Medicina Flagellata; Or, The Doctor Scarify'd

by Anonymous

Another Complaint against the Apothecaries is, That they are not well acquainted with the Materia Medica; the Knowledge of which is an essential Part of their Profession, but must take the Words of Druggists, who themselves are sometimes mistaken, and differ about the Names of several Drugs; and which is worse, their trusting to Herb-women, who obtrude almost any thing upon the greatest Part of them; and that those Women do often mistake one Thing for another, sometimes ignorantly, sometimes designedly, is well known to many Physicians, who have seen them sell the Apothecaries Herbs, Roots and Seeds, under other Names than those they do really bear, for many among them cannot distinguish between Ingredients noxious and salutary: So that we have not Patients daily poisoned is rather from the Care of Herb-women than Apothecaries. Another just Cause of Complaint against the Apothecaries are, their old Medicines; for suppose them as faithfully prepared as they can pretend or we desire, yet Length of Time will make some Changes in them, which are not often Improvements: The Syrups grow acid, and Waters full of Mother, Electuaries and Pills dry and deprived of their most active Parts, Powders themselves are not free from this Fate, whose Virtues in Time we find marvelously diminished. But were they to be told of this, you may with as good Success preach to a Wall, for not a Dram of any other Medicine will the Apothecaries part with but for Sale: So that many times they sell their Preparations five or six Years after they were made, and whether their Medicinal Properties are not much impaired, if they have any left, we leave to others to determine. And indeed the Apothecary has many Things in his Shop which are not called for in many Months, yet these must be vended with the rest; all which, when they have lost their Virtues, should they be rejected, it would be much to their Prejudice, and they have a fundamental Practice that no such Thing should be allow’d of: For ’tis much better the Patient should suffer somewhat in his Body than the Apothecary in his Estate; and if he has injured by his bad Physick, perhaps he will take Pity of him, and the next Prescription shall be better prepared; whereby he makes him abundance of Recompence for the Hurt he receiv’d by that which was bad: And he himself makes an Advantage of both, although perhaps if he had consulted the Patient, he would rather have chosen to keep his Head sound than have it broken, that a proper Plaister might be applied for the Cure. This is so notorious a Truth, that all the World, even their best Friends, exclaim against them for it, and ’till they amend this among many other Peccadillo’s, it behoves the Patient to take care how seldom he employs them. Another, that the Apothecaries and their Servants are so careless, slovingly and slight in preparing of dispensatory, or prescribed Medicines, that neither the Physicians, or the Diseased, have Reason to repose that Trust in them which they challeng’d as their Due. As for Slovenliness, they may, I confess, plead the old Proverb, That what the Eyes see not, the Heart rues not. Indeed of all the rest it may be dispensed with; but should Patients but once behold how their Physick was prepared in some Shops, they would nauseate it: But least I should offend some nice Stomachs, I shall dismiss this Subject, and proceed to another, which is the Carelessness of Apothecaries and their Apprentices; on which I can never reflect without Fear and Indignation, to think what Numbers have been destroy’d and injur’d by such Proceedings: That this is not a groundless Apprehension many Families can witness, and you can converse with few Persons who are not able to give an Account of some such Miscarriages.

