemporary observers.

If we turn to the bottom third of this document, we see all the deaths in London listed by cause of death. Obviously, plague was far and away the biggest cause of death in 1665. Other major causes of death (i.e. things that killed a thousand or more people) were: aged (1545), ague and fever (5257), chrisoms and infants (1258), consumption and tissick (4808), convulsion and mother (2036), dropsy and tympany (1478), griping in the guts (1288), teeth and worms (2614), spotted fever and purples (1929) and surfeit (1251). Several of these “causes” are actually age categories. “Aged” would include people who died of old age. Chrisoms and infants are deaths (from a variety of causes) of children under the age of one year. Likewise, the category “Teeth” includes child deaths coincident with teething. As Rebecca Onion has pointed out in a post on the Bills of Mortality, they document the very high rates of infant and child death in the early modern period.

In many (perhaps MOST!) cases, the causes of death do not fit modern disease categories. I had groups of students look up each cause of death in the Oxford English Dictionary, in order to understand the 17th-century use of the term. Many of these definitions are taken verbatim from the OED.  I list them here for those who might be interested.  Some of the oddest are “calenture” (in which a sailor believes the sea is a field and leaps into it) and “plannet” (which we believe to be the condition of being struck by the malign influence of a planet).  Others, especially those involving the deaths of children, are very poignant.  Headmouldshot and overlaid were ways that very young infants could die.  And one would like to know the tragic stories behind the bleak “found dead in the street” and “grief.”

Abortive and Stilborne: Miscarried fetuses or stillborn infants.

Aged: Of advanced age; very old.

Ague and Feaver: An acute or high fever; disease, or a disease characterized by such a fever.

Appoplex and Suddenly: Apoplexy means a malady, very sudden in its attack, which arrests more or less completely the powers of sense and motion; it is usually caused by an effusion of blood or serum in the brain, and preceded by giddiness, partial loss of muscular power, etc.

Bedrid: Confined to bed through sickness or infirmity. Worn out, decrepit, impotent.

Blasted: Balefully or perniciously blown or breathed upon; stricken by meteoric or supernatural agency, a parching wind, lightning, an alleged malignant planet; the wrath and curse of heaven; blighted.

Bleeding: The flowing or dropping of blood (from a wound, etc.); hæmorrhage.

Bloody Flux: Bloody diarrhoea; disease causing such diarrhoea, spec. dysentery of infectious origin; an instance of this; now hist. or arch. Also (now rare): (an instance of) bleeding from another part of the body, spec. menstrual bleeding, esp. when excessive or prolonged.

Scowring: A looseness or flux of the bowels, diarrhœa.

Flux: An abnormally copious flowing of blood, excrement, etc. from the bowels or other organs; a morbid or excessive discharge. spec.An early name for dysentery.

Burnt: Set on fire, consumed with fire.

Scalded: Inflamed or raw as if injured by hot water.

Calenture: A disease incident to sailors within the tropics, characterized by delirium in which the patient, it is said, fancies the sea to be green fields, and desires to leap into it. The word was also used to mean fever and sometimes sunstroke.

Cancer: Any of various types of non-healing sore or ulcer.

Gangrene: Necrosis (death) of an area of tissue in the body, esp. as a result of impairment of its blood supply, often accompanied by bacterial infection and putrefaction; an instance of this process; a small circumscribed ulcer on the skin, esp. on the leg or in the mouth.

Fistula: A long, narrow, suppurating canal of morbid origin in some part of the body; a long, sinuous pipe-like ulcer with a narrow orifice.

Canker: A chronic, non-healing sore or ulcer, esp. one that extends into surrounding tissue; (in early use) spec. a cancer, or the disease cancer.

Thrush: A disease, chiefly of infants, characterized by white vesicular specks on the inside of the mouth and throat, and on the lips and tongue, caused by a parasitic fungus.

Childbed: Maternal death in childbirth or immediately after.

Chrisomes and Infants: A chrisom is an infant that dies within a month of birth (and was often buried in the “chrisom” or christening gown). An infant is a child under a year.

Cold and Cough: Respiratory sickness.

Collick and Winde: Severe paroxysmal griping pains in the belly, due to various affections of the bowels or other parts; also to the affections of which such pains are the characteristic symptom.

Consumption: abnormality or loss of humors, resulting in wasting (extreme weight loss) of the body; later used more specifically for tuberculosis.

Tissick: (Also phthisis) Coughing or wheezing; any of various diseases characterized by this, esp. asthma or bronchitis.

