London (Ancient and Modern) from the Sanitary and Medical Point of View

by George Vivian Poore

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.

THE COLLEGE OF PHYSICIANS.

The time was now at hand when the first step was to be taken to give the profession a position of independence, and to allow it to regulate its own affairs without reference to ecclesiastical dignitaries. We owe this in all probability to Thomas Linacre, who possessed the confidence of Cardinal Wolsey, and probably also of the king. Be that as it may, on September 23rd, 1518, letters patent were granted constituting the Royal College of Physicians. By this instrument the College was given the control of all medical practitioners in London and within seven miles of it, and none were to be allowed to practise unless previously examined by the College. Four years later these powers were extended to the whole of England, except in the case of University graduates. The charter and subsequent Act gave ample power to the College to regulate its affairs, and accorded privileges and exemptions to the physicians similar to those previously accorded to the surgeons. The great fact, however, was the power of controlling the profession, and it must be remembered that the censors had power to fine and imprison delinquents. In Henry’s charter six persons were named—viz., John Chambre, Thomas Linacre, Ferdinand de Victoria, Nicholas Halsewell, John Francis, and Robert Yaxley, and it will be interesting to consider the personality of some of these founders of the Royal College. The real founder and first president was Thomas Linacre, who was born in 1460. Having graduated at Oxford, and become a Fellow of All Souls in 1484, he went abroad in 1485, and visited Bologna, Florence (where he enjoyed the friendship of Lorenzo de Medici), Rome, Venice, and the famous school of Padua (where he took the degree of M.D.). In 1501 he was appointed physician and preceptor to Prince Arthur, and also physician to Henry VII. He was also physician to Henry VIII., and it is recorded that he was consulted by many men of note, notably Cardinal Wolsey and Erasmus. He took holy orders in 1509, and the same year was presented to the rectory of Merstham, then became prebend of Wells (1510), rector of Hawkhurst (1510), canon of St. Stephen’s, Westminster, prebend of York (1517), precentor of York (1519), rector of Holsworthy, Devon (1518), and rector of Wigan, Lancashire (1520). This list of eight clerical benefices in almost as many years—benefices which were probably given as professional fees, and which were probably passed on, as soon as given, to a successor “for a consideration”—throws a curious light on the state of the Church, and helps us to understand the crash which was so soon to come. It is interesting, as showing the origin of the medical within the clerical profession, to remember that the first President of the College of Physicians was the rector of four parishes, the occupant of two prebendal stalls, a canon, and a precentor. We all owe a debt of gratitude to Linacre. He not only obtained the charter for the College, but gave his house in Knightrider Street (which is a street running parallel to part of Queen Victoria Street, E.C.) as a meeting-place for the new corporation. All who are competent to judge seem agreed in stating that Linacre was one of the greatest scholars of his age, and possessed a knowledge of Latin and Greek which for that time was quite exceptionally great. He founded lectureships at Oxford and Cambridge. He died in 1524, six years after the foundation of the College, and was buried in Old St. Paul’s, where in 1557 Caius erected a monument with an epitaph of his own composing. Of John Chambre, the first person named in the charter, we know little; but it is interesting to note that he was a Fellow of Merton College, Oxford; that he studied at Padua; that he was physician to the king; that he was censor of the College in 1523; that he was doubly a vicar, doubly an archdeacon, a prebend, a canon, and a dean, and the treasurer of Bath Cathedral. He died in 1549. Of the other four persons named in the charter we know very little, and they need not detain us. Linacre’s house, which was given by its owner, was the first home of the College of Physicians, was occupied by the College until 1614, and remained the property of the College until 1860, when it was taken for the Crown by an Act of Parliament. Only the front part of the house was given by Linacre, the back part belonging to Merton College, Oxford, which is one of the many connexions between Merton College and the College of Physicians. The house represented at p. [61] was certainly not Linacre’s original dwelling.

LINACRE’S HOUSE. (From a Print in the “Gold-Headed Cane.”)

We have thus seen the science of medicine in London beginning with the clergy, then organised under the supervision of bishops and deans, and finally with an independent controlling body, of which the early members were many of them in holy orders. It will now be convenient to trace the subsequent history of the College of Physicians, and I shall endeavour to bring before the mind’s eye some of its most remarkable early Fellows, and in so doing I shall hope to give some idea of the condition of medicine in London in the days of the Tudor and Stuart sovereigns. My information on these points is mainly drawn from Dr. Munk’s learned work, entitled “The Roll of the Royal College of Physicians of London.”

