April 29, 2014, by Nicola Royan
The Lylye of Medicynes – Guest post by Erin Connelly
‘ȝif it be a pore man . . .’: Healthcare for the Rich and Poor in the Lylye of Medicynes
Economic disparity has come to the forefront of public consciousness in recent years: a report produced by Oxfam ahead of the World Economic Forum in 2014 states that ‘half of the world’s wealth is owned by the top 1 percent’. The consequences of this disparity trickle into all areas of life, including healthcare. With no access to costly healthcare, even minor conditions can become a death sentence. For instance, take the not uncommon case of a 24-year old American who died of a tooth infection in 2011 because of an inability to pay for treatment (http://abcnews.go.com/Health/insurance-24-year-dies-toothache/story?id=14438171). Even in countries that have a national healthcare system, life expectancy and health outcomes are still linked with income (with the wealthiest living an average of 25 years longer than the poorest).
Of course, great disparities in wealth and differences in access to healthcare between the rich and the poor are hardly new experiences in human history. The Lylye of Medicynes is an important fifteenth-century Middle English translation of a Latin medical text, the Lilium Medicinae, which was written in 1305 by Bernard of Gordon, a medical doctor and lecturer in Montpellier. The English manuscript (Ashmole 1505) is nearly 500 pages long and contains hundreds of treatments, arranged in seven books, for diseases of the entire body and mind. In the Lylye, differences in treatment for the rich versus the poor are mentioned more frequently than differences in treating men versus women or in treating children versus adults.
Different treatments are not given for every illness, but those in which differences are noted can be summarised into two categories: chronic conditions and diseases more commonly found amongst the poor. It’s not surprising that differences in treatment are mentioned for chronic conditions, such as leprosy and epilepsy, where the ability to pay for treatment over time becomes problematic for a low income person. Furthermore, these chronic conditions were considered next to impossible to cure and difficult to treat, except by using a diversity of remedies and ingredients. A rich person was provided with a wide range of expensive medications, such as ‘ambra gresie’ (from sperm whales), which was considered ‘ful presyous’ in treating stomach ulcers/vomiting, while a poor person was limited to standard, readily available ingredients, such as mint.
Conditions, such as lice and coughing, were associated with poverty. The Lylye states ‘pore men havyþ myche þis pascioun’ and provides remedies for them without ever mentioning their rich counterparts. Just as in the example given above of the young man who died of a treatable minor ailment due to an inability to pay for treatment, many of the available medieval remedies were beyond the reach of the poor. For instance, to cure coughing in a poor person, Bernard states that the first treatment is to ‘lete hym holde ofte his breþe as myche as it is possible’ or ‘blowe þe fuyre ofte’. These treatments were surely affordable, but perhaps not all that effective.
So, in summary, is there an answer to be found in these medieval pages for current disparities in access to healthcare? The Lylye makes clear that cures are hardly ever straightforward, but perhaps Bernard’s advice for treating the afflicted poor is as true today as it was in medieval times: ‘þe cure herof may be by chaungynge of hys lyf’.
Erin Connelly is in her second year of her PhD in the School of English, editing the Middle English Lylye of Medicynes.