Learned physicians, medical heterodoxy, and Court patronage: conflict in early modern England Frances Dawbarn

The protection of the king’s subjects from the dangers posed by quacks and empirics was central to the promotion of learned Galenic physic, and to the claims made by the London College of Physicians to be its guardians. However, the attempts made by the College to prosecute illicit and illegal practitioners were at times frustrated by the intervention of influential court patrons whose actions challenged its claims to statutory and moral authority. Patronage, as revealed through important cases of prosecution, had implications for the status not only of the individuals concerned but also for the physic they practised or promoted.

Why did certain highly placed patrons at the late Elizabethan and early Jacobean courts support physicians who were prosecuted by the London College of Physicians? The reasons raise questions that centre upon the tensions that existed between rival sources of authority, and the nature of the complex and often uneasy relationship between orthodox and heterodox physic. Certain key features of a difftcult relationship must be appreciated in order to add to our under- standing of medical provision in early mod- em England’.

Physic and medicine The source .of formal authority and power for physicians practising in London in the late 16th and early 17th centuries was the London College of Physicians*. Established by royal statute in 1518, the College enjoyed considerable powers to control the practice of physic in London by issuing, to those it deemed suitable, its licence to prac- tice in the city, and for seven miles around. To protect the Ring’s subjects from the dangers of quacks and empirics it estab- lished an elaborate mechanism for examin- ing those whose sought its licence (and/or eventual membership), and the statutory right to fine, and imprison any who flouted its authority. In effect this made it judge, jury and executioner in matters of medical provi- sion in London, allowing it to prosecute for both illegal, that is non-licensed, practice, and illicit, that is non-Galenic, practice. The

Frances Dawbam

Is a PhD student in the Dept of History at Lancaster University, UK. Her thesis examines the tensions between rival sources of medical authority in early modern England (c. 1580-1620). She was the winner of the 1996 Singer Prize, which is awarded biennially by the British Society for the History of Science for the best research paper written by a non-established scholar.

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differences between the practice (and the practitioners) of orthodox Galenic physic, and those practising medicine, are impor- tant, and lie at the heart of the tensions which divided rival sources of authority.

Traditionally, learned physicians practised physic whose primary purpose was not to cure or fight disease but to preserve health and prolong life. In the case of sickness the physician aimed to return the patient to health by restoring him or her to the harmo- nious state, particular to that individual, which would encourage and promote good health and longevity. The lengthy training undertaken by the learned physician entailed the acquisition of a solid founda- tion in physic as handed down by Galen (d. c. 200 CE), who was considered to be the greatest physician of antiquity, Based upon the principles of Aristotelian natural philos- ophy, Galenic physic embraced the humoral theory of disease that aimed to restore the balance of the patient’s bodily humours which had been disrupted by sickness. This required a very detailed, in depth knowledge of the patient as an individual, and the formulating of a regimen that was equally personalized and individual. Recommending how to lead a regulated life according to the principles of natural philos- ophy distinguished the learned physician from the unlearned, and set him apart from the countless rivals he encountered in a chaotic and highly competitive medical marketplacex.

Of crucial importance to both the individ- ual and corporate image of the elite physi- cian was the degree of moral authority such learning bestowed upon the practitioner; it implied the possession of good character, inner discipline and the social deportment becoming to a member of a dignified and grave profession. Indeed the College statutes stipulated that physicians should be ‘profounde, sad, and discreet’ as well as

‘groundlie learned and deplie studied in physic’d.

Medicine, by contrast, might be practised by anyone. No formal training was needed to tout and administer quick-fix remedies that were designed to cure particular dis- eases, not to restore the individual to a har- monious state of good health. Male or female, young or old, medicine was suitable for everyone. No knowledge of the humoral theory of disease, or of the natural philoso- phy that underpinned it, was needed, although the pretension to such knowledge greatly enhanced the authority of the peddler practitioner.

Not surprisingly, those who practised what was perceived to be ‘medicine’ rather than ‘physic’ encountered the statutory, and indeed the moral, authority of the learned physicians of the London College of Physicians, and were prosecuted for what, in the eyes of the College censors, was a lack of the all-important theoretical under- standing of treatment, and - of central and utmost importance - the demeanour, bear- ing and authority of the learned practitioner of physic. However, the Annals of the Royal College of Physicians of London5 reveal that significant numbers of London based physicians were able to bypass or ignore the authority of the College, despite the so- called illegitimacy of their practice, and that some succeeded in not only obtaining the licence, but also in becoming members, censors and even fellows.

