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

of a smith’s bellows drawing in the air when they are expanded [and you will find] that this action is above all characteristic of the heart; or if you think of the flame of a lamp drawing up the oil, then the heart does not lack this facility either, being, as it is, the source of the innate heat, or if you think of the Herculean stone [a loadstone or magnet] attracting iron by the affinity of its quality, then what would have a stronger affinity for the heart than air for its refrigeration? Or what would be more useful than blood to nourish it?’¹⁵ Like nutritive blood in the veins, the bright red blood vitalized by the heart ebbs and flows through the pulsing arteries, like tidal water through rivers and streams, irrigating the body. The brain produces the animal virtue, which is distributed through the body via the nerves, producing feeling and movement. In addition to these three virtues, the male body also produces procreative spirit in the testicles that is distributed as sperm through the ‘spermatic vessels’ to the woman’s womb (whether the ovaries produced procreative material in a similar manner was to remain a matter of controversy for centuries to come).¹⁶

      Galen was very pleased with this theory, and considered it definitive. ‘I have done as much for medicine as Trajan did for the Roman Empire, when he built bridges and roads through Italy,’ he wrote. ‘It is I, and I alone, who have revealed the true path of medicine. It must be admitted that Hippocrates already staked out this path … he prepared the way, but I have made it passable.’¹⁷

      Galen underestimated his influence. His ideas survived not only Trajan’s Rome, but the sacking of the great Library of Alexandria, the birth and spread of Christianity and Islam, the Black Death, the invention of printing, and the Reformation – a millennium and a half of history – with barely any adjustment. As late as 1665, one medical reformer was complaining that ‘an Extreme Affection to Antiquity [has] kept Physic, till of late years as well as other Sciences, low, at a stay and very heartless, without any notable Growth or Advancement’. Galenism held sway over the College of Physicians from the day it was founded. Everyone who wanted to practise medicine in London had to conform to its principles. This was still the case on 4 May 1603 when the twenty-five-year-old William Harvey presented himself to the Censors of the College of Physicians to apply for a licence to practise.¹⁸

      Little did the Censors appreciate what the young man who sat before them would do for their profession. William Harvey went on to become a colossus of the medical world, hailed as one of the world’s greatest anatomists and England’s first true scientist. Sir Geoffrey Keynes, author of the definitive 1967 biography of Harvey, was so overcome with admiration for his subject, he concluded that ‘even if we wished to do so, it would be difficult, from the evidence in our possession, to find any serious flaw in Harvey’s character’. One contemporary wrote that his ‘Sharpness of Wit and brightness of mind, as a light darted from Heaven, has illuminated the whole learned world’.¹⁹

      Harvey was born on 1 April 1578 to Joan, ‘a Godly harmless Woman … a careful tender-hearted Mother’, and Thomas Harvey, mayor of Folkestone in Kent, a rich landowner with properties not far from Isfield.²⁰ After attending King’s School in Canterbury, he was sent to Gonville and Caius College Cambridge, where its benefactor Dr Caius was Master. Caius had made medicine a core part of his college’s curriculum, securing a royal charter allowing two bodies of criminals executed in Cambridge to be used for anatomical demonstrations. Harvey’s own education benefited from this arrangement as he later recalled seeing ‘a frightened person hanged on a ladder’ at Cambridge, and presumably witnessed the subsequent dissection.²¹ The variety of medicine taught was, of course, devoutly Galenic. Caius had studied at Padua with Andreas Vesalius, the father of modern anatomy, whose discoveries based on human dissections had challenged many of Galen’s, which had relied upon animals. Despite this, when Vesalius later suggested to Caius that an obsolete passage should be dropped from a collection of Galen’s writings Caius was editing, Caius refused on the grounds it would be too dangerous to tamper with such an ancient work.

      In 1600, Harvey himself went to Padua and studied anatomy under one of Vesalius’ successors, Hieronymus Fabricius. Fabricius had designed the first modern anatomy theatre, a wooden structure set up in the university’s precincts, which featured a stone pit surrounded by five concentric oval terraces. Harvey gazed from those terraces and into that blood-spattered pit on many anatomical, and in particular venereal, marvels that he would later memorably recall in his lectures, including syphilitic ulcers that had gnawed into the stomach of a prostitute, a boy whose genitals had been bitten off by a dog, and a man without a penis who was apparently still capable of sex.²²

      Harvey may also have witnessed Fabricius’ work on one small but important area of anatomical controversy: valves in the veins. These were shown by dissection to block the passage of blood through the veins into parts of the body such as the legs. Though working in the shadow of Vesalius, Fabricius was a Galenist such as Caius would have been proud of and was concerned that the valves conflicted with Galen’s view that the veins carried blood from the liver into the body. His ingenious solution was to argue that the valves were there to act like sluice gates, preventing the legs becoming engorged with blood, and ensuring an even distribution of nutritive spirit to other parts.

      Harvey received his Doctorate in Medicine (MD) in Padua after just two years and was back in London by 1603, living in a modest house near Ludgate, under the shadow of St Paul’s Cathedral. Eager to start work, he approached the College of Physicians, perhaps with an introduction from Caius, seeking the all-important licence he needed to practise. He arrived at the College for his first examination at a nervous time. The previous week, Queen Elizabeth had been buried at Westminster Abbey after forty-four years on the throne. Her legacy to her Scottish cousin and successor James was not the settled stability of patriotic memory but seismic tensions produced by her refusal in her final years to deal with pressing issues of political and religious reform. London also faced the onset of plague, one of the worst epidemics for a generation. ‘He that durst … have been so valiant, as to have walked through the still and melancholy streets, what think you should have been his music?’ wrote Thomas Dekker in his review of the year. ‘Surely the loud groans of raving sick men, the struggling pangs of souls departing, in every house grief striking up an alarum, servants crying out for masters, wives for husbands, parents for children, children for mothers; here he should have met some frantically running to knock up Sextons; there, others fearfully sweating with coffins, to steal forth bodies, least the fatal handwriting of death should seal up their doors.’²³ It was through such streets that Harvey walked as he made his way to the small stone house in Knightrider Street then occupied by the College.

      Harvey’s credentials assured him a sympathetic reception. For his first examination he faced an interview board of four rather than the usual five Fellows, the absentee presumably being one of the many physicians who had fled the capital during the epidemic. The young man the assembled doctors beheld was short, with raven-black hair and small dark eyes ‘full of spirit’. He was, as a contemporary put it, ‘choleric’, referring to the Galenic tradition that associated an individual’s character with his or her ‘complexion’, the natural balance of their humours – choleric, melancholic, sanguine, phlegmatic. Choleric people had an excess of choler, which made them, as Nicholas Culpeper later put it in his guide to Galen’s medicine, ‘quick witted, bold, no way shame-fac’d, furious, hasty, quarrelsome, fraudulent, eloquent, courageous, stout-hearted Creatures’.²⁴ In some respects at least, this appears to be an accurate portrait of Harvey, who was certainly quick-tempered. According to one gossip, as a youth he carried a dagger with him, and was apt to draw it ‘upon every slight occasion’.²⁵