The Herbalist: Nicholas Culpeper and the Fight for Medical Freedom. Benjamin Woolley

books, but this responsibility belonged to another livery company, the Stationers’, working under the supervision of the Church. As censors of morals they were primarily concerned with enhancing the physicians’ professional image. The Fellows were touchy about their social status. Since antiquity, physicians had aroused mixed feelings in society. ‘The physician is more dangerous than the disease,’ went the proverb.⁹ In the prologue of the Canterbury Tales, Chaucer introduced a ‘Doctor of Physic’ as a figure of learning, knowledgeable in ‘magic natural’ and well read in the medical classics, but ‘His study was but little on the Bible’. This was a reference to the old saying ubi tres medici, duo athei: ‘where there are three physicians, there are two atheists’, the suspicion of atheism arising from their devotion to classical (i.e. pagan) knowledge. The slur rankled – the ‘general scandal of my profession’, the physician, essayist, and Honorary Fellow of the College Sir Thomas Browne called it in his masterwork Religio Medici (1642). Chaucer had also alluded to another accusation, that doctors were greedy, making money out of the misery of others by prescribing expensive medicines and charging exorbitant fees: ‘For gold in physic is a cordial;/Therefore he loved gold in special’.¹⁰ The sentiment was echoed by Christopher Marlowe in his play Dr Faustus (published 1604), when the eponymous hero contemplates his prospects:

      Bid Economy farewell, and Galen come:

      Be a physician, Faustus; heap up gold.¹¹

      But, as every physician knew, in a medical emergency, attitudes were different. When a child sickens, when boils erupt, when fever grips, when plague knocks on the door, then the physician is ‘God’s second’, as the playwright and satirist Thomas Dekker put it, lampooning the public response to plague. ‘Love thy physician,’ he advised, adding that ‘a good physician comes to thee in the shape of an Angel’, unable to resist the common play on a word that then referred both to a divine messenger and a gold coin.¹²

      The Censors’ moral role was aimed at counteracting this image by imposing a strict code of conduct. This code was not concerned with issues such as behaviour towards patients, the level of fees, or charitable obligations. It was about insisting that Fellows dressed in scarlet and silk caps on public occasions and addressed the College President always as ‘your excellency’. It was about prohibiting College members from accusing one another of ignorance or malpractice, intervening in a colleague’s case unless invited, questioning a colleague’s diagnosis, employing apothecaries who practised medicine, or disclosing the recipes of medicines.¹³

      The College’s Annals show that most Fellows observed these ‘moral’ strictures to the letter. When it came to internal discipline, the only matter the President and Censors had to concern themselves with on a regular basis was absenteeism, which was rife. The primary concern was external discipline, the policing not of colleagues, but competitors.

      As censors of medicine, the College was entitled to control the practice of medicine in London or within a seven-mile radius of its walls. Anyone reported to be practising without a licence faced a summons from the College beadle and the threat of a fine or imprisonment. And what an apparently motley bunch the beadle brought in, with names, as the medical historian Margaret Pelling has noted, worthy of a Jacobean comedy: Gyle, Welmet, Wisdom, Blackcoller, Lumkin, Doleberry, Sleep, Buggs, Hogfish, Mrs Pock, Mrs Paine and Mother Cat Flap.¹⁴ Those who voluntarily presented themselves to the Censors, seeking a licence, tended to appear under more respectable names, usually Latinized, like that of the College luminary Dr Caius: Angelinus, Balsamus, Fluctibus. They had to prove to the Censors that they had a firm grasp of medical theory. To establish whether or not this was the case, they were examined, not on their knowledge of the latest anatomical theories or diagnostic techniques, the revolutionary findings of the great Renaissance medics and anatomists such as Jean Fernel of Paris or Gabriele Falloppia of Padua, but on their understanding of the works of a physician and philosopher who had lived a millennium and a half earlier.

      No other field of knowledge has been dominated by a single thinker as medicine was by Galen. Born in AD 129 in Pergamon (modern Turkey) to wealthy parents, Galen was, in many respects, a model physician: studious, clever, and arrogant. In his youth, he studied at the Library of Alexandria, the great repository of classical knowledge, and travelled to India and Africa, learning about the drugs used there. He became a skilful anatomist who could expertly cut up an animal living or dead, and, though the dissection of humans was taboo, he had attained a grasp of human physiology thanks to a spell as physician to the gladiators. He also had an astute understanding of patient psychology and was very good at attracting prestigious clients, including the Roman Emperor Marcus Aurelius, an endorsement he never lost an opportunity to advertise.

      As well as being a brilliant practitioner, Galen gave medicine academic respectability. Basing his ideas on those of Hippocrates, the semi-mythical Greek physician immortalized as the author of the Hippocratic Oath, he created a comprehensive theoretical system that seemed to provide a sound basis for understanding and treating disease. Underlying this system was a view of the body as a system of fluids in a state of constant flux. There were four such fluids or ‘humours’: blood, phlegm, choler (yellow bile), and melancholy (black bile). The relative proportions of these humours in different parts of the body determined its temperament, and an imbalance produced illness. A runny nose was a result of excess phlegm, diarrhoea of choler, a nosebleed or menstruation of blood, particles of black material in vomit or stools of melancholy (the most elusive of the humours). The identification of these four humours provided a convenient way of tying the workings of the body in with the prevailing view of how the universe worked. Everything in the cosmos was understood to have a character defined by its place in a quadrilateral scheme: the four seasons, the four ages of man (infancy, youth, middle age, old age), the four points of the compass, the four ‘elements’ that make up all matter (fire, air, water, and earth), the four ‘qualities’ that determine their character (hot, dry, moist, cold). Each humour had its place in this scheme: phlegm was cold and moist, combining the character of winter, frozen by northerly winds, and the wet weather of the westerlies that blew in spring, which explained why so many people suffered runny noses during those seasons; choler was hot and dry, excessive during summer and autumn, the seasons of stomach disorders, when it would flow most copiously.

      The treatment of disease involved trying to rebalance the humours, achieved through diet or eliminating the surplus humour. A fever, for example, might be caused by an excess of blood in a particular part of the body, which, unable to escape, putrefies, producing heat (just as organic material in a compost heap becomes warm as it rots). The solution, therefore, was to drain off the superfluity by such methods as blood-letting or, in the case of other humours, prescribing ‘purgatives’, medicines that provoke the evacuation of bile through vomiting or diarrhoea, or herbs that produce a runny nose.

      Galen’s understanding of disease was supplemented by an equally systematic understanding of the body, derived from his own dissection and vivisection experiments, as well as prevailing philosophical ideas. He saw the body as a system for extracting from the environment the life force or pneuma, an ‘airy substance, very subtle and quick’, and modifying it into three spirits or ‘virtues’: vital, which vivified the body; natural, which fed it; and animal, which produced sensation and movement. According to this view, ‘chyle’, a milky substance derived from the digestion of food in the intestine, is carried to the liver via the portal vein, where it is manufactured into blood imbued with natural spirit. This dark nutritive blood passes through the veins into the body, where it is consumed, feeding the muscles and creating tissue. Some of this blood also reaches the right chamber or ‘ventricle’ of the heart, from where it either passes into the lungs, which filter and cool it, or seeps into the left ventricle via invisible pores in the septum, the membrane separating the heart’s two chambers. Thus the heart ‘snatches and, as it were,