Courtly life and patronage The College was able to act swiftly in cases of prosecution in which the ‘accused’ had no patron, or one not powerful enough to offer sufftcient protection. The lengthiest cases of prosecution are those of individuals who had found favour with extremely highly placed royal or noble patients/ patrons. Crucially, such patrons were in a

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position to defend and protect their clients from the censorship of the College, a process that in some cases entailed very lenathv battles in order to secure for their client the all-important licence to practice in London.

The physicians’ desire to protect their individual and corporate image, which they perceived as having been hard-won through lengthy training, was jealously guarded. This is understandable given the many rivals they encountered in the informal medical marketplace, but a pre-occupation with matters of manners and deportment was not their sole preserve. Rather, it was a very important feature of courtly life, which all those who sought social or personal advancement through patronage must know and master.

Elaborate displays of civility pervaded every aspect of social interaction, and etiquette in all its forms played a central role in gaining access to elevated patrons. However, a complex pecking order existed to protect patrons from the advances of prospective clients, and to allow for the suit- ability of a petitioner to be assessed by one of the numerous influential patronage bro- kers whose duty it was to protect the patron from the direct (and possibly unwanted) attention of would-be client@. Matters of self-presentation and manners were the key to a successful bid for patronage, and were the subject of the many dozens of ‘mirror’ books7 that provided the aspiring courtier with descriptions of all the behavioural accomplishments essential for his advance- ment: all aspects of courtly life were cov- ered, including the importance of establish- ing links with ones’ patron through a system of brokerage, gift-giving and self- presentation*.

That heterodox physicians should seek to complement favoured positions in the households of eminent patrons with mem- bership of the College is indicative of the uncertain and risky nature of patronage, and illustrative of its crucial importance to the functioning of early modem society. It also suggests that membership of the College was considered to be not only a ‘safety net’ in the event of a patrons’ fall from favour, or death, but also an alternative form of le- gitimization, which shared many of the features of courtly patronage. As such, the demeanour of the would-be licentiate was of two-fold significance: first, it must befit a representative of a learned profession, and secondly, that of an aspiring ‘client’ of the College.

Moffet, Poe and Anthony The major cases of the prosecution which are to be found in the Annals provide con- siderable insight into the complex nature of patronage and patronage relationships, but three in particular demonstrate exception- ally well the clash of interests between the learned physicians and powerful court patrons. They are the cases of Leonard Poe, Francis Anthony, and Thomas Moffet, each

of which throws more light upon an inter- esting aspect of what is a multifaceted and far from straightforward phenomenon.

Thomas Moffet (1553-1604) was the favoured physician of both Elizabeth I and James VI of Scotland and I of England, and had impressive connections with the alchemical court of James’s father-in law, Frederick II of Denmark9. Moffet was also physician to, and a member of, the circle of Philip Sidney and his sister Mary Countess of Pembroke, both of whom had been taught chemistry as children by the great John Deelo. Moffet was a known supporter of the chemical and metallic cures promoted by Paracelsusn (1593-1541), the Swiss mystic and physician, whose radical challenges to the classical world of Galenic medicine had found great favour at some of the Protestant courts of Europe12. Moffet’s admission to the College had been far from unproblem- atic, largely because of his brusque manner and unorthodox views about the place and significance of learned theory in the prac- tice of physic.

Because of his elevated patronage con- nections, Moffet became a significant patronage broker, and as such encountered the problem of a conflict of loyalties between the College, his patron Robert Devereux, 2nd Earl of Essex (15661601), and their shared client, Leonard Poe (d. 1631). Having recommended, in his capac- ity as Essex’s broker, that Poe be granted the College licence, he was embarrassed, as indeed were the College President and cen- sors, when upon examination Poe proved, in their opinion, to be ‘ignorant and com- pletely unlearned in every respect’ls. Moffet’s case serves as a reminder that in this intensely hierarchical world in which links were established both vertically and horizontally, to be a patron, a client and a broker inevitably invited confusion and conflict.

