London (Ancient And Modern) From The Sanitary And Medical Point Of View — Chapter 2 - London From The Medical Point Of View: Chaucer's Doctor; Earliest London Practitioners; The Severance Of Medicine And Surgery; The Earliest Medical Act

LONDON FROM THE MEDICAL POINT OF VIEW.

It is impossible to appreciate the causes of the insanitary condition of Old London without a knowledge of the state of medical education at the time.

This chapter will show clearly that scientific medicine is of comparatively modern growth, and it will not need any professional training to distinguish between the superstitious dogmas of the past and those scientific principles which have resulted from the systematic study of medicine by strictly scientific methods.

If the scientific study of medicine should from any cause be checked, there can be no doubt that we should soon again make acquaintance with those pestilences which wrought such fearful havoc in the Middle Ages.

CHAUCER’S DOCTOR.

In giving an account of the profession of medicine as seen in London, both in ancient and modern times, one cannot do better than begin with that “Doctour of Phisik” described by Chaucer as setting out from the “Tabard” in Southwark with the other pilgrims bound for the shrine of St. Thomas of Canterbury about the year 1380. Chaucer’s lines have been often quoted, but I make no apology for giving them once more, because the description of the “doctour” bears the stamp of truth and is sufficiently minute to bring the individual before us:-- “There was also a Doctour of Phisik, In al this world ne was ther non him lyk To speke of Phisic and of Surgerye.

” It may be that the poet means to convey the idea that doctors of the fourteenth century, like some of those of the nineteenth, were prone to talk “shop.

” “For he was grounded in astronomye.

” Astrology at this time was an essential part of medicine, and the simplest remedies were not applied without consulting the stars, so that to be “grounded in astronomye” was most essential.

“He kept his pacient wondurly wel In houres by his magik naturel.

Wel cowde he fortune the ascendent Of his ymages for his pacient.

” Here we have reference to mystical modes of treatment which were then much in vogue.

Amulets and charms were constantly prescribed; the doctrine of signatures--_i.

e. _, the giving of those plants having some slight resemblance to parts of the human body or to some prominent symptom of disease, for the relief of the organs or diseases which they resembled--was in every-day use; and the treating of images in order to affect the original of the image was a constant practice among witches, and was probably used by the profession.

“He knew the cause of every maladye Were it of cold or hete or moyst or drye, And where thei engendrid, and of what humour.

” Here we have allusion to the Hippocratic humoral pathology as developed by Galen.

“He was a verrey parfight practisour, The cause i-knowe, and of his harm the roote Anon he yaf the syke man his boote” (remedy).

Quick diagnosis and prompt treatment.

“Ful redy hadde he his apotecaries To sende him dragges, and his letuaries, For eche of hem made othur for to wynne.

Here frendschipe was not newe to begynne.

” It would seem that even in Chaucer’s time the advertising druggist was as pushing as at present.

“Wel knew he the olde Esculapius, And Deiscorides, and eeke Rufus, Old Ypocras, Haly and Galien;

Serapyon, Razis and Avycen;

Averrois, Damascen and Constantyn, Bernard and Gatisden, and Gilbertyn.

” Our friend’s library was tolerably complete, for here we have a list of the medical “scriptures,” Greek, Roman, and Arabian, an acquaintance with which was the whole duty of a physician, and which to doubt was heresy.

The last two names on the list refer to John of Gaddesden and Gilbert, both English writers, of whom I shall have a few words to say presently.

“Of his diete mesurable was he, For it was of no superfluité, But of gret norisching and digestible.

” Doubtless there were many things then which took the place of pancreatic emulsion and extract of malt.

“His studie was but litel on the Bible.

” This line is frequently quoted to show that the scepticism with which doctors are often charged is of no modern growth.

The point of the line is, however, to be found in the fact that Chaucer’s doctor was certainly a priest, as were all the physicians of his time, and that the practice of medicine had drawn him away, somewhat unduly perhaps, from the clerical profession, to which he also belonged.

“In sangwyn and in pers he clad was al, Lyned with taffata and with sendal.

” A robe of scarlet and sky-blue, lined with silk.

Equally gorgeous doctors may be seen at the present time by those who attend at Burlington Gardens on “Presentation Day.

” “And yit he was but esy in dispence;

He kepte that he wan in pestilence.

For gold in phisik is a cordial;

Therefore he lovede gold in special.

” The priest-physician was fully as fond of his fees as are any of his successors.

But to come to particular instances which prove the truth of Chaucer’s graphic picture.

EARLIEST LONDON PRACTITIONERS.

The “Gilbertyn” of Chaucer’s doctor was =Gilbertus Anglicus=, an Englishman who wrote a work on medicine about the year 1290, and it is remarkable from the fact that it gave the first description of leprosy written by western writers, leprosy being a disease which has long ceased to exist in this country.

He treated apoplexy with ants’ eggs, scorpions’ oil, and the flesh of lions; but where he obtained this latter commodity it is hard to tell.

