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What It Was Like to Go to the Doctor in 1610

Not unlike seeing an astrologer, really, except when someone leaves the house with poop on a spatula or starts menstruating through her breast.

Back in 1610, horoscopes weren't the kind of thing you'd flick through on your coffee break; they were a regular part of British medicine.

In the early modern period, long before anyone dreamed of the NHS, English society had a number of different types of medical practitioners: everyone from the local wise woman to the expensive "learned physicians."

Lauren Kassell of Cambridge University is the director of an archiving project for the casebooks from this period written by Britain's two most prolific astrologer-physicians. She has been studying some 80,000 clinical records left by Simon Forman and Richard Napier for more than 20 years of her career as a medical historian, and the work was recently the subject of a specially commissioned art exhibition in central London.


Kassell explained what it was like to go to the doctor in the late 16th and early 17th century, why astrology was so important, and how recognizing the importance of medical consultations can improve our understanding of how medicine works today.

What was it like for an average person to consult the astrologer physicians as represented in the casebooks?

The astrologer-physicians would expect a client or a client's representative to come to them with a question—physically, in writing, or through a messenger. The approach was important, since to the astrologers, the will to ask the question was what determined their reading of the stars. The moment the question was asked was the moment that carried the astrological significance.

In the vast majority of these consultations the question was What is my disease? A smaller percentage were questions like Am I pregnant? or even Where is my lost dog? or Should I move house?

The astrologer-physicians accepted a patient's urine [not so much to be analyzed but] more as a token of the patient's will to be healed. Occasionally they looked at the urine, but mostly what the astrologers were doing was reading the positions of the stars and other signs of health or illness, whether this had to do with the color of someone's cheeks, the size of their body, or the patient's description themselves.

Most of the patients that we have in Simon Forman and Richard Napier's casebooks, something like 70 percent of them, only consulted the astrologer once. But we have some who came back dozens and dozens of times.


What was your initial reaction to reading these casebooks?

When I was in my early 20s and started reading the casebooks I was just in the early years of graduate study and I didn't know a tremendous amount about the history of medicine. I think like so many people I had presumed that people became more candid, more open, more modern as the centuries had gone by. And of course that's just wrong.

So when I first started reading the casebooks you would find people talking about sex and menstruation and extreme fear, extreme despair, all of these personal, intimate things in a way that seemed quite frank. And this is often a woman talking with a man, a doctor—a man in a position of authority about these things.

It rankles with some of our sensibilities. You know, there's an instance where Simon Fulman describes walking into a house and somebody is leaving the house with a turd on a spattle [like a spatula]. Now what is going on in that? First of all, why did he write it down? He must have thought it was a little bit unusual. But he didn't say, "Oh my god this is the grossest thing I've ever seen, why is somebody coming out with a poo on a plate?"

These things make it clear that our conventions now aren't the same as their conventions, and for historians, that's where all the excitement comes from.

Are there other examples of that?

We have loads of cases where the astrologers just describe as a matter of course the woman menstruating through her nose or mouth, or in one case through her breasts. And so you say you can't menstruate through your nose or breasts. They have a model where there's a balance of four humors in your body. When there is a blockage, of any sort, and the humors aren't moving as they should be moving, you become ill. So what we have in the casebooks is a huge amount of information about excretion of all different sorts, because excretion is getting rid of the foul humors.


So if for some reason a woman's body isn't working quite right and she's not excreting foul blood through her ordinary menstrual cycle, her body will rectify this and make her healthy by emitting the blood through another orifice. You get instances of men "menstruating"; they're described as menstruating through hemorrhoids or bloody noses as this sort of natural form of excretion.

When you first come across these things you think, Gross! Weird! Then it just becomes, Oh: this is another case where she is menstruating through her nose.

Why were they so reliant on horoscopes and astrology at that time?

One of the things that's unusual about the two practitioners we're looking at, Simon Forman and Richard Napier, is that they were so reliant on the stars. There were other astrologers but most medical practitioners were not doing this kind of elaborate astrology.

At the time, people questioned the validity of astrology, particularly this kind of individually oriented astrology. But they also saw themselves as located in the seasons and in the calendar, and in a geography, in the cosmos. And so it made perfect sense that just as the tide moves with the stages of the moon, so the fluidity of the body is perfected by the cosmic motions. You don't have to overthink it: Somebody who has knowledge of these changing motions has knowledge of the workings of your body.

Have you had any feedback from doctors about your research?


There are things that doctors aren't supposed to record any more—like, "This is normal for Mr. Norfolk." Doctors intuit all sort of things about their patients through the nature of the encounter, and that is very hard to codify [these days].

They know there is a place for all of the testing and the scrutinizing, whether it's through MRI scans or other devices, but they also know that there's a subtlety in the encounter that in many cases is important for them to capture for diagnostic value and to harness in terms of helping somebody heal. They often identify with the familiarity of the encounter as something that carries value.

How has studying the casebooks affected you as a researcher?

When I began as researcher I took the position that things in the past were foreign to us. But one of the reasons I liked the casebooks as records was because they showed you the minutiae of ordinary people's lives. They're personal, and they feel immediate, albeit through the astrologers' pens.

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