The case of Leonard Poe provides a rich and detailed example of the ways in which such conflicts were managed. It also indi- cates the lengths to which patrons were pre- pared to go in order to secure their clients’ recognition by the College, and the extent of the moral indignation of learned physicians at the challenge to their authority. Heading the extremely impressive array of patrons who supported Poe was the 2nd Earl of Essex. Although the battle continued long after his death in 1601, the case is remark- able for the letters exchanged between Essex and the College, which illustrate a dramatic clash of interest and wills. Apparently ignorant of the powers of the College, or perhaps choosing to ignore them, Essex ‘very earnestly praie[d the College] not only to ceasse to trooble him [Poe] hereafter, for emploieng his skill and trauell to the benefit and good of freends, who have a particular desire to deale with him: But also to graunt him Toleration: as yow haue in like cases geven to some of lesse experience and desert ‘14. The Earl was under the impression that exceptions

had been made in other less deserving cases, and clearly thought ‘private’ practice was something with which the College need not concern itself. The College, however, made no such distinction; practising in London without a licence was illegal however elevated the patient.

In its repeated attempts to convince the Earl that Poe was a thoroughly unsuitable candidate, the College, while mindful of the status of the individual with whom they were dealing, but valiantly trying not to be swayed by it, invoked time and again its statutory right to examine Poe, and to find him wanting. No exception was made, and no ‘toleration’ of Poe’s practice without a licence was granted. The Earl persisted. and it was decided to send a delegation from the College to the Earl’s house to try to more clearly explain their position. Essex’s response was to send a letter to the College President demanding that Poe be permitted to ‘quietlie _. exersise the __. practice of physic . whereof you maie not fail, as you, and everie one of yow will answer to the contrary to your utmost perill’15.

Poe was ultimately successful in his quest for recognition by the College; indeed William Munk tells us that ‘[o]n the 26th June, 1609, having then received the appointment of physician to the royal household, and bringing letters from four distinguished noblemen of the court, recom- mending him for admission [to the College] as a fellow, he was elected as such, and on the ensuing 7 July ( 1609) actually admit- ted.’ On 22 July 1609, his triumph com- plete, he was granted the M.D. from Cambridge through a mandate from King James’“.

Although his fortunes were characterized by peaks and troughs of success and failure, Poe rose in twenty years from a so-called ‘empiric’, marginalized and reviled by the College, to a highly sought-after physician who attended royal and noble patients alongside other eminent physicians. Throughout his 20-year struggle he was supported by powerful patrons who were prepared to challenge the right of the College of Physicians to be the sole arbiter of what constituted legitimate physic, and who should be permitted to provide it.

It was axiomatic that the manner in which a client presented himself within the struc- tured and ritualistic world of courtly life must be correct. However, matters of courtly behaviour and decorum also extended to the written word, and the elabo- rate language of civility was supposed to be evident between the covers of books as well as within the corridors and chambers of the court.

In 1610, Francis Anthony (1550-1623) a Master of Arts of the University of Cambridge (although not, so far as can be determined from the Annals, the holder of a medical degree) published what he described as ‘a short discourse for the Assertion of Chymicall Physick, and of true Potable Gold . .‘I7 in which he claimed that

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‘the highest and most powerful excellence of Medicine is in Metalls [and] that among all Metalls gold hath the prerogative’t*. He discussed how to disolve and distill gold, and declared that there should be a ‘pub- licke question to examine and try this truth of this Magisterie, that so the mouth of all gainsayers might be stopped’.

A little over five years later he com- plained, in a second book entitled The Apologie, or defence of a verity heretofore published concerning a medicine called Aurum Potabile . . . that his first treatise, although ‘simply and plainly explained so that it satisfied both here and in foraine parts many learned men . . . yet it wanted not the common lot of all vertues, to finde malevo- lent eyes and detracting encoumberers [among those who] repine at a fee lost, then desire . . . true knowledge . . . The . . . land of this descent was chiefly, if not only in London’.

The chief detractors were certain learned members of the London College of Physicians, which over a period of years had had cause to fine and imprison him for both illegal and illicit practice. As good Galenists they must have been alarmed by the claims made for a substance that Anthony described as a ‘general or univer- sall medicine, good for all Diseases.’