Convulsion: An involuntary contraction, stiffening, or ‘drawing up’ of a muscle, limb, etc.; cramp; tetanus.

Mother: A medical condition thought to arise from a disorder of the uterus, esp. its (supposed) upward displacement against other organs. Also: a condition with similar symptoms in men and children.

Distracted: Mental disturbance, perplexity. Deranged or mad.

Dropsie and Timpany: Accumulation of water in the lungs, brain, et cetera; morbid swelling, tumors.

Drowned: Killed by submersion in water.

Executed: Killed by an outside force.

Flox and Small Pox: An acute infectious disease characterized by high fever, headache and backache, and a rash which affects esp. the face and extremities and consists of pustules which heal with scarring

Found Dead in Streets, Fields, etc.: Unknown cause of death.

French pox: Syphilis.

Frighted: Affected with fright, scared.

Gout: A specific constitutional disease occurring in paroxysms, usually hereditary and in male subjects; characterized by painful inflammation of the smaller joints, esp. that of the great toe, and the deposition of sodium urate in the form of chalk-stones; it often spreads to the larger joints and the internal organs. The name is derived from the notion of the ‘dropping’ of a morbid material from the blood in and around the joints.

Sciatica: Originally: pain in the hip; disease causing such pain. In later use: the condition of having pain along the course of the sciatic nerve, radiating from the hip down the back of the leg, and most commonly resulting from protrusion of a lumbar vertebral disc.

Grief: Hardship, suffering; a kind, or cause, of hardship or suffering.

Griping in the Guts: Severe pain in abdomen and bowels.

Hanged and made away themselves: Suicide.

Headmouldshot and Mouldfallen: Disease or injury affecting the sutures or bones of the skull; a condition in which the skull is compressed in the pelvic canal during delivery, causing the cranial bones to ride over each other.

Jaundies: A morbid condition caused by obstruction of the bile, and characterized by yellowness of the conjunctiva, skin, fluids, and tissues, and by constipation, loss of appetite, and weakness.

Impoftume: A purulent swelling or cyst in any part of the body; an abscess.

Kild by severall accidents: Implies that death was caused by accidental means.

Kings evill: Scrofula (a constitutional disease characterized mainly by chronic enlargement and degeneration of the lymphatic glands), which in England and France was formerly supposed to be curable by the king’s (or queen’s) touch.

Leprosie: A disease causing scaliness, loss of pigmentation, or scabbiness of the skin; an instance or type of such disease; (now hist.). In later use: the chronic disease caused by infection with the bacterium Mycobacterium leprae, which affects mainly the skin and peripheral nerves, causing nodular and macular lesions of the skin which are often pale and scaly, and loss of sensory and motor function (esp. in the limbs) resulting in destruction of tissue and deformity of the affected parts of the body in severe untreated cases.

Lethargy: A disorder characterized by morbid drowsiness or prolonged and unnatural sleep.

Livergrown: Suffering from an enlarged liver, or a liver adherent to other part.

Meagrom and Headach: Dizziness or vertigo; headache, specifically migraine.

Measles: An infectious disease caused by a morbillivirus, characterized by a dark red maculopapular rash preceded and accompanied by catarrh and fever, usually with Koplik’s spots in the early stages, tending to occur in epidemics that chiefly affect children. In early use also: any of various other diseases causing a red rash.

Murdered and Shot: Murdered and shot.

Overlaid and Starved: To overlay is to lie over or on top of so as to suffocate (a child, etc.); to smother by lying on (generally an accident associated with nursing a baby). Starved (at nurse) is the failure of an infant take in enough nutrients from breast milk.

Palsie: Paralysis or paresis (weakness) of all or part of the body, sometimes with tremor; an instance of this.

Plague: Any infectious disease which spreads rapidly and has a high mortality rate; an epidemic of such a disease. OR A particular affliction, calamity, or evil, esp. one interpreted as a sign of divine anger or justice, or as divine punishment or retribution (usually with reference to the ten plagues of Egypt described in Exodus chapters 7 to 12).

Plannet: Struck by the evil force of a planet.

Plurisie: Abscess of the ribs or inner surface of the chest; pain in the chest or the side, especially when stabbing in nature and exacerbated by inspiration or coughing.

Poysoned: Affected, made ill, or killed by poison (of a wound, etc.) infected.