Another thing of great Blame with the Apothecaries is, their enhancing the Prices of Medicines so much above what they might in Reason expect; about which the Physician must no ways concern himself, because it has a bad Influence on him, as on the Account of his Patient; though certainly, if the Apothecaries were more modest in the prising of their Physick, the Patient would be more liberal to the Physician: Whereas on the contrary, the Apothecary holds them at such unreasonable Rates, that in most Courses of Physick he gains more than the Doctor, how deservedly let others determine, though in my Opinion, were their Pay proportion’d to their Care and Honesty, I doubt they would gain little besides Shame and Reproaches: But their Bills must be paid without Abatement; and with how much Regret they are discharg’d, I shall refer it to those who have suffered by them. Now several Things contribute to, or are the occasional Causes of this Universal Grievance. The Physician’s Silence, and the Number, Pride, or Covetousness of the Apothecaries, and that Prices are not set upon their Medicines: the Apothecaries being reduc’d into a Company, were at first few; and therefore having full Employment, could afford their Medicines at moderate Prices; but being since that time increased to a great Number, each Person bringing up two or three, or more, that Imployment which was before in a few Hands, became more dispers’d, so that very small Portion thereof falls to the Share of some, and indeed very few of them have more than they can manage. Now the Sick must maintain all these, for although there be no occasion for a sixth Part, yet they must all live handsomely; to supply which Expence, they have no other Way than to exalt the Prices of their Medicines, and still the less they are employ’d, the higher they must prize them, otherwise they could not possibly subsist, unless they became Physicians, and prescribe as well as prepare; to which Practices they are not only propense, but more arrogantly assume, which is no less fatal to their Patients, than by the impudent Prescription of your common Quacksalver, Emperic, or Mountebank.

Now would it not be much better, if it were with us as in some Parts of Europe, where the Magistrates of many Cities agree upon a certain Number of Apothecaries, so many as they can apprehend are necessary, all the rest are excluded, and must either seek other Seats, or be content for a small Salary to work under those that are allow’d; their Apothecaries not being permitted to multiply by Apprentices, but one out of the Shop is by the publick Authority appointed to succeed in the Employment. Hamburgh has but one, Stockholm and Copenhagen four or Five, Paris (which rivals London in its Inhabitants) has but one or two and fifty; they are from the due Regard to the Safety of the People exempted from Offices, either troublesome or profitable, that they may always be inspecting the Preparations, or compounding of the Doses, to prevent the deadly Consequences of sophisticated Medicines, or the fatal Errors of one Composition for another, not easily to be distinguished: They are not permitted to visit the Sick, that they may not be wanting from the Duties of the Shop, or be tempted to gratify themselves as they please for the Trouble, by introducing the Custom of taking too often of the Bolus and Cordials. The Physicians Fees are settled according to the various Conditions and Abilities of the Patient; ’tis not allow’d them to make any Advantage by the arbitrary Rates of Physick, when prepared by themselves, that the Patient and the Bill may not be too much inflam’d by a Profit on that side, not easily to be limited or confined. I would not be suspected to design any Prejudice to the careful and industrious Apothecary, (if such there be) his Business requires the greatest Diligence and Fidelity in selecting the Drugs, and preparing them faithfully according to the Appointment of the Faculty, and in making up the Doses with that just Regard to the Life of the Sick, that all Suspicion of the least Mistake may be prevented, in the Weight and Measure, or the Number of Drops, &c. But when the Apothecary deserts his Station, is always abroad, and leaves the compounding Part to his unexperienc’d Apprentice, who cannot avoid sometimes infusing one thing for another, by which Errors many are known to have lost their Lives; when ’tis known that the Prescripts are made up of Medicines bought by Wholesale of the Chymist, and not made up by the Apothecary himself, as is too much the present Practice, and consequently can’t be known to be made of all, and best Ingredients, but are suspected, because bought at low Prices; you will doubt whether the Character of an Apothecary can be given to this new, and till lately unknown Employment: When he neglects the Business of his Trade, neither prepares himself the Compositions, nor forms the Doses for them, to be deliver’d at the most urgent Occasions, but daringly undertakes to advise in all Distempers, he becomes an Emperic, and invades a Profession which he cannot be supposed to understand.

