Reading the Legal Record like a Physician

Posted by Sara M. Butler; 19 May 2017.

Social historians have long recognized the value of the legal record to gain entrance into the lives of the average medieval Joe and Joanna. For most medieval men and women, records of their court appearances – which might range from paying a fine for selling spoiled meat, to being presented before the bishop for sexual incontinence, or suing a family member for a “stolen” inheritance —  represent the only mark they have made on history. And because the English crown relied heavily on governance by jury, drawing much of the English populace into its administration in one way or another (often against their will!), records of their judgments offer real insight into communal values. Nonetheless, medical historians have not been so quick to get on board the legal document wagon. In my recent book, Forensic Medicine and Death Investigation in Medieval England, chapter five entitled “Health and Healthcare in the Coroners’ Rolls,” makes a plea to medical historians to foray into the world of late medieval legal documents in order to augment our knowledge of popular understanding of health.[1] My goal in this post is to follow up on that plea by demonstrating to the audience of this blog just how useful legal documents can be in understanding disease history, medical practice, and popular health concerns in this period. Below are four case studies drawn from coroners’ inquests from late medieval England. For each, I have included a translation of the record, a quick glossary for any unusual terms, reading suggestions, and a brief discussion of what is noteworthy about those cases. Please note: the translations are my own. Punctuation has been inserted in order to increase the readability of the case studies. At times, I have opted for the more eloquent translation rather than adhering strictly to the medieval phrasing. In the footnotes, you will discover links to each of the cases where they can be found digitally in their original manuscript format at the Anglo-American Legal Tradition website, hosted by the University of Houston.

“Blodymeneson”

Nature of illness: dysentery.L0037333 Man with cheek wound; surgeon sews head wound, 14th C

[2]TNA JUST 2/40, m. 4 (Gloucestershire):

Inquisition take before the said coroner of the King [Stephen Pope, coroner of the city of Gloucester] noted above on the day and year mentioned above [Nov. 16, 1387], namely at Gloucester on the oaths of Laurence Shethere, John Gerall, Thomas Benge, John Scoch, David Penbrok, John Fey, John Pyppe, John Mury, Henry Seymper, Thomas Grene, Richard Goldesmyth, and John Bullok, twelve jurors who say on oath that the said John Hendeman on the ninth day of March in the regnal year above mentioned came to Gloucester into the house of the said William Barbor and stayed there while he was healed from a lesion that he had on his head [made] by a certain arrow. And in the midst of that time there, John Hendeman was taken ill, seized by an illness called “le blodymeneson” and so he suffered until the last day and from that infirmity he suddenly died. And no other cause of death, but that he was ill from the illness.  So that nothing accrues to the king from deodand.*

Marginal notation: Accident

* deodand: an object or animal forfeit to the king because a coroner’s inquest jury found it had caused a person’s death. To read more about deodands, see Anna Pervukhin, “Deodands: A Study in the Creation of Common Law Rules,” American Journal of Legal History 47.3 (2005): 237-56.

What to notice about this case:

Was William Barbor actually a medical practitioner? By the fourteenth century in England, hereditary surnames were still not fixed for the vast majority of the population.[3] Thus, it seems highly credible that William Barbor was in fact a barber, who entered into a contract with Hendeman promising to cure him of a wound he incurred through a hunting accident (or some such incident). Contracts for a cure in medieval England often stipulated that the patient move into the home of the medical practitioner (or vice versa) for the duration of treatment so that the practitioner had continuous access to monitor the patient’s health. This entry in the coroners’ rolls, then, appears in order to clear William Barbor’s name of any allegations of medical malpractice. The jurors state definitively that it was not the cure that killed John Hendeman. In fact, “le blodymeneson” seemingly was unrelated entirely to the treatment, or to the original wound. Accordingly, his death was not deliberate but accidental.