Quinsie: Inflammation or swelling of the throat; tonsillitis

Rickets: A disease of children caused by vitamin D deficiency, which results in abnormal calcium and phosphorus metabolism and deficient mineralization of bone (osteomalacia) with skeletal deformity. In later use also (chiefly with distinguishing word): any of various other diseases resembling this, affecting children, adults, or animals, and typically of metabolic, nutritional, or renal origin.

Rising of the Lights: A medical condition characterized by difficulty in breathing or a choking sensation (probably arising from various causes, such as croup, asthma, pneumonia, or pulmonary embolism); (later also) indigestion with belching; heartburn.

Rupture: A break, tear, or split in a surface or substance, esp. the skin or other tissue.

Scurvy: A disease characterized by general debility of the body, extreme tenderness of the gums, foul breath, subcutaneous eruptions and pains in the limbs, induced by exposure and by a too liberal diet of salted foods. Now recognized as due to insufficient ascorbic acid (vitamin C) in the diet.

Shingles and Swine pox: Originally an inflammation or infection of the skin, esp. when accompanied by heat and redness; spec. erysipelas (obs.). In later use: a disease of the skin characterized by an eruption of vesicles on a reddened base, typically occurring along the distribution of a cranial or spinal nerve, and accompanied (and often preceded) by severe neuralgic pain.

Sores: A place in an animal body where the skin or flesh is diseased or injured so as to be painfully tender or raw; a sore place, such as that caused by an ulcer.

Ulcer: An erosive solution of continuity in any external or internal surface of the body, forming an open sore attended with a secretion of pus or other morbid matter.

Spleen: Excessive dejection or depression of spirits; gloominess and irritability; moroseness; melancholia.

Spotted fever: A fever characterized by the appearance of spots on the skin; now spec. epidemic cerebro-spinal meningitis, and typhus or petechial fever.

Purples: Any of various diseases characterized by a dark red or purplish rash; also used of the deadliest form of smallpox

Stopping of the stomach: Want of digestion; incapacity of or difficulty in digesting food.

Stone: A hard mineral mass resembling a stone or grain of sand which may form in the kidneys by the abnormal precipitation of salts (esp. calcium oxalate) dissolved in the urine; a renal calculus.

Stranguary: A disease of the urinary organs characterized by slow and painful emission of urine; also the condition of slow and painful urination.

Surfet: Excessive consumption of food or drink; overindulgence in eating or drinking; gluttony. Also in figurative contexts.

Teeth: Children who die as result of teething complications or fever during teething.

Worms: Any endoparasitic helminth breeding in the living body of men and other animals. Usu. pl. (formerly often with the). Also, the disease or disorder constituted by the presence of these parasites.

Vomiting: The act of ejecting the contents of the stomach through the mouth; an instance of this.

Wenn: A lump or protuberance on the body, a knot, bunch, wart.

For more information on some of these diseases, Therese Oneill’s 15 Historic Diseases that Competed with Bubonic Plague

Finally, to emphasize that early modern people DID have ways of coping with illness, and that they DID NOT just lay down and wait for death when they got sick (even if that sickness was the plague) I ask students to find 17th-century remedies for some of the diseases or conditions listed as causes of death in the Bill. One group (John Stacy, Taylor Greene, Kiley Poppino, Brandon Curd, Jason Troy, Michael Rath, and Matt Banks) found a hand-written collection of recipes from a 17th– or 18th-century English manuscript currently held by the Wellcome Library in London. One page of this book is reproduced below. You will see recipes for some of the ailments listed as causes of death on the Bill, including jaundice, thrush, plague and stone.

MS8097_0051 MedicalMS

Here’s my favorite of the recipes they came up with – because how can you resist a recipe that begins: “take a peck of garden snails”?

For Jaundice, or weakness in the stomach.

Take a peck of garden snails, wash them in beer, and put them in an iron dripping pan on a hot fire of charcoal stirring them up and down, and set one end of the pan higher than the other that the liquor may run from them, and take it out with a ladle, and when it hath done coming, they are broiled enough, put them in a mortar and bruise them shells and all. Take a quart of earth worms, scour them with water and salt and wash them very clean and beat them in a mortar, then take angelica, 2 handfuls and lay in the bottom of your pot, 2 handfuls of selendine, on the top of them a quart of rosemary flowers. Agrimony and betony of each 2 good handfuls, bears foot red dock roots, bark of barberry tree, wood sorrel each a good handful and half, of rue half a handful, of fenugreek and turmeric each an ounce, saffron dried the weight of 6 ounces, a handful of clara. When these are put together in the pot, put your worms and snails and 3 gallons of the strongest ale you can get and cover it close for 24 hours, and when you go to put fire under it put in 6 ounces of harts horn shavings, but stir not lest you make those things go to the bottom that should be on top, and set on your alembic, and distill it with a fire, you may draw 5 or 6 quarts.

