A m ong humankind, different men learn or profess different arts; b ut everyone should learn this one art which is vital to everyone. But alas for the extreme perversity o f human judgement! While no man will remain ignorant o f the difference between genuine and counterfeit coin, lest he be cheated in some way in matters o f gross materialism, there is no corresponding zeal to discover how he can protect his m ost valuable possession. In monetary matters he does not trust to somebody else’s eyes, but in the business o f life and health he is content to follow somebody else’s judgement, with his eyes shut. But if absolute knowledge o f the whole art is renewed only to a few w ho have dedicated a lifetime to this single branch o f study, there is no reason why anyone should be ignorant o f at least that part which pertains to good health.
Erasmus, Oration in Praise of the A r t ofMedicine}'^
Definition and demarcation are processes that rely on the construction o f differences between two or m ore individuals or groups. A ‘bogey-man’ laden with negative qualities is set up only to be knocked down by an exemplary character. As Brian M cGregor suggests in a recent commentary on Erasm us’ Oration^ there are similarities between this technique and the techniques employed by Renaissance rhetoricians. A problem is introduced and narrated, arguments are then given and refuted before finally a peroratio
England, 1660-1800’, in Peter Burke and Roy Porter (eds), The Social Histoiy of Tanguage^
(Cambridge: Cambridge University Press, 1987), pp.76-77
Declamatio in haudem Artis Medicae, translated and annotated by Brian McGregor in E. Fantham
et al. (eds). The Collected Works of Erasmus, Vol.7, (Toronto and London: University of Toronto Press, 1989), p.45
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or close is made.^® Erasmus introduced the question o f w hat status should be accorded to the physician. H e argued first that his status should be lower than that o f theologians (who save m en from sin) before refuting his own argument by pointing out (with the wit for which he is known) that ‘w ithout the physician, there would be no m en to be s a v e d ' . L i k e w i s e , there would be no-one to rule as good magistrates were all sustained by good physicians, Erasmus then w ent on to give a long oration on the qualities o f the learned physician and the m anner in which those qualities are neglected by the common people who, because o f their credulity, mistake natural healing for miracles. While the com m on people, hke fools, have their quahties (they lack the pom p and pride o f their superiors), they should not be allowed to make decisions,^® Though not a physician himself, Erasmus, in com m on with a num ber o f humanist physicians before him, pushed for the elevation o f the art o f medicine in relation to the other hberal arts^^ — a task which was famUiar to him by virtue o f his contact with Thom as Linacre in early sixteenth-century Oxford,^^
While few seventeenth century writers ever reached the level o f literary excellence in Erasmus’ work, recognition o f his technique is nevertheless helpful in assessing later works that prom oted the position o f the physician in relation to other laymen, n ot least because humanism and the elevation o f medicine as a learned art were central to those (albeit fudged and unsuccessful) attempts by physicians to define the boundaries o f their practice,^^ O rations on the skill o f learned physicians in relation to other practitioners and criticisms o f erroneous texts became commonplace, either as works in their own right, or as parts o f texts dealing with other medical matters, in particular texts dealing
Declamatio in Laudem Artis Medicae^ p,32
Declamatio in haudem Artis Medicae^ p,40
20 The differences between fools and rulers were also discussed by Erasmus in ‘Whether One Ought to be Bom a King or a Fool’ in The Erasmus Reader (ed,) Erika Rummel, [Toronto: University of Toronto Press, 1990), pp, 334-44, Erasmus judged that fools and kings were equal in happiness. This emphasis on the positive value of foolery, play, and laughter was gradually transformed during the course of the early modern period,
2’ Similar attempts had taken place in the middle ages. For an example see, Gundolf Keil and Rudolf Peitz, ‘ “Decem quaestiones de medicorum statu” Beobachtungen zum Fakultatenstreit und zum mittelalterlichen Unterrichtsplan Ingolstadts’, in Gundolf Keil (ed,), Der Humanismus
und die oberen Fakultdten, (Weinheim: VCH, 1987), pp,215-38
22 Erasmus met Linacre at Oxford and London in 1511, He may also have met him in Oxford in 1499,
23 Richard J, Durling, ‘Linacre and Medical Humanism’ in Francis Maddison, Margaret Pelling, and Charles Webster (eds) Essays on the Life and Work of Thomas Linacre, c. 1460-1524, (Oxford: Clarendon Press, 1977), pp, 76-106, As Durling noted, the philological work of English medical humanists has also been overplayed.
