The Herbalist: Nicholas Culpeper and the Fight for Medical Freedom

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Being his first appearance, Harvey was probably examined on physiology and, thanks to his time at Padua, was likely to have acquitted himself well. It would be nearly a year before he was next examined, perhaps to give him a chance to gain some practical experience and bone up on the seventeen Galenic treatises on the College’s reading list. He faced the Censors three times in 1604: on 2 April, 11 May, and finally on 7 August, when he was elected a candidate. This meant he was free to practise and, after four years, would become a full Fellow.

Harvey climbed London’s monumental medical hierarchy with the deftness of a steeplejack. Four months after becoming a candidate, he married Elizabeth, the daughter of a former College Censor and royal physician, Dr Lancelot Browne. Very little is known about Elizabeth, not even the year of her death, which was some time between 1645 and 1652. She apparently bore no children, and contemporaries who wrote about Harvey do not even mention her. Thomas Fuller, in his Worthies of England, published five years after Harvey’s death, described him as ‘living a Batchelor’.

(#litres_trial_promo) Harvey never wrote about Elizabeth, except in connection with her pet parrot. He evidently spent hours resentfully scrutinizing the creature, ‘which was long her delight’, noting how it had ‘grown so familiar that he was permitted to walk at liberty through the whole house’.

Where he missed his Mistress, he would search her out, and when he had found her, he would court her with cheerful congratulation. If she had called him, he would make answer, and flying to her, he would grasp her garments with his claws and bill, till by degrees he had scaled her shoulder … Many times he was sportive and wanton, he would sit in her lap, where he loved to have her scratch his head, and stroke his back, and then testify his contentment, by kind mutterings and shaking of his wings.

The flirtations finally ceased when the bird ‘which had lived many years, grew sick, and being much oppressed by many convulsive motions, did at length deposit his much lamented spirit in his Mistress’s bosom, where he had so often sported’. Harvey exacted his revenge on the pampered pet by performing a prompt dissection. Perhaps because of its adoring relationship with his wife, he had assumed it to be a cock, so was surprised to discover a nearly fully formed egg in its ‘womb’.

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Elizabeth’s influential father wasted no time in trying to advance his new son-in-law’s career. In 1605, he heard that the post of physician at the Tower of London was about to come vacant and wrote at least twice on Harvey’s behalf to the King’s secretary of state, Robert Cecil, the Earl of Salisbury, once in haste from an apothecary’s shop in Fenchurch Street, where he was presumably ordering up prescriptions. The application failed, but by 1609, his son-in-law was sufficiently well placed with the royal household to receive a letter of recommendation from the King proposing Harvey for the post of hospital physician at St Bartholomew’s Hospital in Spitalfields. St Bart’s (as it was and still is known) was one of only two general hospitals in London that survived the Reformation, the other being St Thomas’s in Southwark (Bethlehem Hospital, or ‘Bedlam’, north of Bishopsgate, was a lunatic asylum). Its role was to offer hospitality, including free medical care, to London’s poor ‘in their extremes and sickness’. This was an immense task at a time when London’s population was ravaged by some of the highest mortality rates in the country, and swelled by influxes of migrants. St Bart’s had around two hundred beds, cared for by a ‘hospitaler’ (a cleric, who also acted as gatekeeper), a matron, twelve nursing sisters, and three full-time surgeons. The physician’s job was to visit the hospital at least one day a week, usually a Monday, when a crowd of patients would await him in the cloister, ready to be assessed and treated when necessary. In return, he was provided with lodgings, a salary of £25 a year (approximately four times the annual living costs of a tradesman such as a miller or blacksmith) plus 40s. for the all-important livery of office.

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Harvey was offered the job in October 1609. At around the same time he was admitted as a full Fellow of the College of Physicians, confirmed with the publication in the College Annals of the list of Fellows according to ‘seniority and position’, which placed him twenty-third.

