[I ask you to send me, in all possible haste, by the next reliable messenger that you can get, a large preparation of your poultice “flose ungwentorum,” for the king’s attorney James Hobart. For all his discomfort is but an ache in his knees.… But when you send me the plaster you must send me some writing about how it should be laid on and taken from his knee, and how long it should stay on his knee unremoved, and how long the plaster will remain good, and whether he should wind any more cloth about the plaster to keep it warm or not.]
Paston asks not only that Margery send him the medical preparation but also that she include written instructions, which marks her participation in the wide ranks of English medical literacy.54 It is striking that Paston writes from his location among more elite court circles to seek out the medical expertise of his Norfolk home. In this, he perhaps echoes the perspective of his mother, who wrote to John Paston I in 1464, “fore Goddys sake be ware what medesynys ye take of any fysissyanys [physicians] of London. I schal never trust to hem.”55 One medical book that may have been made for the Paston family—the “litel boke of fisik” written by the professional scribe William Ebesham—contains Middle English texts about uroscopy, the plague, and astrology juxtaposed with roughly equivalent Latin versions.56 This book, with its doubling of Latin and Middle English expertise, raises questions about how it might have been read and used in the Paston household.
Many further examples could be adduced to show how medieval patients moved among care-givers, testing whether this one or that one could help. Records of cures at saints’ shrines tell a similar story: those healed often reported prior visits to medical experts, whose failures drove them to seek miraculous aid.57 While such details of past treatment function to bolster saintly reputations and cannot be taken at face value, they do attest to the prevalence of conceiving healing as a winding, multistop route. Just as it was difficult to determine the exact chain of causes behind a symptom, it was hard to know just whose efficacy, or what kinds of expertise and influence, would lead to a cure. Whether the Nottingham surgeon trumps the local domina, or Margery Paston’s cure outpaces those of court physicians, these and other examples suggest that medical discourse in late medieval England was composed of variegated and overlapping therapeutic competencies and that hierarchies of expertise often emerged locally through particular itineraries of care.
There were, however, two notable and closely related attempts at systematic change. In the first quarter of the fifteenth century, university-trained physicians twice tried to centralize the regulation of who could practice medicine. The first of these attempts was national in scope. In 1421 a group of physicians from Oxford and Cambridge petitioned Parliament and Henry V to establish them as a licensing body. Medical practice, they claimed, should be restricted to those who “have long tyme y used the Scoles of Fisyk withynne som Universitee, and be graduated in the same.”58 They demanded “that no Woman use the practyse of Fisyk.” To enforce the new rule that all medical authority be academically ratified, the physicians asked that warrants be sent to “all the Sherrefs of Engelond” summoning anyone lacking academic credentials to “trewe and streyte examinacion” in “one of the Universitees of this lond.” In other words, they called on the state’s system of judicial power, its traveling courts endowed with an authority leading back to the crown, to make medicine a university-controlled pursuit.
One of the most insistent aspects of the petition’s rhetoric is its effort to yoke science and practyse. The word practyse is used with hectic frequency, ten times in the petition’s brief span. The physicians are eager to make the concrete business of healing depend on academic training. Phisik, they claim, is like theology and law; it “should be used and practised” only by those trained in it—but “in this Roialme is every man, be he never so lewed [ignorant], takyng upon hym practyse,” leading to the “grete harme and slaughtre of many men.” However, the petition continues, “if no man practised theryn” except “connynge [knowledgeable] men and approved sufficeantly y learned in art [the liberal arts], filosofye, and fisyk,” then “shulde many men that dyeth, for defaute of help, lyve, and no man perysh by unconnyng [should many men who die for lack of help instead live, and no man perish on account of ignorance].” A university education here is cast as a matter of life and death, in a bid for the intellectualization of healing authority. The physicians’ labor to link academic learning to the efficacy of care suggests that the connection was far from universally recognized. As we have seen, in the Metaphysics Aristotle admits that the empiric’s know-how may top theoretical knowledge in the business of curing: “If, then, someone has the explanation without the experience, … he will often fail to cure.” The ongoing significance of the Aristotelian comment is evident in Antonius of Florence (d. 1459), whose chapter on physicians in his Summa Theologica (a handbook for preachers) refers to what “the Philosopher says in book I of the Metaphysics” in order to remind readers that “we should choose experienced doctors to treat us, rather than those who have knowledge without experience.” Antonius continues, “I consider it safer and better to commit oneself for treatment to practical physicians rather than theoretical ones.”59 The petitioning physicians were trying to counter just this idea and the social practices that went with it.
By all evidence, the physicians’ petition came to nothing. For the tiny medical faculties at Oxford and Cambridge, the responsibilities described in the document were unfeasible, and there is no evidence that the act ever came before Parliament after the draft was prepared. Yet two years later, in 1423, university-trained physicians again attempted to secure the rights to medical practice, this time not in all the shires of England but in its most powerful city, London. In alliance with London surgeons, they asked the mayor and aldermen to establish “all Phisicians and Cirurgeans, withinne the libertees of London” as “oon Comminalte [one fellowship].”60 In rhetoric similar to the draft act of Parliament, the petition cast practitioners’ ignorance as a menace to public health: many people are “spillide be [ruined by] wreeched and presumptuous practisours in phisyk, nought knowyng the treuthe or ground of that Faculte of Phisyk, and be [by] unkonnyng wirkers in Cirurgy, nought knowyng the trewe crafte of Cirurgy.”61 Phisik is called a “glorious konnyng [knowledge]” and surgery a “crafte,” but both kinds of expertise require proper training; otherwise, the professions are “disclaundered [slandered]” and people hurt. Insistence on the dangers of medical ignorance in both the 1421 draft act and the London petition implies that the popularization of healing expertise was the occasion for anxiety and that elite physicians thought they could play on such anxiety to launch their ambitious reforms.
The ordinances of the London comminalte extend the vision of two complementary branches of expertise, medicine and surgery, to the physical architecture of the group’s meeting space. The document asks that “oon place” be established in the City of London “contenyng atte lest thre howses [chambers] severall.”62 One of these chambers would be for physicians exclusively (“oonly pertenynge to the Faculte of Physick”) and one for surgeons exclusively (“oonly pertenynge to the Crafte of Cirurgye”). The third, however, would be a nonexclusive space of learning, “ichaired and desked for redyng and disputacions in Philosophye and in medicyns.” “Medicine” seems to be the petition’s preferred term for the unified field that physicians and surgeons shared. The common chamber for “redyng and disputacions” corresponds institutionally to the highest office of the comminalte, the “Rectour of the Faculte of Medicyn,” beneath whom are two “Surveiours of the Faculte of Phisyk” and two “Maistres of the Crafte of Cirurgye.”63 While the draft act of Parliament ignores surgery’s independent footing, the comminalte carefully acknowledges it, even incorporating it into the built environment and structures of governance—though the group reserved its highest post, that of rector, for someone with a university degree in medicine.
The only documented