Morgan Kubelka
Morgan Kubelka
Library Services, Wiley

The history of medicine.  It sounds like a “Final Jeopardy” category, doesn’t it?Print of a physician wearing a mask at the time of the plague 17th century small.jpg

 

The subject is almost existential. How do you pinpoint the origin of something as essential as medicine? Of doctors, surgeons, and other medical practitioners? How do you get to the beginning of the story and how did we get to where we are today?

 

I figured one reasonable way to get there is to ask the people that were there at the time of its evolution. Since I can’t exactly get Galen on the phone, I took advantage of the archives of the Royal College of Physicians (RCP), one of the oldest medical colleges in England.

 

Celebrating its 500th anniversary this year, the RCP is inextricably tied to both the history of medicine and modern science as a whole. As the Wiley Digital Archives team is currently in the process of digitizing the RCP’s archives, I had the luxury of supplementing my crude research with “the truth”—or the authentic firsthand accounts of those that lived it.

 

Check out some of the most surprising and interesting things you probably didn’t know about the history of medicine and the Royal College of Physicians.

 

Captain, the doctor has no experience!

 

Charter of Incorporation for the College by Henry VIII under the Great Seal, 1518 .jpg

I guess it’s not entirely surprising that the medical landscape looked different in the 16th century than it does today, but it’s shocking to learn just how different.

 

With little to no regulation, medical practice often consisted of “physicians” with no formal training or knowledge. Malpractice in England was rampant and unnecessary deaths abundant as unqualified impersonators took advantage of the wild west of practicing medicine.

 

As a result, the College of Physicians formed in 1518 with a royal charter from King Henry VIII in order to separate the “real” doctors from the quacks by granting licenses to qualified people and punishing imposters. The number of fellows was very small and consisted of only the well-educated elite.

 

You can’t sit with us

 

In the 16th century, there was a defined social hierarchy when it came to different members of the medical field.  Physicians, for instance, were considered the most educated and elite, enjoying command and superiority over surgeons and apothecaries.

 

At the time, apothecaries dispensed drugs at the physician’s instruction (think pharmacist), while surgeons performed a ‘practical’ trade that could be learned by apprenticeship. The lack of formal education required not only informed their place in the medical hierarchy, but also left their qualifications up to inconsistent methods and quality of training.

 

 

When barbers and surgeons were one in the same

 

Barbers and surgeons-small.jpgFrom the 16th century to the 18th century, barbers and surgeons in London belonged to the same guild, known as the Company of Barber-Surgeons.  With a perceived overlap in skills, barbers were allowed to perform a wide variety of both cosmetic and surgical functions, from cutting hair to amputating limbs, for instance.

 

As you can imagine, the amount of people who died from these surgeries rivaled the number cured. Not only that, there remained an elite subset of surgeons who resented being lumped into the same category as the lowly barber. Instead, ‘pure’ surgeons wanted to be more like the physicians—respected and esteemed.

 

Yet, it wasn’t until 1745 that surgeons would officially separate from the Company and begin establishing the formal educational standards which would enable them to rise to the same standard as their long-time rivals, the physicians

 

Scope creep and blurred lines

 

Try as they might, the physicians struggled to maintain sole control of practicing medicine. As the general population rapidly exceeded the number of licensed doctors, the apothecaries stepped into the role of de facto physicians to the country’s poor. Still, the RCP ardently fought for the physician’s position at the top of the medical tree.

 

The ongoing battle between the apothecaries and physicians persisted for centuries and was even the subject of a popular satirical poem at the time. Published in 1699, The Dispensary, written by RCP member Sir Samuel Garth, captured the spirit of the time as the elite “medical authority” tried to undercut the growing legitimacy of the apothecaries.

 

By the early 18th century, the conflict came to a head. In what would be a landmark case that would define the role and legal status of those providing care to the sick, the Royal College of Physicians sued a Liveryman of the Society of Apothecaries for malpractice. Ultimately, the Rose Case (1701-1704) ruled in the apothecaries’ favor, granting them legal recognition as doctors and marking the beginning of the general practice of medicine.

 

 

What’s your sign?

Illustration of the 'zodiac man' in Fasciculus medicinae, Johannes de Ketham, published Venice, 1500.jpg

 

While nowadays you might flip to the back of a magazine to read your horoscope for fun, in Renaissance Europe astrology was actually a part of everyday medical practice. Physicians combined medical knowledge with careful studies of the stars and often carried special almanacs containing star charts which were said to rule each part of the body.

 

In fact, in the books of one of Tudor England’s most enigmatic figures, John Dee, a table illustration links the different signs of the zodiac with the four humors of the body: yellow bile, black bile, phlegm and blood.  It wasn’t until the 18th century that emergent scientific disciplines led to the breakdown of astrology as part of the medical realm.

                                                               

 

William Harvey: physician and witch detector?

