The Herbalist: Nicholas Culpeper and the Fight for Medical Freedom. Benjamin Woolley

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СКАЧАТЬ do little therefore, and by reason thereof they do oftentimes impair and hurt their patients,’ it objected. Because of this, the act ruled that ‘every person being the King’s subject, having knowledge and experience of the nature of herbs, roots and waters or of the operation of the same’ should be allowed ‘to practise, use and minister in and to any outward sore, uncome [attack of disease], wound, apostemations [abcess], outward swelling or disease, any herb or herbs, ointment, baths, poultices and plasters, according to their cunning, experience and knowledge’.⁷ This effectively allowed more or less anyone to perform any surgical operation that did not require a scalpel.

      The identity of those who initiated the Quacks’ Charter is unclear, but the physicians must be among the suspects. They were concerned that the Barber Surgeons Act had given the surgeons too much power and were eager to undermine their privileges. The act may also have been a response to Henry VIII’s religious reforms. In the late 1530s, the process had begun of closing the Catholic monasteries, which until then had run the hospitals. This created a crisis in public healthcare that the act could help alleviate. Whatever prompted it, the effect was chaos, as it did not specify who was to determine the ‘knowledge and experience’ of those that it allowed to practise.

      The College lobbied both monarch and Parliament for further acts and charters reinforcing its own position. It also produced its own ‘statutes’, setting out in meticulous detail its rules and procedures. The earliest that survive date from 1555. They were written by Dr John Caius, one of the College’s most influential sixteenth-century presidents. His name was originally ‘Keys’, but, following a practice popular among intellectuals wanting to add gravitas to their names, he Latinized it to ‘Caius’, but kept the original pronunciation.

      Dr Caius’ statutes specified that there should be quarterly meetings, ‘Comitia’, attended by all the Fellows. At the Michaelmas Comitia (held on 30 September), the College selected from among its number a president and eight seniors or ‘Elects’. The Elects would then choose the ‘censores literarum, morum et medicinarum’, censors of letters, morality, and medicine – effectively the custodians of the physicians’ monopoly. They were to exercise these roles, not with the ‘rod of iron’ of olden times, Caius declared, but with a caduceus, the mythical wand entwined with two serpents carried by the Greek god Hermes, representing gentleness, clemency, and prudence, which has since become a symbol of medical practice. Caius personally donated a silver caduceus to remind the Censors of this responsibility. It was one they would often forget.⁸

      Their first role as censors of ‘letters’, or medical literature, was aspirational. They may have wanted to control the licensing of medical books, but this responsibility belonged to another livery company, the Stationers’, working under the supervision of the Church. As censors of morals they were primarily concerned with enhancing the physicians’ professional image. The Fellows were touchy about their social status. Since antiquity, physicians had aroused mixed feelings in society. ‘The physician is more dangerous than the disease,’ went the proverb.⁹ In the prologue of the Canterbury Tales, Chaucer introduced a ‘Doctor of Physic’ as a figure of learning, knowledgeable in ‘magic natural’ and well read in the medical classics, but ‘His study was but little on the Bible’. This was a reference to the old saying ubi tres medici, duo athei: ‘where there are three physicians, there are two atheists’, the suspicion of atheism arising from their devotion to classical (i.e. pagan) knowledge. The slur rankled – the ‘general scandal of my profession’, the physician, essayist, and Honorary Fellow of the College Sir Thomas Browne called it in his masterwork Religio Medici (1642). Chaucer had also alluded to another accusation, that doctors were greedy, making money out of the misery of others by prescribing expensive medicines and charging exorbitant fees: ‘For gold in physic is a cordial;/Therefore he loved gold in special’.¹⁰ The sentiment was echoed by Christopher Marlowe in his play Dr Faustus (published 1604), when the eponymous hero contemplates his prospects:

      Bid Economy farewell, and Galen come:

      Be a physician, Faustus; heap up gold.¹¹

      But, as every physician knew, in a medical emergency, attitudes were different. When a child sickens, when boils erupt, when fever grips, when plague knocks on the door, then the physician is ‘God’s second’, as the playwright and satirist Thomas Dekker put it, lampooning the public response to plague. ‘Love thy physician,’ he advised, adding that ‘a good physician comes to thee in the shape of an Angel’, unable to resist the common play on a word that then referred both to a divine messenger and a gold coin.¹²

      The Censors’ moral role was aimed at counteracting this image by imposing a strict code of conduct. This code was not concerned with issues such as behaviour towards patients, the level of fees, or charitable obligations. It was about insisting that Fellows dressed in scarlet and silk caps on public occasions and addressed the College President always as ‘your excellency’. It was about prohibiting College members from accusing one another of ignorance or malpractice, intervening in a colleague’s case unless invited, questioning a colleague’s diagnosis, employing apothecaries who practised medicine, or disclosing the recipes of medicines.¹³

      The College’s Annals show that most Fellows observed these ‘moral’ strictures to the letter. When it came to internal discipline, the only matter the President and Censors had to concern themselves with on a regular basis was absenteeism, which was rife. The primary concern was external discipline, the policing not of colleagues, but competitors.

      As censors of medicine, the College was entitled to control the practice of medicine in London or within a seven-mile radius of its walls. Anyone reported to be practising without a licence faced a summons from the College beadle and the threat of a fine or imprisonment. And what an apparently motley bunch the beadle brought in, with names, as the medical historian Margaret Pelling has noted, worthy of a Jacobean comedy: Gyle, Welmet, Wisdom, Blackcoller, Lumkin, Doleberry, Sleep, Buggs, Hogfish, Mrs Pock, Mrs Paine and Mother Cat Flap.¹⁴ Those who voluntarily presented themselves to the Censors, seeking a licence, tended to appear under more respectable names, usually Latinized, like that of the College luminary Dr Caius: Angelinus, Balsamus, Fluctibus. They had to prove to the Censors that they had a firm grasp of medical theory. To establish whether or not this was the case, they were examined, not on their knowledge of the latest anatomical theories or diagnostic techniques, the revolutionary findings of the great Renaissance medics and anatomists such as Jean Fernel of Paris or Gabriele Falloppia of Padua, but on their understanding of the works of a physician and philosopher who had lived a millennium and a half earlier.

      No other field of knowledge has been dominated by a single thinker as medicine was by Galen. Born in AD 129 in Pergamon (modern Turkey) to wealthy parents, Galen was, in many respects, a model physician: studious, clever, and arrogant. In his youth, he studied at the Library of Alexandria, the great repository of classical knowledge, and travelled to India and Africa, learning about the drugs used there. He became a skilful anatomist who could expertly cut up an animal living or dead, and, though the dissection of humans was taboo, he had attained a grasp of human physiology thanks to a spell as physician to the gladiators. He also had an astute understanding of patient psychology and was very good at attracting prestigious clients, including the Roman Emperor Marcus Aurelius, an endorsement he never lost an opportunity to advertise.

      As well as being a brilliant practitioner, Galen gave medicine academic respectability. Basing his ideas on those of Hippocrates, the semi-mythical Greek physician immortalized as the author of the Hippocratic Oath, he created a comprehensive СКАЧАТЬ