And here give me Leave to be serious, in examining their general Practice in all Diseases. Suppose your self to be troubled with any Distemper, it matters not which, for all is one to him you send to; upon his Arrival he feels your Pulse, and with a fix’d Eye upon your Countenance, tells you your Spirits are low, and therefore it’s high time for a Cordial; the next Interogatory he puts gravely to you is, When was you at Stool, Sir? if not to Day, he promises to send you a laxative Clyster by and by; and if you complain you have a Looseness, then instead of one laxative, he will send you two healing Clysters: If besides you intimate a Pain in your Stomach, Back and Sides, then, responding to each Pain, you shall have a Stomach Plaister, another for the right Side, another for the left, and one for the Back, and so you are like to have a large Patch and well fortified round the Middle. Now before we go farther, let’s compute the Charge of the first Day. There is the Cordial, composed by the Direction of some old dusty Bill on his File, out of two or three musty Waters (especially if it be towards the latter End of the Year, and that his Glasses have been stopt with Corks) viz. it may be a Citron, a Borrage and a Baum Water, all very full of Spirits, if River Water may be so accounted; to these is to be added one Ounce of that miraculous Treakle Water, then to be dissolved a Dram of Confectio Alkermes, and one Ounce of nauseous Syrup of July-Flowers; this being well shaked in the Vial, you shall spy a great Quantity of Gold swimming in Leaves up and down, for which your Conscience would be burthened should you give him less than Five Shillings; for from the meanest Tradesman he expects, without Abatement, Three and Six pence, the ordinary and general Price of all Cordials, tho’ consisting only of Baum Water and half an Ounce of Syrup of July-Flowers. Your Clyster shall be prepared out of two or three Handsful of Mallow Leaves and one Ounce of common Fennil Seeds, boiled in Water to a Pint, which strained, shall be thickned with the common Electuary lenitive, Rape Oil and brown Sugar, and so seasoned with Salt; this shall be convey’d into your Guts by the young Doctor, his Man, through an Engine he commonly carries about with him, and makes him smell so wholsome; for which Piece of Service if you present your Engineer with less than Half a Crown, he will think himself worse dealt with than those who empty your necessary Closets in the Night; the Master places to Account for the Gut-Medicine (though it were no more than Water and Salt) and for the Use of his Man, which he calls Porteridge, Eight Groats. Item, For a Stomatick, Hepatick, Splenetick, and a Nephretick Plaister, for each Half a Crown: What the Total of this Day’s Physick does amount to you may reckon. The next Afternoon or Evening the Apothecary returns himself to give you a Visit, (for should he appear in the Morning, it would argue he had little to do) and finding, upon Examination, you are rather worse than better, by Reason those Plaisters caused a melting of the gross Humours about the Bowels, and dissolved them into Winds and Vapours, which fuming to the Head, occasion a great Head-ach, Dulness and Drowsiness, and Part of ’em being dispersed through the Guts and Belly, discompose you with a Cholick, a Swelling of your Belly, and an universal Pain or Lassitude over all your Limbs. Thus you see one Day makes Work for another; however, he hath the Wit to assure you, they are Signs of the Operations of Yesterday’s Means, beginning to move and dissolve the Humours; which successful Work is to be promoted by a Cordial Apozem, the Repetition of a carminative Clyster, another Cordial to take by Spoonfuls, and because your Sleep has been interrupted by the Unquietness of swelling Humours, he will endeavour to procure you for this next Night a Truce with your Disease, by an Hypnotick Potion that shall occasion Rest: Neither will he give you any other Cause than to imagine him a most careful Man, and so circumspect, that scarce a Symptom shall pass his particular Regard; and therefore to remove your Head-ach by retracting the Humours, or rather, as you are like to discern best, by attracting Humours and Vapours, he will order his young Mercury to apply a Vesicatory to the Nape of your Neck, and with a warm Hand to besmear your Belly and all your Joints with a good comfortable Ointment for to appease your Pains: The Cordial Apozem is a Decoction that shall derive its Virtue from two or three unsavoury Roots, and as many Herbs and Seeds, with a little Syrup of July-Flowers, for three or four Times taking; which because you shall not undervalue by having it brought to you all in one Glass, you shall have it sent you in so many Vials and Draughts, and for every one of them shall be placed Three Shillings to