5th October Dr John Forrester: Archbishop Thomas Hamilton of St Andrews

In 1551 Archbishop John Hamilton of St Andrews was 40 and had suffered from increasingly troublesome asthma for some ten years. His own physician was William Cassanate, a Frenchman originally from Besançon whose struggles to treat the asthma had fared ill. The Archbishop was Catholic Primate of Scotland, of great influence, and evidently of great wealth too; his half-brother (John was illegitimate) was at the time Regent of the Kingdom, but was reckoned a lesser man than the Archbishop. It was time to seek the best medical opinion in Europe. The physicians in attendance on the King of France and the Emperor Charles V were consulted, but did not actually attend the patient.


Then Cassanate recommended consulting Girolamo Cardano of Milan.  He wrote to Cardano, hoped to arrange a meeting between Cardano and the Archbishop in Lyons or Paris, and implied that substantial reward would be forthcoming. The letter took two months to cross warring countries. It set forth the nature of the disease in the terms of the time: “The first accession of the disease was a distillation from the brain into the lungs, associated at that time with hoarseness, which, by the help of the physician then present, was for the time removed, but there was a bad temperament left in the brain; it was too cold and moist, so that an unnatural matter was collected in the head, which was retained there for a short time, because the brain could neither properly digest its own aliment (especially since it was nourished with pituitous blood), nor had it power to resolve the vapours brought into it from the parts below.” And “there is a hot and burning breath out of the mouth, which causes the air to be rarer than is proper for health, and insufficient even when the chest is very much dilated.”


The hoped-for meeting did not take place. In 1552, Cardano did get from Milan to Lyons, where Cassanate met him after some delay, and then in time he went on to Paris. There, a case conference is mentioned between Cardano, Sylvius, Jean Fernel (two of the leading Paris physicians of the time), and another physician, on the Archbishop’s case. The others spoke before Cardano; he allegedly confined his contribution to remarking in Italian that the patient required an enema.


But at this juncture in the troubled politics of Scotland, the Archbishop, still in Scotland, was seriously uneasy that his own half-brother would be ousted from the post of Regent. He did not dare to depart from Scotland and leave his half-brother without his support. Cardano was finally induced to journey all the way to Edinburgh for a rendezvous there. He travelled from Paris down the river Seine to Rouen, and then sailed from Calais to London. The onward trip from London to Edinburgh, evidently overland, took 23 days.


The scene of the subsequent prolonged three-month interaction between physician and patient was the Archbishop’s favourite residence at Monimail in central Fife, where a tower (built later, in 1578) on the site of that residence still remains to commemorate its use by the earlier Archbishop Beaton and by Hamilton. The Tower has recently been restored and provided with displays illustrating the history of it and of its site.


Before advising on management, Cardano conducted a forty day study of all the features of his patient and his patient’s disorder; it was hard for the Archbishop to tolerate such a long introductory phase without immediate benefit. The ensuing exceedingly detailed advice on regimen, diet and medication survives as 165 printed octavo pages. A copy of them from the Archbishop’s own library reposes in the Library of the College of Physicians of Edinburgh The work is a very large specimen of the then conventional “consilium”or account of a consultation in which a physician could paint a professional self-portrait in colours of his own choice, display his learning, and identify his distinguished patient. It is the longest in the collection of 57 consilia which Cardano published. The consilium recounted how despite the ten years of asthmatic attacks lasting almost always less than 24 hours, “when well between attacks, patient is able for all the functions of an entirely healthy man.” Cardano reckoned that the underlying cause was a humour attracted into the brain and then partially obstructed there; the brain grew overheated, though Cassanate had surmised that the opposite was the case.


A rational cause for the attacks thus provided, management too was rational. For the overheated brain, a diet conceived as middling cold and distinctly moist was recommended. One favoured constituent was asses’ milk, the ass preferably to be free-range, fed on nice herbs and cereals, and recently delivered of a female offspring. The dietary advice is extremely long and detailed: for example, eggs should be boiled till midway between hard and “suckable”, and are then called “trembly”. And even the fuels to be used for cooking are prescribed. It was a time for restriction of excessive eating on the part of church functionaries and other grandees, but not too much restriction. A Privy Council Commission of 1550 addressing this issue laid it down that an archbishop, a bishop or an earl could consume up to 8 dishes at his “mess”, while lords, abbots, priors and deans were limited to 6, and mere barons or freeholders to 4.


The excess humour must  be extracted, by an array of different paths. Experience had made Cardano chary of the most notorious and long-celebrated path for letting surpluses of humour out of a patient’s body: venesection, the removal of blood by cutting a vein. So other channels were to be used; among these, the bowel was to purged with cassia and hyssop. To extract excess matter and water and phlegm from the head, a goats’ or cows’ milk preparation was squirted up the nose. And Greek pitch with mustard was applied to the skin overlying the coronal suture of the skull, so as to draw excess out through the skull; if it did not achieve enough, cantharides was to be added – a celebrated and indeed effective means of generating blisters. To soothe the brain, ivory combs should be used for hair care.