Here, it seems pertinent to ask what was the common law position on medical malpractice?  The thirteenth-century legal treatise, The Mirror of Justices, spells out the situation quite clearly in its discussion on homicide, clarifying that intention and diligence are the key factors. It states:

Physicians and surgeons being learned in the their faculties and probably making lawful cures, and having clear consciences, so that in nothing have they failed their patients that to their art belongs, if their patients die, are not homicides nor mayhemers; but if they undertake to make a cure which they do not know how to bring to a successful end, or, although they have such knowledge, they behave stupidly or negligently, as by applying heat instead of cold, or the reverse, or too little of the cure, or if they do not apply a due diligence, more especially in their cauterisings and amputations, which are things that cannot lawfully be done save at the peril of the practitioners, then, if their patients die or lose a limb, they are homicides or mayhemers.[4]

Are you interested in reading more about medical malpractice in medieval England? See:

“Postema”

Nature of illness: an abscess; swelling or inflammation.

[5]TNA KB 9/195/1, m. 12 (London; today borough of Camden):

Inquisition taken at Kentish Town in the county of Middlesex, Thursday closest before the feast of Saint Gregory the Pope [March 5], the eighth regnal year of King Henry the fourth after the Conquest [1406/7] before John Lilleston, coroner of the lord king for the said county, concerning the death of William Aldenam there dead by accident, on view of his body, by the oath of Gilbert Couper, John Dygon, Robert Harpden, John Fynche, Giles Smyth, William Webbe, Henry Horseley, William Wheler, Roger Aldenam, John Drewe, John Mordannt and Hugh Aldenam, jurors who say on oath that as the said William Aldenam crossed by way of a highway towards London from the village of Kentish Town, carrying on his back a wooden butt* full of beer containing two gallons of half-beer,** the said William Aldenam, on the same road across from the lane called Figs Lane near the church of St Pancreas, stumbled and fell to the ground so that the weight of the butt on the back of the said William in falling shook his body so that a certain swelling [postema] around his genitals burst so that in breaking William Aldenam died from the corruption and poison of the abscess. The said butt and beer are in the hands of Roger Aldenam who comes and appreciates it at eight pennies, to which is confiscated to the said king as deodand. And the said jurors state that no man is suspected of this death.

*butt: a measure of liquid volume equaling two hogsheads (108 gallons, or 490 liters)

**half-beer: presumably “small beer.”  For more on beer, read Richard Unger’s highly informative Beer in the Middle Ages and Renaissance (Philadelphia: University of Pennsylvania Press, 2013).

What to notice about this case: 

The dead’s surname (Aldenam) is shared by two of the jurors (Roger Aldenam and Hugh Aldenam). If not family members, then it is likely they were all from the same locality originally and may well have known each other. What does this tell us?  The bailiff who impaneled the jury wanted to find men close to the victim who might have some sense of his medical history in order to determine whether cause of death was nature (that is, related to a prolonged illness) or unnatural and thus worthy of further investigation. Who sat on the coroner’s jury has been a source of some (relatively dispassionate) contention among legal historians. While some have argued in favor of those who lived in the vicinity, others have suggested that the jurors may have been local elites. This particular jury would seem to point to the need to impanel individuals familiar with the dead.[6]

An important question to ask: is this a plague-death? Reading William Aldenam’s death against a classic description of bubonic plague helps us to better assess what might have been going on. Giovanni Boccaccio described the symptoms of bubonic plague in the introduction to his Decameron.  He wrote:

Not such were they as in the East, where an issue of blood from the nose was a manifest sign of inevitable death; but in men and women alike it first betrayed itself by the emergence of certain tumors in the groin or the armpits, some of which grew as large as a common apple, others as an egg, some more, some less, which the common folk called gavoccioli. From the two said parts of the body this deadly gavocciolo soon began to propagate and spread itself in all directions indifferently; after which the form of the malady began to change, black spots or livid making their appearance in many cases on the arm or the thigh or elsewhere, now few and large, then minute and numerous. And as the gavocciolo had been and still were an infallible token of approaching death, such also were these spots on whomsoever they shewed themselves. Which maladies seemed set entirely at naught both the art of the physician and the virtue of physic; indeed, whether it was that the disorder was of a nature to defy such treatment, or that the physicians were at fault – besides the qualified there was now a multitude both of men and of women who practiced without having received the slightest tincture of medical science – and, being in ignorance of its source, failed to apply the proper remedies; in either case, not merely were those that covered few, but almost all within three days from the appearance of the said symptoms, sooner or later, died, and in most cases without any fever or other attendant malady.[7]