For urinary calculi he advised the administration of the blood of a he-goat fed upon parsley and saxifrage.

=John of Gaddesden= was a graduate of Merton College, Oxford, and wrote his famous medical treatise, “Rosa Anglica,” about 1305. He is said to have been greedy of money, and he recommends his contemporaries to make arrangements about fees before undertaking a case.

He was an ecclesiastic, and was court physician to Edward II.

and Edward III.

He tells us that bleeding is hurtful at the time of the feasts of St. John and St. Stephen, but necessary at Christmas because of the custom of overloading the stomach with cakes at that season.

Pigs’ dung was his favourite hæmostatic; and when the son of the King had small-pox, he was careful that everything about his couch should be red.

In South’s “Craft of Surgery” is a most interesting and full account of =John of Arderne=, one of the earliest English writers on surgery.

This worthy was a specialist for the cure of fistula, and dwelt at Newark between 1349 and 1370, when he moved to London.

His work “Praxis Medica” is among the Sloane Manuscripts in the British Museum.

He made his great reputation by curing Sir Adam Everyngham of fistula after he had been pronounced incurable by the chief doctors in France.

He relates the cases (some of them with details) of other patients.

The most interesting of the writings of John of Arderne is that entitled “Of ye Manere of ye Leche,” because it throws a flood of light on professional manners and ethics in the fourteenth century.

The following paragraphs (taken from South) are well worth quoting;

but in doing so I think it advisable to (in some degree) modernise the spelling and the expressions:--“First, it behoveth him that will profit in this craft that he set God ever before him in all his works, and evermore call meekly with heart and mouth his help, and occasionally, according to his power, give of his earnings to the poor, that they by their prayers may get him grace of the Holy Ghost.

Let him not be found rash or boastful in his words or deeds.

And let him abstein from much speaking, especially among the great.

And let him answer questions warily, lest he be overtaken by his words....

Also be a leche not much laughing nor much playing, and let him as much as may be fly the fellowship of knaves and disreputable persons.

And be he evermore occupied in things beholding to his craft, whether he read or study, write or pray, for the exercise of books whorshippeth a leche....

And above all this, it profiteth to him that he be found evermore sober, for drunkenness destroyeth all virtue, and bringeth it to nought, as sayth a wise man.

Be he content in strange places with the meat and drink there found, using measure in all things....

Scorn he no man....

And if there be made speech to him of any leche, neither set him at nought, nor praise him too much, nor commend him, but thus may he courteously answer: ‘I have not any knowledge of him, but I have neither learned nor heard of him but good and honest.

’...

Consider he not over openly the lady or the daughters, or other fair women in great men’s houses, ‘ne profre them not to kisse, ...

that he come not in to the indignacion of the lord ne of noon of his.

’...

When such men come to the leche to ask help or counsel, it speedeth that he make seeming excuses, that he may not incline to their asking without harming or without indignation of some great man or friend, or for necessary occupation; or feign he him hurt, or for to be sick, or some other convenient cause by which he may likely be excused.

Therefore if he will favour to any man’s asking, make he covenant for his travail and take it beforehand....

And if he see the patient, pursue busily the cure then, and ask he boldly more or less, but ever be he warre of scarce askings, for over scarce askings setteth at nought both the market and the thing.

Therefore for the cure of fistula in ano, when it is curable, ask he competently of a worthy man and a great an hundred marks or forty pounds, with robez and feez of an hundred shillyns terme of life, by year.

And take he not less than an hundred shillyns, for never in als my life took I less than an hundred shillyns for cure of that sekeness.

” John of Arderne advises that prognosis should be very guarded, and that as to the time of recovery it is good to say double what you think, and if the patient ask “why he putte him so long a time of curying, sithe that he heled him by the halfe?

Answer he, that it was for that the patient was strong hearted and suffered well sharp things, and that he was of good complexion and had able flesh to heal, and feign he other causes pleasable to the patient, for patients of such words are proud and delighted.

” The leech is further advised to dress like a clerk (_i.

e. _, a priest), “for why it seemeth any discrete man clad with clerk’s clothing to occupy gentlemen’s boards.

” “Have the leche also clean hands and well shapen nails, cleansed from all blackness and filth.

” There are many other directions for conduct given in this remarkable document, and sundry extracts from Scripture are given as suitable for quotation by the bedside: “And it speedeth that a leech can talk of good tales and of honest that may make the patient to laugh, as well of the biblee as of other tragediez.

” Finally, he is charged to most scrupulously observe all professional confidences.

It is evident that John of Arderne was a consummate man of the world, and knew all the tricks of his trade.

His fees seem to have been enormous, and, indeed, he is only one out of many examples among our early professional forerunners who made very large professional incomes.

Whether Gilbert, Gaddesden, and John of Arderne were associated with any guild which took upon itself the duty of protecting the interests of physicians and surgeons is not known.

Certainly they belonged to no association of which we have any trace remaining.

I shall now endeavour to show how the medical corporations of London had their origin, and it is necessary to make a few preliminary remarks.