A very prominent figure in the early history of medicine in London is John Kaye, or Caius, as he called himself, well known, by name at least, in connexion with Gonville and Caius College, Cambridge, which he enlarged and endowed. Caius was born in 1510, and studied at Gonville Hall, Cambridge, which was ultimately to be better known by his own name. He went to Padua in 1539, and lived in the same house with the celebrated anatomist, Vesalius. He became professor of Greek at Padua, and took the M.D. there in 1541. He became F.R.C.P. in 1547, and settled in London in 1552. He was president of the College in 1555. He was physician to Edward VI., Mary, and Elizabeth, but he is said to have been removed from the latter position because of his Romish tendencies. He died in 1573 at his house in Bartholomew Close, and was buried in the chapel of Caius College, with the epitaph “Fui Caius.” Caius was certainly rich, as is shown by his splendid munificence at Cambridge. Although he was much occupied at Cambridge in the latter years of his life, he was frequently re-elected to the presidency of the College, the last time being in 1571. The frequent re-election of a president, who was latterly much of an absentee, may have been from the hope that the College would ultimately obtain some of his great wealth, but, if this were so, (of which indeed there is no evidence), the College was doomed to disappointment. Caius appears to have had great regard for form and order. He was the inventor of the insignia of office—the silver wand, the Book of Statutes, and the cushion—which are still used by the president of the College. On the occasion of the funeral of Dr. Bartlot, in 1556, we learn that the College attended in state, and that the Book of Statutes, adorned with silver, was carried before the president. Caius was very punctilious about the respect to be paid to the dead, and we find it laid down in the statutes of Caius College that the president, fellows, and students are to attend the funerals of subjects used for dissection with as much reverence and pomp as though it were the corpse of some more worthy person, because of the advantage which they had derived from it. Caius kept the accounts of the College with great accuracy, and in 1560, on the termination of his first six years of office, handed over the whole of the funds to his successor, amounting to £55 13s. 3d. He wrote out the annals of the College with his own hand, and thus did much to establish order in the proceedings. His love of what we should call “ritual” seems to have led him into trouble in his later years, and a large amount of material connected with religious ceremonial, which was found in Caius College, was burnt by order of the vice-chancellor. Caius was a profound scholar, and edited many of the writings of Galen, Celsus, and Hippocrates. He was also a naturalist, and wrote a treatise on British Dogs. His only original medical work was a “Boke or Counsel against the Sweat”—a treatise, in fact, on the sweating sickness. Strangely enough, the first edition was in English, but its ultimate appearance was in orthodox Latin. He was much concerned about the faulty pronunciation of Latin in this country, and tried to introduce the continental method of pronouncing the vowels, to which he had become accustomed during his long residence abroad. He was something of an antiquary, and proved to his own satisfaction that the University of Cambridge was founded by “Cantaber,” B.C. 394. He defended the privileges of the College, and in a case tried before the Lord Mayor in the reign of Elizabeth as to the right of surgeons to give internal remedies for the sciatica, &c., the evidence of President Caius seems to have convinced the Court that they had no such right. The name of Caius is inseparably connected with the teaching of anatomy in this country. When King Henry VIII. in 1540 gave the charter to the Barber-Surgeons (of which I shall have more to say hereafter), the following important clause formed part of the charter: “The said masters or governors of the mystery and commonalty of barbers and surgeons of London and their successors yearly for ever, after their said discretions, at their free liberty and pleasure, shall and may, have and take without contradiction, four persons condemned, adjudged and put to death for felony by the due order of the King’s laws of this realm, for anatomies, without any further suit or labour to be made to the King’s Highness, his heirs and successors for the same.” When the first anatomy lectures were given at Barber-Surgeons’ Hall is not quite clear; but according to South it was before 1563, and according to Sir George Baker, Dr. Caius was the first lecturer appointed, and this appointment was made shortly after his return from Italy, which was in 1547. It was during Caius’s lifetime, and while he was taking an active interest in the College, although not actually president (namely, in 1565), that Queen Elizabeth accorded to the physicians facilities with regard to anatomy similar to those enjoyed by the Barber-Surgeons; and it is evident from the statute of Caius College which I just now read, and which has been kindly brought to my notice by Mr. Ransom, that Caius made proper arrangements for the teaching of anatomy in connexion with his Cambridge foundation. Anatomy is the very groundwork of medicine, and without it it can have no existence as a branch of science. Undoubtedly we owe a deep debt of gratitude to the Barber-Surgeons, to the College of Physicians, and to Dr. Caius. I cannot dismiss this remarkable man without further illustrating his character by recalling three events which took place at the College during the time that Caius was president. In 1558, Christopher Langton, M.D., F.R.C.P., was expelled from the College for “rashness, levity, and foolish contentions with his colleagues at consultations, as well as for incontinency.” Five years later, for this latter failing, this worthy “was carted through London in a ridiculous attire.” In 1559, John Geynes, M.D., F.R.C.P., was cited before the College for impugning the infallibility of Galen. On his acknowledgment of error and humble recantation he was received into the College. In 1556 the College objected to the admission by the University of Oxford of one David Laughton, an illiterate coppersmith. The College laid before Cardinal Pole and the visitors the following instance of his illiteracy: “Cujus infantia, cum suggessit ut quomodo corpus declinaretur, exigeremus, respondit hic, hæc, et hoc corpus accusativo corporem,” adding “egregius certe ex universitate medicus cui humana vita committeretur.” This objection was successful. Clearly formal President Caius was not the man to countenance loose morals, heterodoxy, or bad grammar. We must not dismiss Caius without alluding to the Dr. Caius of Shakspeare, as drawn in the “Merry Wives of Windsor.” Shakspeare’s Caius is described as a French physician, and throughout the play he is made to speak broken English. Caius died in 1573, when the poet was ten years old, and it is very probable that Shakspeare borrowed the name without thinking of the man. On the other hand, it must be remembered that Caius probably spoke Latin like a Frenchman and that he lost favour at the court of Elizabeth, and it is possible that Shakspeare may have heard him held up to ridicule.