As Boccaccio’s writing implies, the typical first symptoms of bubonic plague are swellings in the groin, neck, and armpits. John Aberth tells us that the groin was such a popular location for these swellings, that the very word bubo derives from the Greek word for groin, boubon.[8]  Given the location of William Aldenam’s swelling in the region of the genitals there is a strong likelihood that he may have been suffering from bubonic plague. William Aldenam’s tumble clearly caused the bubo to burst, an experience that is said to be incredibly painful, although it was in fact the goal of much of medieval treatment. Suppuration, or the spontaneous bursting open of the bubo in order to release the pus from the body, was achieved through poultices, cupping, cutting, or cautery, and it was generally interpreted as a mark of recovery.  In this situation, though, William’s swelling did not burst naturally, and it may not have burst externally – an internal rupture could have led to blood poisoning.  Perhaps the most critical evidence to help us determine more precisely whether Aldenam was suffering from bubonic plague is to realize that this death coincides with what Charles Creighton has described as the “first great outburst of plague” in the fifteenth century, which occurred in the years between 1405 and 1407.[9]  Does this case then represent a coroner’s early encounter with a plague victim?

“Le Narth”[10]

Nature of illness: “narrowness,” relating to, a) labored breathing and feeling of

L0006816 Dancing skeletons, 'Dance of Death'

constriction in the chest; b) constriction in the region of the heart.

[11]TNA JUST 2 /31, m. 13d (Derbyshire)

Inquisition taken at Derby on the Thursday before the feast of Saint Hillary in the eighth regnal year of King Richard II [7 January 1384/85] before Arthur de Rolleston, one of the coroners of the king in the county of Derby, with a view of the body of John atte Walle de Sydensen on the oaths of Robert Marchall, William Cook de Barwe, William Hotet, Adam Fissher, Thomas Robard, Adam de Overton, Adam de Halle, John le Reveson, Robert Warde, Richard Stevenson, Walter Robynson, and John Freeman who say on oath that it happened on the Monday of the feast of Saint Nicholas of the said year that the said John atte Walle went to the church of Barwe [Barrow] and he was taken ill there so that around the hour of vespers and in returning from the hospital through his old age and debility from an infirmity called Le Narth he fell in the street by the fields of Barwe and he died there at night.

What to notice about this case: 

At first glance, it is hard to imagine why the death of John atte Walle merited inclusion in a coroner’s roll at all. Coroners were charged with investigating sudden and unnatural deaths, while John was clearly an elderly man who died from a heart-attack, or some other such condition. His would seem to fall quite comfortably into the category of “natural death.” The explanation for why it appears in the records of the coroner lay with the final words of the entry: “at night.” Murder in the medieval context typically took place during the dark of night, and given that hospitals housed transient populations, a death by night close to a hospital required investigation.

What can this record tell us about healthcare in the late medieval period?  Carole Rawcliffe has written that hospitals played a key role in the era following the outbreak of the Black Death in caring for the elderly, who lucked out in surviving the plague but might well have no younger relatives to assist them at the end of life.[12]  It is not hard to imagine that John atte Walle may exemplify that experience. John atte Walle’s case is just one death among many that appears in the coroners’ rolls of the elderly, helping us to get a sense of how the medieval world accommodated those with limited mobility, failing eyesight and hearing, who could no longer contribute fully to society or live independently.

“Fallyngevyll”

Nature of illness: epilepsy, also known as “the falling evil.”