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with infectious illnesses (such as plague) where the contentious status o f the disease made the need for physicians to assert themselves all the m ore pressing. Ironically, as we shall see below, the language o f learning and the tendency to distinguish one’s own medical practice from that o f others (in particular artisans and tradesmen) was quickly appropriated by those from w hom humanist physicians were keen to disassociate themselves.
Early aspects o f this humanist discourse can be seen in the writings o f the Cambridge based physician Jo h n Caius (1510-73). Caius lacked the milder attitude towards the com m on people that can be found in Erasmus’ work. He, Hke later writers, regarded com m on opinion as a hindrance to the work o f the physician. A t the beginning o f his
^oke or Counseill against the Disease called the Smate (1552) he warned his readers to ‘avoide
the judgement o f the multitude, from whome in matters o f learnyng a man shal be forced to dissente, in disprovyng that which they most approve.’^'* Choosing a physician should be carried out with as much, if not more care as if one were choosing a hosier or shoemaker. Still, physicians should not be confused with craftsmen, alchemists, supposed miracle workers, and other foreign impostors. The sick should ‘fHe the unlearned as a pestilence in a com mune wealth’ by avoiding,
...simple women, carpenters, pewterers, brasiers, sopeballeseUers ... apotecaries (otherwise for their drogges) avancers o f themselves w ho come from Pole, Constantinople, ItaHe, Alamane, Spaine, Fraunce, Grece and Turkie, Inde, Egipt...from ye service o f Em perours, Kinges and queenes, promising helpe o f al diseases, yea incurable, with one or two drinkes, by waters five m onethes in continuaUe distillinge, by aurum potabile...sunne, moone, or starres...by blessynges...meanynge nothing els but to scorn your Hght beHeve [sic], and scorn you behind your backes.^^
Though Caius pubHshed this work in the vernacular, he was largely opposed to the translation and vulgarisation o f learned work beHeving that ‘the com m on settyng furthe and printing o f every fooHsh thynge in engHsh, both o f physicke unperfectly, and other matters undiscretely, diminishe the grace o f thynges l e a r n e d . I n com m on with other humanist physicians, (particularly in Italy where he had received some o f his education). 2“^ John Caius, A Bake or Counseill against the Disease Called the Smate (1552), Archibald Malloch (ed.), (New York : Scholars’ Facsimiles & Reprints, 1937), f.4v
25 Caius, A Boke or Counseill f.28v. Stating a grievance such as this may have been fairly standard course for aspiring physicians in the sixteenth century. BL Sloane MS 2563 contains an unpubHshed text detailing ‘A just and necessarie complaint concerning Physicke’.
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Caius created an image o f him self that was based on proficiency and agility in Latin and Greek. In his opinion, these languages best suited the ‘adornyng o f the com m on welthe, better service o f their kyng, & great pleasure and commodité o f the owne selve selves, to w hat kinde o f Hfe so ever they shold appHe them .’ M oreover, in Caius’ estimation, humanist learning and an accurate knowledge o f ancient texts made the physician a far better judge o f the individual’s ailments.^^
Caius’ equation o f learning with state service and his emphasis on proficiency in Latin and Greek was com m on in a society where humanism was central to w hat Stephen Greenblatt has term ed 'self-fashioning’.^^ Humanism encouraged scholars to study a wide range o f disciplines from a com m on body o f texts both in classical and vernacular languages, and placed the educated layman in a position that was close to that o f the physician^^. This on the other hand created difficulties for those physicians who did try to delineate the boundaries o f their practice. Categories such as literati and illiterati (i.e. people unable to read Latin), which had been used since the middle ages (and continue to be used by some historians) to separate educated éhtes from the rest o f society, could not be appHed to those w ho shared knowledge with physicians or who acted as patrons to physicians.^®
As Paul Slack has detailed, throughout the sixteenth century educated laymen w ithout any formal medical education produced numerous small printed vernacular texts giving therapeutic advice. Though these were just one o f many ways in which medical knowledge was diffused through society, their low cost and ready avaüabihty, at a time
26 Caius, A. Boke or Counseill f.4v
27 Caius, A Boke or Counseill f.6r. On Caius and the promotion of humanist medicine see Vivian Nutton, ‘John Caius and the Linacre Tradition’, Medical History, Vol.23, (1979), pp.373-91. On the continued use of vulgarised medieval texts see Vivian Nutton, ‘Hellenism Postponed: Some Aspects of Renaissance Medicine (1490-1530), Sudhoffs Archiv, Vol.81, No.2, (1997), pp.l 58-70.
