The iatrochemical school existed alongside the iatrophysical. Whereas the iatrophysical thought primarily in terms of matter, forces, and motions, the iatrochemical thought chemical relationships were fundamental. One of the founders of this school, the Dutch scientist Sylvius (1614-72), explained diseases chemically (an approach not completely unlike the humoral of Galen) and treated them on the basis of a supposed chemical reaction between drug and disease. Another leading figure in the iatrochemical school, Thomas Willis (1621-75), was an Englishman. These two advocated the use of drugs at a time when their respective nations were developing great colonial empires rich with the raw materials of pharmacology.
However, it would be an error to think of the medicine of the period, either European or Virginian, only in terms of rational or scientific theories. Treatment was too often based on magic, folklore, and superstition. There were physicians relying upon alchemy and astrology; the Royal Touch was held efficacious; and in the materia medica of the period were such substances as foxes' lungs, oils of wolves, and Irish whiskey. Nor should it be forgotten that many of the sick never saw a medical man but relied upon self-treatment.
With theories from the ancient authorities and from experimenting scientists to draw upon, the practicing physicians could deduce therapeutic techniques or justify curative measures, but the emphasis on theory brought with it the danger of ignoring experience and abandoning empirical solutions. Aware that many of his fellow physicians tended to overemphasize theory Thomas Sydenham (1624-89), who received his doctorate of medicine from Cambridge University, recommended personal experience drawn from close observation. He scoffed at physicians who learned medicine in books or laboratory, and never at the bedside. His study of epidemics, his emphasis on geography and climate as casual factors in the genesis of disease, make this Englishman's views and practices especially relevant to the medical history of Virginia where geography and climate did play such important roles in the life of the colony.
The history of surgeons and surgery during the century is less distinguished than that of the physician and his practice. Surgery produced no individuals of the stature and significance of Sydenham nor any revolutionary theories as important as Harvey's. Dissections were made but the knowledge acquired was not applied; amputation was common but not always necessary or effective.
Battle wounds and injuries lay in the province of the surgeon. While the surgeon was primarily concerned with the military, using mechanical force (cutting, tying, setting, and puncturing) in his treatment of body wounds and injuries, physicians on the Continent and in England also filled these functions. For example, physicians in Italy sometimes performed surgical operations they considered worthy of their dignified positions, and in England the licensed physician could practice surgery. On the other hand, surgeons licensed by Oxford University were bound not to practice medicine. Both in France and in England surgeons and barbers held membership in the same guild or corporation, and physicians considered them of inferior social status. The American frontier tended to reduce such professional and social distinctions.
In Europe and England, where medical education was institutionalized to a far greater extent than in colonial Virginia, education explains much of the difference in social status between physician and surgeon. The surgeon learned by apprenticeship to an experienced member of his guild while the physician had to meet certain educational and professional requirements, depending upon local or national law. The best medical education of the period could be had at the great centers of Leyden, Paris, and Montpellier. Cambridge and Oxford also offered a degree in medicine.
Englishmen preferred to study medicine abroad—according to a recent study made by Phyllis Allen and printed in the Journal of the History of Medicine and Allied Sciences—because a better education could be obtained there in the same number of years. The Doctorate of Medicine required fourteen years of undergraduate and post-graduate study at Oxford; the Cambridge requirement was similar. Despite reforms during the seventeenth century, education at these universities remained dogmatic and classical. Students usually found their studies dull and their social life stimulating. The more enterprising students could find the new ideas of the period in books not required in their course of study. Cambridge, Oxford, and the Royal College of Physicians all licensed physicians who had survived their education, met certain professional requirements, and passed an examination.
That physicians in England did possess a high social status as well as more extensive formal education is evidenced by a precaution taken by the Virginia Company, to avoid causing displeasure among men of rank, in preparing letters patent. The Company requested of the College of Heralds, in 1609, the setting "in order" of the names of noblemen, knights, and Doctors of Divinity, Law, and Medicine so that their "several worths and degrees" might be recognized when their names were inserted on the patents. Surgeons received no mention.
On the other hand, physicians and surgeons in England might well have come from similar social backgrounds and even on occasions from the same families. When there were three or four sons in the family of a country gentleman, he might have followed the custom of keeping the eldest at home to manage and eventually inherit the estate. The second, then, would be sent to one of the universities in order to follow a profession such as that of physician, lawyer, or clergyman. The third might be apprenticed to an apothecary, surgeon, or a skilled craftsman. This practice should be borne in mind when former medical apprentices are found in high offices in Virginia; their origins were not always humble.
Although the physician enjoyed the greatest social and professional prestige, he received the most verbal abuse and criticism. Perhaps the most damaging and galling satire of the century flowed from the pen of the French dramatist, Molière, who had a medical student—not completely fictitious—swear always to accept the pronouncements of his oldest physician-colleague, and always to treat by purgation, using clysters (enemas), phlebotomy (bloodletting), and emetics (vomitives). These three curative measures followed the best Galenic technique: releasing corrupting humors from the body. Molière's Le Malade Imaginaire confronted the audience with constant purgings and bleedings, and the caricature was not excessive.