[13]TNA JUST 2/61, m. 14/1 (Leicestershire):

Inquisition taken at Burton Saint Lazars [today, Burton Lazars] on the Friday after the feast of Saint Scolastica the Virgin [11 February] in the nineteenth regnal year of the King Richard second after the Conquest [1395/96] before John Folvylle one of the coroners of the king of the county of Leicester, on view of the body of John Porter of the said Burton and the four neighboring vills, namely Melton, Stapleford, Little Dalby, and the said Burton, on the oaths of John Wright, Henry Smyth, William Hendeman, Robert Cratull, William Keyt, Richard Mason, John Smyth, Richard Cratull, John Cratull, John Robyn, Andrew Deye, John Taillour, and John Rystan junior, who say on their oaths that it happened at the said Burton by night on the preceding week at the hour of night that the said John Porter went into the house of the master of the hospital* of Burton where he was detained for many years with an illness called falling evil and there he was taken by the said illness and fell into a well and was drowned there by accident and the said William Boo was the first to find him.  And the body was seen by the coroner and buried.

Marginal Notation: Burton Saint Lazars; accident

*The hospital at Burton Lazars was the most well known leper hospital in England, founded by the Order of Saint Lazarus in the twelfth century and used as the Order’s headquarters in England. The hospital’s master was in fact the general commander of the Order of Saint Lazarus for the entire country.

What to notice about this case: 

The coroner’s inquest reports that John Porter had been living at the hospital for years before he died. Why might that have been the case? This was a leprosarium  — a monastic institution to which those afflicted with Hanson’s disease (then called leprosy) voluntarily retreated to follow “an itinerary of conversion.”[14] WhileL0038308 Jesus Christ raises Lazarus from his tomb. Coloured often stigmatized in medieval society as sexual sinners, the Church claimed that lepers were chosen by God to suffer the pains of purgatory here on earth rather than after death, and thus they numbered among God’s elect. Leprosaria offered its residents food, lodging, solitude, and support – but no treatment. In that respect, these medieval institutions were much more akin to modern-day hospices than hospitals.  Did Porter suffer from Hanson’s disease as well as epilepsy? Or did medieval leper hospitals admit those with other long-term illnesses into their orders, too? Leper hospitals were usually small establishments, with a sum total of inmates numbering in the single digits.  Not only did they have to join the order, requiring them to take vows and live a stringent ascetic lifestyle, but they often had to pay for admission also. Popular suspicions about the contagion of leprosy, thought to be contracted through sexual intercourse with a menstruating woman and then spread by the poisoned breath of a leper, would likely have driven many of the afflicted into the isolation of leper hospitals, where they might be revered rather than feared. Would such an institution have willingly accepted those afflicted with other diseases?  Was John Porter an isolated example? And if not, how does this skew our expectations of the numbers of those afflicted with “leprosy” across medieval Europe?

Returning to the jury list, once again we have an opportunity to view how the impaneling of a coroner’s jury might work.  Please note that three of the coroner’s jurors share the same last name: Robert Cratull, Richard Cratull, and John Cratull.  It is hard not to imagine that they were all somehow related.  Here it is worth remembering that the medieval world took a very different approach to juries than we do today.  While we expect impartiality of our jurors, helped along by total ignorance of the case prior to its formal presentation by a lawyer, the medieval world felt much differently. Medieval jurors were expected to be self-informing, meaning they were selected for service precisely because of their intimate knowledge of the details of the case and were expected to participate in the gathering of evidence as required. Relationship with the victim was not necessarily grounds for exclusion from the jury; nor, as we can see from the above case, was a relationship with other jurors sufficient to bar a man from participation.