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As well as providing a regular salary, the position at St Bart’s proved fruitful in introducing new clients, as influential courtiers often found it convenient to call upon the hospital’s medical staff when they were ill. In early 1612, the most powerful politician of them all, Robert Cecil, was laid low ‘by reason of the weakness of his body’, a reference to a deformity described unflatteringly by one enemy as a ‘wry neck, a crooked back and a splay foot’. According to the courtier John Chamberlain, ‘a whole college of physicians’ eagerly crowded around Cecil’s sick-bed, Sir Theodore de Mayerne, James I’s personal physician, being ‘very confident’ of success, ‘though he failed as often in judgement as any of the rest’. Treatment was hampered by a disagreement over diagnosis, which within a fortnight changed ‘twice or thrice, for first it was held the scorbut [scurvy], then the dropsy, and now it hath got another Greek name that I have forgotten’. Harvey and his surgeon, Joseph Fenton, were then summoned from St Bart’s and were deemed to have done ‘most good’ in treating the condition, Fenton particularly, though neither managed a cure, as Cecil died two months later – probably of the disease originally diagnosed, scurvy.

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In 1613, Harvey took a further step towards the summit of his profession by offering himself for election as a Censor, one of the key positions in the College hierarchy. He attended his first session on 19 October and made an immediate impact. He and his three colleagues, Mark Ridley, Thomas Davies, and Richard Andrews, examined the case of one Edward Clarke, who had given ‘some mercury pills to a certain man named Becket, which caused his throat to become inflamed and even spitting ensued’. Dr Ridley, a veteran Fellow and serving his sixth term as a Censor, demanded a fine of £8, much higher than usual (apothecaries and other medical tradesmen were typically fined around forty shillings; fines of £5 or more were usually reserved for foreign physicians who set up practice in London without a licence). The distinguished scholarly physician Dr Davies, less active in College affairs and serving his third term as a Censor, objected that this was too severe a punishment for a first offence. Then Harvey, uninhibited by his lack of experience, intervened. He backed Ridley, arguing that such ‘ill practice’ demanded an exemplary punishment. However, he conceded Clarke’s fine should be ‘remitted’, reduced, on account of his ‘submission’ to the College, though he should be imprisoned if he failed to pay it. In November, Harvey further demonstrated his zest for discipline and standards by apparently insisting that an applicant for a licence to practise be examined three times on the same day.

And so the meetings continued, week after week, considering case after case, imposing fine upon fine. In December, a Mr Clapham, an apothecary of Fenchurch Street, was brought before the Censors, charged with, among other things, selling an unauthorized medicine ‘for the stone’. Kidney stones were one of the most common complaints physicians had to deal with, and many doctors, including Harvey, had their own secret and lucrative remedies for treating them. Mr Clapham omitted to mention that he sold his own formula and, being ‘reminded’ of it by the Censors, ‘confessed that he often accepted five shillings for this’. In response to questions about its recipe, he was oddly specific about the absence of ‘distilled goats’ milk’, possibly because this would reveal the origin of his recipe and open him to further charges. As well as Mr Clapham, another apothecary, Peter Watson of St John’s Street, was asked to produce copies of four prescriptions he had made up, two of which had not been written by a physician.

The records are sketchy but suggest that, in the year Harvey served his first term as a Censor, he enthusiastically enforced, if he did not actually initiate, one of the most comprehensive crackdowns on unlicensed practitioners to date. The main target was the apothecaries, whose combination of medical experience and knowledge of medicines made them a particularly potent threat to the physicians’ monopoly. During this period, as many as one in ten of the capital’s hundred and twenty or so practising apothecaries were summoned before the Censors, to receive a reprimand if they were lucky, a heavy fine and threat of imprisonment if they were not.

(#litres_trial_promo) They seemed to lurk everywhere, down every alley, on every corner, in every backroom. The Censors heard their mocking laughter at the College’s impotence echo through the streets.

As well as threatening the health of the capital’s citizens, these insolent quacks undermined the dignity of the College, at a time when it was preparing to move from its cramped rooms in Knightrider Street to prestigious headquarters next to St Paul’s Cathedral, at Amen Corner – a fitting address for an institution that considered itself the last word in medical expertise. From their grand new premises, they decided it was time to step up their campaign by making a direct appeal to the sovereign.