28 Stephen J. Greenblatt, Rfnaissance Self-fashioning: from More to Shakespeare, (Chicago: University of Chicago Press, 1980)
29 The classical statement of a shared culture for patient and practitioner is N.D. Jews on, ‘Medical Knowledge and the Patronage System in Eighteenth Century England’, Sociology, Vol.8, (1974), pp.369-85. As I suggest here, aspects of Jewson’s analysis — shared knowledge and a patronage system - were in place (albeit in a different form) in seventeenth century England. 3*5 WilHam Eamon, Science and the Secrets of Nature. Books of Secrets in Medieval and Early Modem
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w hen the latest continental texts were scarce in England, made them important.^^ Authors included the lawyer and civil servant Sir Thom as Elyot, the M.P. and author o f antiquarian works Humphrey Lloyd, and the D ean o f Wells William Turner.^^ Their texts offered standard Galenic and Salernitan advice on how to maintain good health. They stressed the importance o f sound morals in m uch the same way as religious texts o f this period touched on the maintenance o f bodily health. Like medical humanists, these medical writers identified themselves as learned and warned their readers to keep away from unlearned craftsmen and empirics. William Clowes, a learned surgeon who was himself pursued by the College o f Physicians for illegally practising physic, complained, in a m anner similar to Caius, about
... tooth-draw ers.. .horse-leeches, idiots, apple-squires...bawds, witches, conjurors, sooth-sayers and sow gelders, rat-catchers, renegades, and proctors o f spittle-houses, with such other rotten and stinking weeds...in town and country, ...abuse bo th physic and surgery.^^
Responses to vernacular medical texts varied. As Slack notes, for m uch o f the sixteenth century ‘there is littie evidence that physicians as a whole disapproved o f these works.’^^^ Physicians did however complain increasingly about w hat they saw as the confusion o f therapeutics with the practice o f physic as a whole. As we shall see below, and in the chapters that follow, it was in this area — the application o f medical therapeutics — that knowledge was m ost commonly shared and re-interpreted by different sections o f early m odern society. Stalwart critics o f lay medical practice such as Jo h n Cotta admitted that.
W here the causes and disease are both com m on and vulgar, and no circumstances requireth m ore than ordinarie consult, there w ithout doubt ordinary harmlesse remedies w ithout deeper counsell or advice, may by themselves sufficiently satis fie an usuaU need.^^
But in general he advised that patients should consult the physician before attempting any form o f domestic medicine. Though at its m ost extreme, self-medication was
31 Paul Slack, ‘Mirrors of Health and Treasures of Poor Men: the Uses of the Vernacular Medical Literature of Tudor England’, in Charles Webster (ed.), Health, Medicine and Mortality in the
Sixteenth Century, (Cambridge University Press, 1979), p. 237
32 Thomas Elyot, The Castel of Helth, (1539); Humphrey Lloyd, Here Beginnith a Utel Treatise
Conteyninge the lugement of Urines, (1555); William Turner, A. New Book of Spiritual Piysic, (1555).
33 William Clowes, A B rief Treatise of Morbus Gallicus, f.8r. Cited in Margaret Pelling and Charles Webster, ‘Medical Practitioners’ in Charles Webster (ed.). Health, Medicine and Mortality
in the Sixteenth Century, (Cambridge: Cambridge University Press, 1979), p. 185
34 Slack, ‘Mirrors of Health’, p.257
35 John Cotta, A Short Discoverie of the Unobserved Dangers of Severall Sorts of Ignorant and Inconsiderate
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regarded by zealous Protestants as ‘self-killing’ and an insolent rejection o f G od’s appointed healer, in the majority o f cases, physicians accepted that self treatm ent did take place but sought to shepherd it wherever possible,^^ According to Browne, physicians could be distinguished from purveyors o f medical therapeutics and materia
medica^ w hether in the marketplace or in print, by their ‘true understanding [of] the
nature o f the disease, its causes, and proper indications for cure.’^^ Physicians, or so the patter went, differed from laymen in their ability to ‘see’ disease, both in terms o f their skill at diagnosis and, metaphorically, in their ability to distinguish the true physician from the false physician. As Cotta put it,
...a com m on eye is n ot capable; while unperceived mischiefes stealing and insensibly enter with unprivileged remedies and by some present benetite or ease for a tune, gayming credit and entertainment, by litle and litle secretly undermine the verie frame and foundation o f life.