Did plague doctors wear those masks?

I get asked this question a lot when I teach courses in the history of medicine or the history of science.  Even more commonly, people tell me they “know” what plague doctors looked like: they had a mask with a long beak, goggles, gloves and a garment that covered them from chin to ankles.  Indeed, the 12-year-old son of some friends of mine just dressed up as a plague doctor for Halloween in precisely this costume.  But doubts about the historical accuracy of the plague mask have nagged at me for a while.  If it was so common, why didn’t I ever run across mentions of this costume in historical sources or in histories of the plague written by academic historians?  A Google search on “plague doctor” turns up an enormous number of images of men in beaked masks and black cloaks, and numerous sites that assert as historical fact that this is what doctors wore during plague epidemics.  Let me give you a couple of my favorite examples:

There is a doctor character in the enormously popular video game Assassin’s Creed who wears a plague mask. I pulled this picture from the Assassin’s Creed Wiki, which explains that,

You_Should_See_The_Other_Guy_5

“To protect themselves from this pandemic, doctors dressed in a long black cloak covered with a coating of wax, along with a very primitive beak-shaped plague mask, although not all doctors chose to wear it. Within this Medico Della Peste mask, there were usually flower petals, burning incense or aromatic herbs to rid of bad smells, since it was believed that disease was transmitted through “bad air.” The eyes of the mask were also made out of glass, as it was believed that sicknesses could be caught through face-to-face contact with patients, or by touching infected objects.”

My other favorite was this fantastically creepy video on YouTube: The Plague Doctor.  Set in 17th-century London, a sick gravedigger visits a plague doctor, only to be told he is dying and that the doctor will not treat him.  In anger, he slashes the doctor’s protective glove, thus infecting him with the deadly plague.

My problem with these representations is that the only even remotely contemporary image I can find of a plague doctor in such a get up is this one, from 1656:

Paul_Fürst,_Der_Doctor_Schnabel_von_Rom_(Holländer_version)

Paul Fürst, “Der Doctor Schnabel von Rom.” Reproduced from Eugen Holländer, Die Karikatur und Satire in der Medizin, 2nd ed. (Stuttgart, 1921), p. 171. Wikimedia Commons.

This image was originally a single-sheet broadside, produced by the German engraver Paul Fürst of Nuremberg.  The reproduction that appears all over the internet (generally without attribution) is from Eugen Holländer’s Die Karikatur und Satire in der Medizin, 2nd ed. (Stuttgart, 1921).  This entire book is available on-line here.  The first thing I would note is that this is VERY late in the history of the plague.  The very last plague epidemics in Europe were in the early eighteenth century.  The second thing is that this is a SATIRE.  As this seems to be the main primary source for what plague doctors wore and what they did, I’d like to look at it in detail.  The title is “Der Doctor Schnabel von Rom” (Dr. Beak from Rome).  The caption at the bottom is in German.  I’ll give the original (for those who can read German but not the old-fashioned Gothic lettering) and my translation.  (Corrections and suggestions are more than welcome!)

Kleidung wider den Tod zu Rom. Anno 1656. Also gehen die Doctores Medici daher zu Rom, wann sie die an der Pest erkranckte personen besuchen, sie zu curiren und tragen, sich widerm Gifft zu sichern, ein langes kleid von gewäxtem Tüch ihr Angesicht ist verlarvt, für den Augen haben sie grosse Crÿstalline Brillen, wider Nasen einen langen Schnabel mit wolriechender Specereÿ, in der Hände, welche mit Handschüher wol versehen ist, eine lange Rüthe und darmit deüten sie, was man thun, und gebraüchen sol.

Clothing to ward off death in Rome, 1656. The doctors of medicine in Rome go about thus, when they visit people sick with the plague in order to take care of them. And they wear, to protect themselves from poison [infection], a long robe made of waxed cloth. Their face is wrapped up; in front of their eyes they have large crystal glasses; over their nose they have a long beak filled with good-smelling spices; in their hands, which are protected by gloves, they carry a long rod and with this they indicate what people should do and what [medicines] they should use.