Harvey was still too junior a member of the King’s household to take on this role, so it was entrusted to a more senior royal physician, Dr Henry Atkins. In early 1614 Atkins was enlisted to whisper the College’s grievances into King James’s ear during one of their routine consultations. On 23 May 1614, the College called an emergency Comitia so that Atkins ‘might inform them what he had done on our behalf before the most serene King’. He ‘reported much’ about his discussions, but did not want to have his words recorded in the Annals, presumably because he felt it might compromise royal confidentiality. His unrecorded remarks encouraged the Fellows, Harvey among them, to draft a letter to the King, entreating James, ‘the founder of the health of the citizens’, to ‘cure this distress of ours, and deign to understand the paroxysms and symptoms of this our infirmity’. The letter reminded the King that under ‘royal edicts … the audacity of the quacks, and the wickedness of the degraded were committed to our senate for correction and punishment’. But the writ of the College was now routinely flouted. ‘They fling scorn and all things are condemned’, particularly by the apothecaries, who ‘ought to be corrected: for as we minister to the universe so they are the attendants of the physicians’.

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Their proposed remedy was to support a move to separate the apothecaries from the Grocers’ Company – the reverse of the manoeuvre used to control the surgeons. The College had little influence over the Grocers, but might have over a company of apothecaries, as long as its founding charter established the physicians’ superiority, which existing legislation only ambiguously supported. Their wish was to be granted, despite the protests of the grocers themselves and of the City authorities, who feared the new apothecaries’ company would, like the College, fall outside their influence.

The new Society of Apothecaries was granted its charter on 6 December 1617, after a great deal of wrangling between the College, the Grocers, the City, and the royal court’s law officers. As a sop to the City, it was agreed that the Society should operate as a guild, with the same organization as other livery companies, having powers to bind apprentices to masters, and free them once they had completed their apprenticeship, and to police the practice of its trade. The doctors also agreed to observe the Society’s monopoly by refraining from making and selling medicines themselves. However, unlike the other guilds, it was not to be regulated by the City fathers. Instead, it fell under the supervision of the College, which was given powers to intervene in crucial aspects of the Society’s business: the passing of by-laws, the ‘freeing’ of apprentices when they completed their term, and the searching of shops.

Another important provision was that apothecaries would have to make their medicines according to a standard set of recipes set out in a ‘London Antidotary’ or dispensatory, drawn up by the College: a bible of medicine.

Bergamo in Italy and Nuremberg in Germany had long used official dispensatories that prescribed exactly how medicines were to be made by apothecaries trading within their borders. Now that the apothecaries of London were to be constituted as a separate body, the College of Physicians decided it was time, after years of discussion, to introduce one of its own.

They did not do a very good job of it. In 1614, a group of Fellows were appointed to produce a draft. Two years later, on 14 September 1616, a meeting was called to review progress. It turned out that very little work had been done. Papers were missing, and there were complaints that the Fellows given the task ‘went away leaving the matter unfinished’.

(#litres_trial_promo) After bouts of recrimination, another committee, with Harvey probably among its members, was set up to complete the project. A year later, it was sufficiently advanced for a draft to be handed to a delegation of apothecaries for consultation – a rare moment of cooperation between the two bodies. In January 1618, the publisher John Marriot was given permission to register the title with the Stationers’ Company, giving him an exclusive right to sell the work on the College’s behalf. Marriot would go on to publish the likes of John Donne, but at the time of his appointment by the College, he had only recently set up shop at the sign of the White Flower de Luce, in St Dunstan’s Churchyard. The College presumably hoped that commercial dependence would make such a callow operator more tractable. They were wrong.