The ‘com m on eye’, hke the com m on fashion for tobacco, rarely led to good health.^®
Physicians engaged with notions o f light and darkness, secrecy and disclosure, in their attacks on ‘books o f secrets’. These small books contained a variety o f household, technological, and medical advice m uch o f which had been plundered from medieval sources such as Roger Bacon and the Pseudo-Albertus Magnus, Secreta Alheri^ as well as older sources such as the Vhjsiologus and the Pseudo-Aristotle, Secretum secretorum^ by such Italian empirics as Leonardo Fioravanti and Girolamo Ruscelli (otherwise known as ‘Alessio o f Piedm ont’ ). They claimed to give ancient or hidden knowledge which was being made available as a m atter o f utility or as a moral duty to those w ho had been deprived o f medical assistance by avaricious physicians.^^ English Galenists responded
36 John Sym, Ufes Preservatives Against Self-killing Or, an Treatise Concerning Life and Self-murder,
edited with an introduction by Michael MacDonald, (London and New York: Roudedge, 1988; orig. 1637), p. 15. Sym’s work was primarily an attempt to refute the Stoic defence of suicide and its presentation in the works of Montaigne and Charron; Thomas Browne, The Pueligio Medici
and Other Writings, (London: J.M. Dent and Sons, 1959), pp.48-50. Browne defended suicide in
Stoical terms (he cited Zeno) as the ultimate expression of the will to live.
37 Thomas Browne to Henry Power [no month] 1646 in The Letters of Sir Thomas Browne, (ed.) Geoffrey Keynes, (London: Faber and Faber, 1946), p.277.
38 Cotta, A Short Discoverie, pp.4-5
39 Eamon, Science and the Secrets of Nature, p.71; ibid., pp.142-7. A number of these Italian authors were highly educated men who had achieved fame, and in many cases notoriety, at foreign courts. Ruscelli was a Venetian humanist and aristocrat who had been educated at Padua. He received patronage from the marquis of Vasto Alfonso d’Avalos; ibid, pp.177-78. Fioravanti received a doctorate from the University of Bologna in 1568. Although in the English context such works as these were sold by empirics, they were also popularised men such as the
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to this som ew hat paradoxical sales pitch by comparing secret knowledge with Catholicism (which also made room for w ord play on the sale o f ‘cathoHcons’ or alchemical nostrums), and by condemning Italian authors as ‘Im posters’. As natural philosophers w ould do forty years later, Galenists likened openness to truthfulness claiming that ‘the best remedies are such as have no secrets.’"*^ They reject the suggestion, m ade by some medieval neo-Platonists, that empirical remedies were akin to the divine and had been placed in the hands o f rustics and w om en — a rejection, which was linked to the likening o f the voice o f the people to that o f fools.
A ncient sources such as Galen’s De Sectis and A rs Parva provided ammunition for physicians w ho were trying to create a medical hierarchy. Cotta cited De Sectis and the distinctions that had been made between methodists, empiricists, and dogmatists in order to support his contention that as dogmatists, university trained physicians possessed a superior ratio or method'*^. In contrast to physicians w ho used ‘right reason’'^^ in order to make judgements based on ‘true’ experience, empirics and the ‘simple and unlettered’ relied on ‘untried and unexperienced truths’. As the Ipswich physician Eleazar D unk put it, ‘the best Empiricke is but a lame and left-legged Physician’.^
The assault on empirical drugs and simple experience came about precisely because the status o f these remedies was contested in the sixteenth and seventeenth centuries. Royal physician George Baker in his Newe ]ewell of Health, (1562), and used by many of those who, in public, scorned them. On Browne’s use of Fioravanti’s secrets see below.
James Primrose, Popular Errours or the Errours of the People in Phjsick, trans. Dr. Robert Wittie, (1651), p.44. Primrose’ work was originally published as De Vulgi in Medicina Erroribus, (1638)
Eamon, Science and the Secrets of Nature, p.l72, cites the twelfth-century author Nicholas of