This sounds exactly like the description of the plague doctor’s attire from the Assassin’s Creed Wiki (and numerous other websites).  That seems pretty conclusive, right?  It’s a primary source document, so here we have a seventeenth-century person’s description of plague doctors he actually observed.  Or do we?  Here’s what gives me pause.  The verses on either side of the figure are what mark the broadside as satirical (also calling the figure “Dr. Beak”).  These verses are in a mixture of Latin and German.  Again, I will include them here in both the original languages and my translation.  I am not nearly good enough to render them into rhymed English, but I’ve tried to capture the sense of the originals.  (Again, suggestions and corrections are welcome!)

Vos Creditis, als eine fabel

quod scribitur vom Doctor Schnabel

der fugit die Contagion

et aufert seinen Lohn darvon

Cadavera sucht er zu fristen

Gleich wie der Corvus auf der Misten

Ah Credite, sihet nicht dort hin

Dann Romae regnat die Pestin.

Quis non deberet sehr erschrecken

für seiner Virgul oder stecken

qua loquitur als wär er stumm

und deutet sein consilium.

Wie mancher Credit ohne zweiffel

das ihn tentir ein schwartzen teuffl

Marsupium heist seine Höll

und aurum die geholte seel.

You believe it is a fable

What is written about Dr. Beak

Who flees the contagion

And snatches his wage from it

He seeks cadavers to eke out a living

Just like the raven on the dung heap

Oh believe, don’t look away

For the plague rules Rome.

Who would not be very frightened

Before his little rod or stick

By which means he speaks as though he were mute, and indicates his decision

So many a one believes without doubt

That he is touched by a black devil

His hell is called “purse”

And the souls he fetches are gold.

The verses begin by marking the plague doctor as an UNFAMILIAR sight.  You may believe what I’m about to tell you is just a fable, the author begins.  In other words, this is NOT how doctors in Germany dress.  This is a strange, Italian custom.  And then he goes on to lampoon the plague doctors of Rome.  They protect themselves from contagion, but they profit from it.  They seek out the dying to get money from them, just like ravens (or crows) scavenging in a pile of shit.  Like the Devil, who goes among the dying, seeking souls he can drag into hell, Dr. Beak goes among the dying, seeking gold coins to put in his purse.  This satire certainly resonates with a good bit of contemporary critique of doctors as rapacious and greedy.  But I wonder, was the comparison of the plague doctor to a raven inspired by the resemblance of the plague mask to a bird’s beak, or was it the other way around?  Was the mask in this image exaggerated to look beak-like because of the comparison to an avian scavenger?  Note that the fingers on the gloves are elongated and pointed, like the talons of a bird.  There is nothing in either the poem or the passage below the image to indicate why this might be medically efficacious. Finally, at the end of the rod is an hour glass with wings, a visual symbol of the saying “tempus fugit” (time flies) (originally from Virgil’s Georgics).  Surely no plague doctor ever literally carried such a device!  Rather, the emblem suggests that the doctor is the harbinger of death rather than a savior.  All things considered, I’m left unconvinced that this is a literal description of the costume of a plague doctor.  And I’ve yet to find evidence that would convince me.

Why does it matter whether or not plague doctors dressed up like ghoulish carrion birds?  One problem I have with the popularity of the figure of the plague doctor is that it erases the very real contributions of women to medical practice generally, and to the care of plague victims specifically.  Numerous historians of medicine (I’m thinking here of Monica Green, Katherine Park, Margaret Pelling, Mary Fissell, Deborah Harkness and Gianna Pomata among others) have documented the presence of female healers in medieval and early modern Europe.  These women did not function exclusively as midwives (although all midwives were women).  Rather, they performed a wide range of medical services and treated men, women and children for all kinds of illnesses and injuries.  A substantial amount of medical care in medieval and early modern Europe was provided by women, and yet women do not figure in any popular representations of the plague, except perhaps as victims.  In 17th-century England, where the creepy video is ostensibly set, the people who sought out plague victims and determined the cause of death were women called “searchers.”  They did the dangerous work of examining dead bodies, not the doctors.  (For more on the searchers, see here.)  Indeed, there were repeated accusations in early modern London that “doctors,” that is, men with medical degrees who were members of the Royal Society of Physicians, fled London for their country houses whenever a plague epidemic threatened.  These same doctors then complained bitterly about female “empirics” cutting into their business by treating plague victims.

So, what’s my answer to the question?  Did plague doctors actually wear those masks?  I still don’t know.  But I find the question of when and why the figure of the masked plague doctor became iconic in representations of plague to be an increasingly intriguing one.

UPDATE: Great video on the plague and plague doctors by Dr. Lindsey Fitzharris.