On 26 April 1618, a royal proclamation was circulated ordering all apothecaries, who were then in the throes of forming their Society, to buy the new book, to be published in Latin under the title Pharmacopoeia Londinensis.36 In May, the more eager and obedient queued up at the sign of the White Flower de Luce to buy copies. Some of these early copies were discovered to have a blank page where the King’s Proclamation should have been and so had to be withdrawn. The Proclamation that appeared in the amended editions was the only section of the book in English, to ensure its message was understood. The King, it announced verbosely, did ‘command all and singular Apothecaries, within this our Realm of ENGLAND or the dominions thereof, that they and every of them, immediately after the said Pharmacopoeia Londin: shall be printed and published: do not compound, or make any Medicine, or medicinal receipt, or praescription; or distil any Oil, or Waters, or other extractions … after the ways or means praescribed or directed, by any other books or Dispensatories whatsoever, but after the only manner and form that hereby is, or shall be directed, praescribed, and set down by the said book, and according to the weights and measures that are or shall be therein limited, and not otherwise &c. upon pain of our high displeasure, and to incur such penalties and punishment as may be inflicted upon Offenders herein for their contempt or neglect of this our royal commandment’.

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The book was, compared with the continental dispensatories upon which it was modelled, concise and simple. Unfortunately, its ‘manner and form’ was, according to its own authors, defective. The College claimed that Marriot had ‘hurled it into the light’ prematurely. Dr Henry Atkins, the royal physician who had first approached the King about the apothecaries and was now the College’s President, had returned from a trip to the country to find, ‘with indignation’, that the work to which he and the College had ‘devoted so much care … had crept into publicity defiled with so many faults and errors, incomplete and mutilated because of lost and cut off members’.

(#litres_trial_promo) A meeting was hastily convened at Atkins’s house, and it was decided that the book should be withdrawn from publication and a new edition issued.

Marriot published this ‘second endeavour’ in early 1619 (though the publication date remained 1618, to obscure the first endeavour’s existence). The fact that Marriot, rather than another publisher, was selected to do the job seems to contradict the College’s claim, in a new epilogue, that he was to blame for the premature release of the defective first edition. So did the news, reported at a Comitia on 25 September 1618, that Marriot was still awaiting material from the College and that he had been promised a further payment ‘when the corrected book appeared’.

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An examination of the differences between the two editions confirms that the need for a reissue had little or nothing to do with printing mistakes or the publisher. The second edition is a substantially different work, containing over a third more recipes. And far from eliminating errors, it introduced several of its own. The real reason for the reissue appears to have been an editorial dispute within the College over the contents. The bulk of the recipes it contained were Galenicals – medicines based on Galen’s writings and drawn from ancient Greek, Roman, and Arabic pharmacopoeias, most dating back to the early centuries ad. However, ten pages of novel ‘chemical’ medicines were also included. Some of the traditionalists in the College probably objected to this and tried to have them removed, in the process provoking a review of the book’s entire contents. When the College, in a metaphorical frenzy, accused the printer of snatching away the manuscript ‘as a blaze flares up from a fire and in a greedy famine deprives the stomach of its still unprepared food’, it was using him to draw the heat from disputes within its own profession.

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Harvey’s involvement in the drafting of the dispensatory is undocumented. However, he is listed as one of its authors, bearing the title Medicus Regis juratus, which shows that by 1618, aged forty, he had become a member of King James’s medical retinue, placing him near the peak of his profession. However, posterity would remember him not for his dazzling rise, nor for his contribution to the botched Pharmacopoeia, but for another achievement made over this period.

In 1615, Harvey was appointed the College’s Lumleian Lecturer in Anatomy, succeeding his fellow Censor Dr Thomas Davies, who had held the post since 1607. The lectureship had been founded in 1582 by Lord Lumley to advance England’s ‘knowledge of physic’.

(#litres_trial_promo) Attendance for College Fellows was mandatory, twice a week for an hour through the year, though they came reluctantly, the College at one stage being forced to more than double the fine for nonattendance to 2s. 6d.