The book is written in Latin with a trans- lation into English by Anthony himself. The first section of the Latin version includes a lengthy Epigram in response to the criti- cisms of Matthew Gwinne, professor of medicine at Gresham College, who repre- sented the College of Physicians in its refu- tation of Anthony claims. Whilst the Apologie begins well enough, in that Anthony observes the required niceties of decorum, his manner deteriorates signifi- cantly as the book progresses. It opens with an impressive collection of testimonials from patients Anthony claimed to have per- sonally cured by using Potable Gold, and evidence from those who tried it on their own patients. But by also including the tes- timony of very ordinary people who had witnessed its remarkable effects, Anthony transgresses the code of credibility required of witnesses’s’. He also recounts at length the death of a nobly born patient at the hands of two members of the College of Physicians. He impugns their competence, and accuses them of attempting to shift the blame for the death from themselves on to

him. And he complains bitterly about the invective heaped against him, his book, and his cure: ‘ . . . my traducers doe . . . spiderlike sucke poyson instead of hony, and force themselves to an unnatural1 vomit of these humors against this medicine . ..‘. In addi- tion, the provision of an English translation (which, curiously, does not include the Epigram) was a snub to the pretensions of the learned physicians of the College. Latin was, of course, the language of learning: the ‘Englished’ version of the book extended the readership to if not an unlearned audi- ence, then to a less learned one.

Anthony’s illicit and illegal practice within the jurisdiction of the College, his defence and use of chemical and metallic substances, his promotion of a universal panacea, his production of an English trans- lation of his book, his reliance upon the tes- timony of ‘ordinary’ people, the uncivil manner in which he advertised and defended his claims, and his accusations of malpractice against members of the College militated against any possibility of accept- ance within its ranks.

Despite his many powerful patrons, Francis Anthony never received a licence from the College, and after a failed attempt, in 1616, to demonstrate to the members of the College ‘the Art, and mystery to dis- solve gold, and distill it up’ his name disap- pears from the Annals. But although he was excluded from the College, he was highly successful in attracting the attention of many courtly patrons who, through their support of him, also endorsed a form of medical practice that explicitly challenged the authority of learned practitioners of physic.

The heterodox challenge The elevation in social status which patron- age conferred upon heterodox physicians not only legitimized forms of physic per- ceived to be unlearned and non-Gale&, but also invited challenges to the statutory authority and moral standing of the physi- cians of the London College. The attempt by the College to separate the pure practi- tioner from the impure clearly failed. By contrast, patronage offered a form of social elevation that not only encouraged the inte- gration of heterodox physicians into the mainstream of medical providers, but also altered the status of the physic they offered.

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Some of the issues raised in this article are discussed at greater length in Dawbarn, F. (1998) BI: J. Hist. Sci. 31, 1-19 Clark, G. A. (1964) History of the Royal College of Physicians of London, Vol. 1, Oxford University Press Cook, HI. (1990) in Reappraisals of the Scientific Revolution (Lindberg, D.C. and Westman, R.S., eds), pp. 395-436, Cambridge University Press; (1986) The Decline of the Old Medical Regime in Stuart England, Cornell University Press Charter of 10 Hen.VIII, cited in Munk, W. (1878) The Roll of the Royal College of Physicians of London, Vol. 1, 1518-1700, P. 8 The Annals of the Royal College of Physicians of London, 1518-1691, five ~01s. English translation and transcript. I am grateful to the President and Fellows of the College for permission to quote from the Annals Levy-Peck, L. (1993) Court Patronage and Corruption in Early Stuart England, Routledge The best known of the many ‘mirror’ books is probably Castigilone, B. (1528) The Book of the Courtier. The first English translation (by Thomas Hoby) was pub- lished in London in 156 1 Biagioli, M. (1993) Galileo, Courtier: The Practice of Science in the Culture of Absolutism, University of Chicago Press Debus, A. (1966) The English Paracelsians, Franklin Watts Trevor-Roper, H. (1985) Renaissance Essays, pp. 149-199, Seeker & Warburg Pagel, W. (1982) Paracelsus: an Introduction to Philosophical Medicine in the Era of the Renaissance, 2nd edn, Karger Debus, A. (1991) The French Paracelsians: The Chemical Challenge to Medical and Scientific Tradition in Early Modem France, Cambridge University Press Annals Vol. i, p. 91 Annals Vol. i, p. 72 Annals Vol. i, pp. 78-79 Dictionary of National Biography, Vol. xvi, p. 14 Anthony, F. (1610) Medicinae Chymicae et kri Potabilis Assertio, Cambridge All quotations regarding Anthony are taken from (1616) The Apology of defence of a verity heretofore published concerning a medicine called Aurum Potabile, London. Courtesy of the Wellcome Institute Library, London See Shapin, S. (1994) A Social History of Truth, University of Chicago Press

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