Subsequent medical tradition has attributed particular wisdom to Cardano’s advice to the Archbishop about pillows and bedding. He was to avoid sleeping in feather beds, and instead sleep in beds of silken fluff, so as not to overheat the spine. He should sleep on his front or side, not on his back, and if water ran out of his mouth in sleep, so much the better – excess humour would be emerging. His pillow to be of dry straw, never of feathers, or if this is not tolerated, then of dried seaweed. The pillow’s cover to be of linen or hemp, not of leather. The flowers in his bedroom to be sprinkled with a special elaborate preparation. He should avoid going to bed right after a meal, but should wait till the food had got to the bottom of the stomach (this was reckoned to take 1½ hours.), and should drop off with his hand on his stomach. To get bowel and urine evacuation on rising, he should use a special formula by mouth. If bowel evacuation failed, he was to use an enema.


Cardano possessed a very wide range of accomplishments: he was of course a physician of wide fame, and probably the first to describe the flea bite-like spots of typhus, in creating the first identifiable description of the disease, and that in the first or second book he ever published, when he was 35. But medicine was just one of his serious interests. He was also, for instance, interested in mechanics, and enjoys a not fully deserved repute still as the inventor of the universal joint, of which two are situated under every rear-wheel drive car in the drive shaft to the rear wheels; they are still known as Cardan joints, or Cardan-Hardy Spicer joints. Cardan’s own interest was in fact in the gimbal rings which allow a marine compass to tilt every way and thus stay always horizontal, and no one thought of rotating these as universal joints until 1893.He also possessed a serious mastery of mathematics and astronomy, which at the time overlapped indistinguishably with astrology. So he cast the Archbishop’s horoscope, and foretold danger from “passion of the heart” or poison, the danger to arise in the year 1560. However, as will appear, the Archbishop survived longer than that.


The very comprehensive regime devised by Cardano covered sexual intercourse too: “it is neither good nor useful,” wrote Cardano, “but when necessary, it should be between two sleeps, that is, after midnight, and not twice in a day, and with ten day gaps.” Sex … but you are restless in your chairs! Wasn’t the Archbishop a celibate Catholic cleric, Primate of All Scotland? Well, he was an illegitimate son himself, and not exactly celibate; in fact the name of his principal lady is on record: the Archbishop “purged his reins” (as the phrase then went) regularly with a widow named Grizzle Semple, daughter of his friend the Master of Sempill,who had three illegitimate sons by the Archbishop. In 1559 the city magistrates of Edinburgh expelled her from the town in disgrace. It is also on record what was made of the Archbishop’s doings by John Knox, the celebrated Protestant reformer of the time, who said: “He took also possession of his kinsman’s wife. The woman is and has been famous. Her Ladyship was holden always in property; but how many wives and virgins he has had since that time in common, the world knows, albeit not all; and his bastard birds bear some witness.” No wonder that very soon afterwards, in 1563, the Catholic Church’s Council of Trent promulgated a decree “to suppress concubinage among the clergy”.


But Knox did have a good word to say for the Archbishop’s other accomplishments: “He had a reputation for learning, an honest life, and uprightness in religion.” Indeed, he amply endowed St Mary’s College at St Andrews, the divinity collegethere to this day. But he was perhaps more interested in recreations than Knox was; the first surviving reference to golf in St Andrews is contained in a Charter of Archbishop Hamilton’s given in 1552. This reserves the right of the people of St Andrews to use the links land “for golff, futball, schuteing and all gamis”.


Reluctant to remain longer with the Archbishop, whatever the inducement, Cardano set off back to Italy in September 1552. He took with him a substantial honorarium in gold coin, and a gold chain, and had also been presented with an ambling horse by his grateful patient. He passed through London on the way, and was persuaded to consider the case of the young King Edward VI. But he avoided France this time, reckoning travel there too dangerous, and proceeded home via the Low Countries.


What became of the Archbishop later? He was certainly much gratified by his progress on the detailed regime laid down by Cardano, as his later letter to him dated 1st October 1554 testifies. He still sought to induce Cardano to return, as his personal physician, but without success. The political tide turned dramatically, and the Protestant Reformation began to triumph. His half-brother’s Regency terminated, and another Regent took over. The Archbishop remained on close terms with Mary Queen of Scots; he helped her to escape from confinement on Loch Leven,and when her side was defeated in 1568 at the battle of Langside, the Archbishop was in attendance on her, and did his very best to stop her fleeing across the Solway to England and casting herself on the mercy of Queen Elizabeth; “he waded knee-deep into the water, held back her boat, and conjured her, by every argument which his agitated mind could suggest, not to trust herself in England. How right he was, in view of her ultimate execution there! Then in April 1571 he fell into the hands of his enemies with the fall of Dumbarton Castle, and was “Hanged on a Gibbet, in his Episcopal Robes, over the battlements of the Castle of Stirling. He was the first Bishop in Scotland who had died by the hands of the Executioner, and the last Primate of the Scottish Roman Catholic Church.” There is an alternative version, less sensational, but with more of a literary flavour: that he “wes hangit at the mercat croce of Striueling [Stirling] vpoun the jebat [gibbet], on the quhilk wes writtin thir tua verses following:


Cresce diu felix arbor, semperque vireto


Frondibus, ut nobis talia poma feras.”


these two lines in Latin, of unclear authorship, sing the praises of the “tree” or gibbet, for bearing such good fruit as an Archbishop!