Do you want to read more about medieval leprosaria? See:

 

Featured images:

a) Saint Valentine blessing an epileptic. Courtesy of the Wellcome Library, London, V0016605.

b) Small pen drawings in margin of manuscript. The illustration on the left depicts the head of a hirsute and bearded man with a cheek wound. The illustration on the right shows a surgeon in a green gown and red cap kneeling beside a wounded man and suturing his head wound. From Miscellanea Medica XVIII, early 14th century. Courtesy of the Wellcome Library, London, L0037333.

c) Dancing skeletons, “Dance of Death,” by Hartmann Schedel, from Liber Chronicarum, Nuremberg, 1493. Courtesy of the Wellcome Library, London, L0006816.

e) Jesus Christ raises Lazarus from his tomb. A woman (Mary, sister of Lazarus?) crosses her arms in faith. Paris, c. 1510. Courtesy of the Wellcome Library, London, L0038308.

 

[1] Sara M. Butler, Forensic Medicine and Death Investigation in Medieval England (London and New York: Routledge, 2015).

[2] Link to this document as it appears on the AALT website, “Anglo-American Legal Tradition,” The O’Quinn Law Library of the University of Houston Law Center by license of the National Archives (accessed 19 May, 2017), http://aalt.law.uh.edu/AALT7/JUST2/JUST2no40/IMG_0008.htm.

[3] See R.A. McKinley, A History of British Surnames (New York: Longman, 1990).  McKinley notes that it was not until the sixteenth and seventeenth centuries that we can reliably find hereditary surnames (p. 22).

[4] William Joseph Whittaker, ed., The Mirror of Justices (Selden Society, v. 7, 1895), 137.

[5] Link to this document as it appears on the AALT website, http://aalt.law.uh.edu/AALT7/KB9/KB9no195no1/IMG_0022.htm.

[6] James Sharpe and J.R. Dickinson, “Coroners’ Inquests in an English County, 1600-1800: A Preliminary Survey,” Northern History 48.2 (2011), 256; James Masschaele, Jury, State, and Society in Medieval England (New York: Palgrave Macmillan, 2008), 137; Thomas A. Green, Verdict according to Conscience: Perspectives on the English Criminal Trial Jury (Chicago: University of Chicago Press, 1985), 32; R.F. Hunnisett, The Medieval Coroner (Cambridge: Cambridge University Press, 1961), 21.

[7] Giovanni Boccaccio, The Decameron, trans. M. Rigg (London: David Campbell, 1921), 5.

[8] John Aberth, Plagues in World History (Lanham: Rowman and Littlefield, 2011), 21.

[9] Charles Creighton, A History of Epidemics in Britain from A.D. 664 to the Extinction of Plague (Cambridge: Cambridge University Press, 1891), 221.

[10] Thank you to Juhani Norri for his assistance in defining “Le Narth.” Personal communication, Nov. 4, 2012.

[11] Link to this document as it appears on the AALT website, http://aalt.law.uh.edu/AALT7/JUST2/JUST2no31/bJUST2no31dorses/IMG_0165.htm.

[12] Carole Rawcliffe, Medicine for the Soul: The Life, Death, and Resurrection of an English Medieval Hospital (Stroud: Sutton, 1999).

[13] Link to this document as it appears on the AALT website, http://aalt.law.uh.edu/AALT7/JUST2/JUST2no61/IMG_0085.htm.

[14] F.-O. Touati, “Les léproseries aux XIIème et XIIIème siècles, lieux de conversion?,” in N. Bériou and F.-O. Touati, Voluntate dei leprosus: les lépreux entre conversion et exclusion aux XIIème et XIIIeme siècles (Spoleto: Centro italiano di studi Sull’alto Medioevo, 1991), 3-19. It is more than likely that many of those inmates suffered from other leprosy-like diseases, that is skin conditions that might be mistaken for leprosy.  As Carole Rawcliffe has noted, in a world where anti-biotics did not exist, many skin conditions might become enough of problem that an inexperienced medical practitioner might easily misdiagnosis them as leprosy.  See Carole Rawcliffe, “The Lost Hospitals of London: Leprosaria,” Gresham College (accessed 19 May, 2017), https://www.gresham.ac.uk/lectures-and-events/the-lost-hospitals-of-london-leprosaria.

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