Harvey was well qualified for the post. Unlike many of his colleagues, he was an enthusiastic and unflinching anatomist. At various stages in his career he performed or witnessed dissections of cats, deer, chickens, guinea-pigs, seals, snakes, moles, rats, frogs, fish, pigeons, an ostrich, his wife’s parrot, a pet monkey, a human foetus, his father, and his sister. It has been estimated that he cut up 128 species of animal as well as numerous humans. His autopsies revealed the size of his father’s ‘huge’ colon, his sister’s ‘large’ spleen (which weighed five pounds), and the condition of the genitalia of a man who was claimed to have died at the age of a hundred and fifty-two, which, as Harvey reported to the King, was entirely consistent with a prosecution for fornication the subject had received after turning a hundred.

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Harvey looked upon anything that moved as potential material, complaining during a journey to the Continent in 1630 that he ‘could scarce see a dog, crow, kite, raven or any bird, or anything to anatomise, only some few miserable people’.

(#litres_trial_promo) London in the early seventeenth century would provide a richer source of specimens, both human and animal. The aviary in St James’s Park had ostriches and parrots; merchants arrived from the East Indies with monkeys and snakes; and the streets were packed with a ready supply of feral dogs and cats. He and his colleagues also had access to a supply of human specimens taken from the scaffolds at Tyburn and Newgate, the traditional places of execution. Examining bodies freshly taken down, and noting how they were soaked in urine, he opened them up while the noose was still tight, in the hope of examining the organs before the final signs of life were extinguished.

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Harvey’s Lumleian lectures began in December 1616, and they were masterpieces. His lecture notes have, unlike most of his other papers, survived, proudly introduced by a title-page upon which he inscribed in red ink, in Latin, ‘Lectures on the Whole of Anatomy by me William Harvey, Doctor of London, Professor of Anatomy and Surgery, Anno Domini 1616, aged 37’. Presumably to guard against casual perusal, the notes that follow are written in the barely legible scrawl for which future generations of physicians were notorious. Though the bulk are in Latin (not very good Latin), they are peppered with fascinating case studies and bawdy asides, all in the vulgar tongue. He poked fun at ‘saints’ – Puritans like William Attersoll – for their calloused knees, the stigmata of their overearnest piety.

(#litres_trial_promo) He told the story of Sir William Rigdon, whose stomach filled with yellow bile, as a result of which he died hiccoughing. He noted that ‘in [men with] effeminate constitution the breasts [may be enlarged]; and in some milk’, citing as an example Sir Robert Shurley (c.1518–1628), envoy to the Shah of Persia and a kinsman of William Attersoll’s patron. Commenting on the anatomy of the penis, he noted that Lord Carey, presumably another aristocratic client, had a ‘pretty bauble, a whale’, and that a man who lived ‘behind Covent Garden’ to the west of the City had one ‘bigger than his belly … as if for a buffalo’.

(#litres_trial_promo) He observed how ‘fecund’ the penis is in ‘giving birth to so many names for itself: twenty in Greek, sixteen in Latin. He dwelt on the nature of sexual urges, estimating that a healthy man can achieve up to eight copulations a night, though ‘some lusty Laurence will crack … 12 times’. ‘Few pass 3 in one night,’ he added, more realistically.

(#litres_trial_promo) He also asserted that males ‘woo, allure, make love; female[s] yield, condescend, suffer – the contrary preposterous’. There were not, of course, any women in Harvey’s audience to challenge these assertions.

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The lectures were broken into three ‘courses’ performed ‘according to the [hour]glass’, in other words to a strict schedule: ‘1st lower venter [belly], nasty yet recompensed by admirable variety. 2nd the parlour [thorax or chest]. 3rd divine Banquet of the brain.’

(#litres_trial_promo) The first course was completed in December 1616, the second in January 1618, the third, the ‘divine Banquet of the brain’, in February 1619. The exact date of the lectures depended on the availability of specimens and the weather, which had to be cold enough to prevent the body from decomposing before the dissection was complete.

(#litres_trial_promo) Harvey reckoned that in the right conditions he had three days to complete a lecture before the body would start to ‘annoy’.