THE SEVERANCE OF MEDICINE AND SURGERY.

The physicians and surgeons were originally very different orders of men.

Medicine is in most Christian countries an offshoot of the clerical profession.

So profitable was the practice of medicine, that not only monks, but many of the higher clergy, devoted themselves to it.

The union of the two professions of medicine and divinity existed up to the middle of the seventeenth century, and evidence of it is still found in the “Lambeth M. D.

,” a degree which the Archbishop of Canterbury still has the right to confer, but only upon a legally qualified practitioner.

It was thought necessary by Pope Innocent III.

(1198-1216) to forbid the clergy to undertake any operation involving the shedding of blood, and by decrees of other popes in the thirteenth and fourteenth centuries they were forbidden to practise surgery in any form.

In this way medicine and surgery became divorced, and this forcible and arbitrary separation of two branches of the same subject served undoubtedly to hinder the progress of medical knowledge to an enormous extent.

Medicine was thus left mainly in the hands of scholars, of men who at that time stood alone in the possession of scholastic learning, while surgery was handed over to men who had little or no scholarship, but who amassed a considerable amount of practical wisdom in the daily struggle with the difficulties of their craft.

The early physicians, like Chaucer’s “Doctour of Phisik,” often had an extensive knowledge of the writings of the Greek, Latin, and Arabian writers, who may be considered as the medical “fathers.

” These were their scriptures, which to doubt was heresy.

They knew nothing beyond them, and it is not surprising that priestly medicine, divorced as it was from those practical matters in overcoming which we alone get wisdom, was absolutely unprogressive and unproductive.

If the early clerical physicians did little for medicine as a science, they did a great deal for it as a profession.

They were men of learning and high culture; they had had a university training; and we shall see that many of them were well born and had been brought up amongst high-minded gentlemen; and undoubtedly it is due to the College of Physicians, and largely to some of its earlier members, that the profession of medicine has been practised in this country in a manner which is mainly creditable.

Glaring exceptions, of course, have occurred; but, as a rule, the men who have neglected to conduct themselves as gentlemen have met with no encouragement from the College of Physicians, and I believe it would be difficult to over-estimate the influence for good which the College has had in this direction.

The early surgeons were many of them illiterate and rough.

Some of them--perhaps most of them--were, in this country and in France, evolved from the barbers; and this is not surprising, for the man who can shave with dexterity has acquired no small skill in handling sharp instruments, and must be often called upon to treat wounds of his own making.

It is not surprising that these men should have been called in to attend to cases of injury, and we know that they very early added tooth-drawing and bleeding to their tonsorial art, and practised all three till a comparatively recent date.

War with its wounds must have made surgery a necessity in every country, from the time of the siege of Troy downwards; and Mr. South gives an interesting account of Thomas Morstede, who was chief surgeon to Henry V. ’s army at Agincourt.

Again, many doubtless acquired their first knowledge by practising on animals, and it must be remembered that there are now throughout this country scores of illiterate men who operate with consummate skill on the lower animals.

It appears that as early as 1308 the barbers of London were incorporated into a guild, and there appears to have been a gradual separation of them into those which practised surgery and those which practised barbery, and in 1460 the Guild of the Barber-Surgeons was one of the livery companies of the City.

Outside this body there was an Association of Surgeons, and also an Association of Physicians, and, according to Mr. South, there appears to have been in 1423-24 a veritable Conjoint Board of Physicians and Surgeons, which, however, survived its birth only a few months.

At the time of the accession of Henry VIII.

it appears that public opinion was getting ripe for legislation.

THE EARLIEST MEDICAL ACT.

In the third year of the reign of that monarch (1511-12) an “Act for the Appointing of Physicians and Surgeons” was passed, the preamble of which was as follows: “Forasmuch as the science and cunning of physick and surgery (to the perfect knowledge whereof be requisite both great knowledge and ripe experience) is daily within this realm exercised by a great multitude of ignorant persons, of whom the greater part have no manner of insight into the same, nor in any other kind of learning;

some also can no letters on the book, so far forth that common artificers, as smiths, weavers, and women, boldly and accustomably take upon them great cures and things of great difficulty, in the which they partly use scorcery and witchcraft, partly apply such medicines unto the disease as be very noxious and nothing meet therefore; to the high displeasure of God, great infamy to the faculty, and the grievous hurt, damage, and destruction of many of the King’s liege people; most especially of them that cannot discern the uncunning from the cunning.

Now therefore ...

be it enacted,” &c. And the Act goes on to provide that all who practise medicine and surgery (except graduates of the University) shall be previously examined, approved, and admitted by the Bishop of London or the Dean of St. Paul’s, or (for the country) by the bishop of the diocese, who shall call to his aid for this purpose four doctors of physick, “and for surgery other expert persons in that faculty.

” The penalty for evading the Act was £5 for each month of illegal practice.

Two years later an Act was passed giving to the members of the Guild of Barber-Surgeons (not exceeding twelve) exemption from bearing arms or serving on inquests.