 

Witches apprehended, examined and executed. Published London, 1613. Wellcome Collection..jpg

 

One of the most famous fellows of the RCP is William Harvey, a physician most notable for his discovery of the systematic circulation of the blood pumped around the body by the heart and for his propagation of the empirical pillars of observation and experimentation to understand “the secrets of nature.”  De Motu Cordis (‘on the motion of the heart’) was published in 1628, controversially challenging over 1,500 years of established scientific and medical belief.

 

What many aren’t aware of was Harvey’s role in applying his pragmatic skillset to investigating the legitimacy of so-called “witches”. As RCP fellows were often called upon to advise on a variety of public matters, it wasn’t all that surprising when King Charles I came to Harvey, his own physician, with a request.

 

After 17 women were found guilty of witchcraft as a result of the Pendle Witch Trials of 1634, a skeptical King Charles I requested four of the convicted women be brought to London to be inspected by a selection of midwives and surgeons, under Harvey’s guidance. And so it was that Harvey found himself examining the women for “physical signs of witchcraft.” As a figure known for his high regard for reason and rationality, it’s unsurprising that Harvey was left unconvinced of the charges made against them. (read more)

 

A man’s world

Letter from Elizabeth Anderson to Mr Hutchinson asking permission to attend his lectures on lupus at the Harveian Society, 1887.jpg

 

While it’s hardly shocking that women weren’t originally admitted into the medical field, letters in the RCP archives demonstrate that this didn’t deter them.

 

Elizabeth Garrett Anderson, a pioneering feminist and physician, applied to the RCP in 1864 to take the exam for the LRCP medical diploma.

 

“I have been registered as a medical student at the Apothecaries Hall, where I have also passed the preliminary examination in Arts and the first professional exam for the license … I can produce all necessary certificates of study from recognized teachers in acknowledged schools of medicine…”

 

Though she was refused, she continued to practice medicine and to be an advocate for education and careers for women. She even continued to rather boldly request permission to attend lectures at medical societies associated with RCP.

 

Dear Mr Hutchinson, I wonder if I might be admitted to some dark obscure corner to hear y[ou]r lectures on Lupus? The good Charing X people are admitting women to their post graduate course so it w[oul]d not be quite novel if the Harveian Soc were disposed to be gracious. Do not trouble to answer unless you can say ‘yes’.

 

Despite her persistence, it wouldn’t be until 1909 that a by-law allowing women to take RCP exams was passed and another 16 years until women could become full members.

 

The evolution of science and medicine

 

Since the days of relying on zodiac charts to understand human health and employing barbers to perform surgeries, it’s clear times have changed. But luckily so has society and our intellectual frameworks, which directly impact science’s evolution.

 

For one thing, the concept of “scientific disciplines” as we know them today didn’t really come up until the 19th century. Before then, there were broader units of knowledge that overlapped and existed to be built on—preserving the philosophical ideas of the past and adding on to them like an encyclopedia.  This is almost the direct opposite of what we see today, where research fundamentally relies on the questioning of what is known as “the truth” and constantly pushes toward new discoveries.

 

Despite this shift from a “encyclopedic” orientation to specific and specialized areas of interest, the fact remains that modern science is still interdisciplinary; as each field evolves, it somehow comments on the others—offering new ideas, methods and concepts that indelibly impact the rest. For instance, without the technology advancements of the 19th century and government funding that enabled clinical research in real hospital and lab settings, our understanding of the body and its various conditions could still be limited to a zodiac chart.

 

The RCP’s own evolution reflects the impact of historical context and the shift toward a more “open” scientific community. Not only did its members grow from an elite set of male physicians from England, to a diverse community of medical practitioners from all over the world, the RCP also embraced its ability to actively impact public health policy on a range of issues. From its 1962 report on the impact of smoking, to its 2016 report on the impact of air pollution, the RCP demonstrates how human health is understood and advanced in relation to the historical, societal and environmental context that surrounds it.

 

So the question is, what will the next 500 years bring?

 

To learn more about the Royal College of Physicians: a Wiley Digital Archives collection, visit here.

 

Images

1. Print of a physician wearing a mask at the time of the plague, 17th century. Credit: Royal College of Physicians

2. Charter of incorporation for the College of Henry VIII under the Great Seal 1518, Credit: Royal College of Physicians

3. Barber-surgeons working on a boil on a man's forehead. Credit: Wellcome Library, London

4. Illustration of the 'zodiac man' in Fasciculus medicinae, Johannes de Ketham, published Venice, 1500. Credit: Royal College of Physicians
5. Witches apprehended, examined, and executed, Published London, 1613. Credit: Wellcome Collection

6. Letter from Elizabeth Anderson to Mr. Hutchinson asking permission to attend his lectures on Lupus at the Harveian Society, 1887.

Credit: Royal College of Physicians