The Sickening Truth: Medicine and Health in Tudor England

The Tudor era (1485–1603) was a time of immense cultural, political, and religious upheaval, yet beneath the glittering surface of courtly life and grand architecture lay a world grappling constantly with disease, superstition, and rudimentary medical practices. For both the peasant in the village and the monarch on the throne, health was precarious, life expectancy was low, and the remedies often seemed as dangerous as the ailments they sought to cure. To understand Tudor society is to understand its relationship with sickness and the often-bizarre methods employed to combat it.

The Foundations of Tudor Medical Theory: Humours and Heavens

Tudor medicine was not based on germ theory—that revelation was centuries away. Instead, it was deeply rooted in classical Greek philosophy, primarily the teachings of Galen and Hippocrates, which championed the concept of the Four Humours. This theory posited that the human body was governed by four essential fluids: blood, phlegm, yellow bile, and black bile. Health was achieved only when these humours were perfectly balanced.

An imbalance, whether caused by diet, environment, or even planetary alignment, led to illness. A fever, for example, might be attributed to an excess of blood (hot and wet), requiring a treatment designed to cool the body or, more commonly, remove the excess fluid.

Astrology and Diagnosis

The Tudors believed the cosmos played a direct role in human health. Physicians often consulted astrological charts before diagnosing or treating a patient. Different body parts were associated with different zodiac signs, and treatments were timed to coincide with favourable planetary movements. This blend of science, superstition, and astronomy meant that a physician needed to be as skilled in reading the stars as in prescribing herbs.

“For if the physician know not the course of the heavens, he is like a blind man, and may do much harm.”
— Thomas Vicary, Surgeon to Henry VIII

The Practitioners: From Physicians to Quacks

The medical landscape was highly stratified. At the top were the university-educated Physicians, typically trained at Oxford or Cambridge, who dealt primarily with internal medicine and diagnosis. They were expensive and served the wealthy elite. They rarely touched patients, relying instead on examining urine (uroscopy) and pulse.

Next came the Surgeons, who were often grouped with Barbers (hence the iconic red and white striped pole, representing blood and bandages). Surgeons performed manual procedures like setting bones, extracting teeth, and, most crucially, bloodletting. They were considered tradesmen rather than scholars.

Finally, the Apothecaries prepared and sold medicines, acting as early pharmacists. However, the majority of the population relied on local healers, wisewomen, and unlicensed practitioners who used traditional herbal remedies, charms, and prayers.

• Physicians: Diagnosed and prescribed, based on humoral theory. Required university education.
• Surgeons/Barber-Surgeons: Performed operations and bloodletting. Learned through apprenticeship.
• Apothecaries: Mixed and sold medicinal compounds.
• Quacks and Charlatans: Sold dubious remedies at fairs and markets, promising miraculous cures.

The Treatments: Bleeding, Purging, and Potions

Given the humoral theory, the primary goal of any treatment was to restore balance. This usually meant removing what was perceived as the offending humour, leading to two brutal but ubiquitous practices: bloodletting and purging.

Bloodletting: The Universal Cure

Bloodletting (phlebotomy) was performed by cutting a vein or using leeches. It was prescribed for almost everything, from fevers and headaches to plague. The belief was that removing 'bad blood' would rebalance the system. Unfortunately, this often severely weakened patients already struggling with illness, contributing to mortality rather than preventing it.

The Power of Herbs and Poisons

Apothecaries and healers relied heavily on the natural world. Herbal remedies were fundamental, with common ingredients including rosemary (for memory), camomile (for sleep), and various purges derived from plants. However, Tudor remedies often contained dangerous substances, including mercury, arsenic, and lead, used to treat syphilis and other persistent diseases. The side effects of these heavy metals were often mistaken for symptoms of the original illness.

A particularly famous remedy for the plague, often carried in pomanders, was the 'Mithridatum,' a complex concoction containing dozens of ingredients, including opium, which provided temporary pain relief but did nothing to cure the underlying infection.

Public Health and the Scourge of Disease

Life in Tudor towns, particularly London, was notoriously unsanitary. Open sewers, crowded housing, and polluted water sources made disease transmission rampant. While the Tudors lacked modern understanding of hygiene, they did recognize the connection between 'bad air' (miasma) and sickness, leading to attempts to clean streets and use strong perfumes to ward off disease.

The Fear of the Plague

The bubonic plague, or 'Black Death,' returned periodically, devastating communities. When the plague struck, the government reacted drastically. Infected houses were boarded up, marked with a red cross, and guarded for 40 days. The occupants were left to die or recover, a terrifying quarantine measure.

“God grant that we may not be visited with the plague, for the city is very unclean, and the poor people are many, and the air is thick and corrupted.”
— Letter from a London resident, 1563, during a plague outbreak.

Another terrifying epidemic was the 'sweating sickness' (Sudor Anglicus), a mysterious and highly fatal disease that struck swiftly, often killing victims within hours. It was particularly feared because it targeted the wealthy and powerful, including members of Henry VIII's court.

Health at Court

Even the monarchy was not immune. Henry VIII suffered from chronic leg ulcers, likely caused or exacerbated by poor circulation and obesity, requiring painful and constant treatment by his surgeons. His daughter, Elizabeth I, was a survivor of smallpox, which left her scarred and forced her to rely heavily on white lead makeup (ceruse) to maintain her appearance—a toxic cosmetic choice that likely contributed to her later health issues.

Mental Health and the Supernatural

Mental illness was poorly understood and often attributed to demonic possession, witchcraft, or severe humoral imbalance (especially an excess of black bile, leading to melancholy). Treatment was often harsh, involving confinement, physical restraint, or religious exorcism.

However, some physicians, influenced by Renaissance humanism, began to advocate for more humane treatments, suggesting music, fresh air, and pleasant company for those suffering from melancholy. This nascent shift marked a slow move away from purely supernatural explanations toward a more physiological understanding, though it remained marginal.

The Role of Diet and Exercise

Physicians understood that prevention was better than cure, and they placed great emphasis on maintaining a balanced lifestyle. Diet was crucial; specific foods were categorized as hot, cold, wet, or dry, and eating the wrong combination could throw the humours into chaos. Exercise was also recommended, though often in moderation, as excessive exertion was thought to deplete vital spirits. Henry VIII, in his youth, was a keen sportsman, believing that physical activity was essential for maintaining his kingly vigour.

The Tudor approach to health was a complex tapestry woven from ancient philosophy, burgeoning scientific observation, deep-seated superstition, and the ever-present reality of high mortality. While their methods seem crude and often dangerous today, they represented the cutting edge of contemporary knowledge, reflecting a society desperately trying to impose order and reason upon the capricious nature of disease.

Exploring Tudor medicine provides a stark reminder of the fragility of life in the 16th century and highlights the extraordinary progress made in medical science since. It encourages us to appreciate the resilience of people who faced down the plague and the sweat with nothing more than leeches, herbs, and a prayer, urging us to delve deeper into the fascinating, if often horrifying, history of health in early modern England.