your own Account, which is five Parts more than the Whole stands him in; for the Cordial Potion as much; for the Hypnotick Potion the same Price; for your Carminative Clyster no less; and for the Epispastick Plaister a Shilling: Thus with the Increase of your Disease you may perceive the Increase of your Bill; and therefore it’s no improper Observation, That the Apothecaries Practice follow the Course of the Moon. The third Day produces an Addition of new Symptoms, and an Augmentation of the old ones; the Patient stands in need of new Comfort from his Apothecary, who tells him, that Nature begins now to work more strong, and therefore all Things go well (and never ill;) but because Nature requires all possible Assistance from Cordials and small Evacuations, he must expect to have the same Cordials over again, but with the Addition of greater Ingredients, it may be Magistery of Pearl, or Oriental Bezoar in Powder, besides the Repetition of a Clyster, and the renewing of your Plaisters, for the Profit of your Physician, you must be persuaded to accept of a comfortable Electuary for the Stomach, to promote Digestion; of a Collution to wash your Gums to secure you from the Scurvy, serving at the same Time to wash the Slime and Filth from your Tongue; of a Melilot Plaister to apply to the Blister that was drawn the Night fore; of some Spirits of Salt to drop into your Beer at Meals; of three Pills of Ruffi to be swallowed down that Night, and three next Morning, which possibly may pleasure you with three Stools, but are to be computed at two Doses, each at a Shilling; the Spirit of Salt a Crown the Ounce; for the Stomach Electuary as much, for the Clysters as before; for your Cordial in relation to the Pearl and Bezoar, their Weight in Gold, which is Two-pence a Grain, the greatest Cheat of my whole Discourse; for dressing your Blister a Shilling; for the Plaister as formerly. Here I presume that Candour in you, as not to believe me so disingenuous, as to take the Advantage of Apothecaries in producing any other than the best Methods of their Practice, and that which favours the least of their Frauds, for in Comparison with others (though these are very palpable, in regard there is not a valuable Consideration regarded as a quid pro quo) they are such as may be judged passable; yet when you are to reflect upon the Total that shall arise on the Arithmetical Progression of Charge of a Fortnights Physick, modestly computed at about Fifteen Shillings a Day, without the Inclusion of what you please to present him for his Care, Trouble, and Attendance, I will not harbour so ill an Opinion of him, or give so rigid a Censure as your self shall upon the following Oration your Clysterpipe Doctor delivers to you with a melancholy Accent, in these Terms: Sir, I have made use of my best Skill and Endeavours, I have been an Apothecary these twenty Years, and upwards, and have seen the best Practice of our best London Physicians; my Master was such a one, Mr. ——— one of the ablest Apothecaries of the City; I have given you the best Cordials that can be prescrib’d; ’tis at your Instance I did it, I can do no more, and indeed it is more properly the Work of a Physician; your Case is dangerous, and I think, if you sent for such a one, Dr. —— he is a very pretty Man; if you please I will get him to come down. Now, Sir, how beats your Pulse? The Loss of your Monies your Bills import, give Addition to your Pain, through the Remembrance it is due to one that hath fool’d you out of it, and deserv’d it no other way, than by adding Wings to your gross Humours that before lay dormant, and now fly rampant up and down, raking, and raging; which had you not been Penny wise and Pound foolish, you would have prevented by sending for a Physician, who for the small Merit of a City-Fee (for which you might also have expected two Visits) would have struck at the Root of the Distemper, without tampering at its Symptoms, or Branches, and by Virtue of one Medicine, restor’d you to your former Condition of Health from which you are now so remote, being necessitated, considering your doubtful State, to be at the Charge of a Physician or two, to whom, upon Examination of what hath been done before, the Apothecary shall humbly declare, he hath given you nothing but Cordials; which Word Cordial, he supposes to be a sufficient Protection for his erroneous Practice; and I must tell you, that had his Cordial Method been continu’d in a Fever, or any other acute Distemper, for eight or ten Days, your Heirs would have been particularly obliged to him for giving you a Cordial Remove out of your Possession, and that through Omission of those two great Remedies, Purging and Bleeding, the exact Use whereof, in respect of Time and Quantity, and other Circumstances, can only be determined by accomplish’d Physicians.

I cannot better describe their Unaptness for so great a Work, nor express the great Difficulties that must be conquer’d to deserve the first Character of a compleat Physician, than in the Words of that eminent and learned Physician Dr. Fuller; ‘It requires (says he) to understand the learned Languages, Natural Philosophy, all the Parts of the Body, and the Animal Oeconomy, the Nature, Causes, Times, Tendencies, Symptoms, Diognosticks, and Prognosticks of Diseases, the Indications of Cure, and contra Indications, the Rules of Errors of living as to the Six Non-naturals; we must have the Skill to judge to whom, for what, when, how much, how often to prescribe Bleeding, Vomiting, Purging, Sweating, and other Evacuations; as also to Opiates, Calybiates, Cortex, and the numberless other Alteratives: We must be very well acquainted with the Virtues, Faults, Preparations, Compositions, and Doses of Vegetables, Animals, Minerals, and all Shop Medicines; and lastly, to compleat all, must be able, upon every emergent Occasion, to write a Bill for a Patient, readily, pertinently, and in Form according to Art. Now to accomplish all this, a Man had need be rightly born, and set out by Nature, with a peculiar Genius, and particular Fitness, and with a strong prevailing Inclination to this Study and Practice above all others.

‘He must endeavour with Diligence, Sagacity and Gravity, Integrity, and such a convenient Briskness and Courage as will bear him up, and carry him through Difficulties, without presumptuous Rashness or barbarous Hard-heartedness; and then ’tis necessary he should be a Man of a competent Estate, to answer the great Expence of Education and Expectation; for he must be brought up directly in it from the Beginning of his Studies in the University; he must lay out all his Time and Talents upon Reading, Advising, Observing, Experimenting, Reasoning, Remembering, with an unwearied Labour of Body and Application of Mind; he must run through Courses of Anatomy, Botany, Chymistry and Galenick Pharmacy: And when he hath done all this, cannot handsomely compleat himself, except he see good Variety of others practise, which (by the by) it’s probable he will have more Time for than he could wish, before he can get any of his own.’

Now each of those singly will require a great deal of Pains, Expence and Time to be attained; and yet all these and much more that can be in short summed up, ought to be done and in some measure accomplished, before a Man can be rightly and duly qualified even to begin Practice.

And as to Matter of Fact, few (very few, God knows) there have been, or now are, who tho’ they spared not for Education or Diligence, ever work themselves up to a tolerable Sufficiency: Nay, Hippocrates himself, that great Genius, is not ashamed to confess, in an Epistle to Democritus, That though he was now got to Old Age and to the End of Life, yet he was not got to the End of Physick; no, nor was Æsculapius neither, the Inventor of it.

By all which, it’s undeniably evident, that the Science and Practice of Physick is one of the largest Studies, and most difficult Undertakings in the World; and consequently, not any the best Collection of Prescripts that ever was, will, or can be writ or printed, can alone make a compleat Physician, any more than good Colours and Pencils alone can make a fine Painter. And yet every illiterate Fellow and paltry Gossip that can make shift to patch up a Parcel of pitiful Receipts, have the Impudence and Villainy to venture at it; and in hopes of a good Pig, Goose or Basket of Chickens, shall boldly stake their Skill (forsooth) against Mens Lives, and lose them; and at the same Time scandalize and keep out true Physicians, that might probably save them.

And this leads me to the third Consideration, The great Danger and Damage occasioned by the rash tampering of such as are not educated rightly and qualified for it.