Great Man

English Historical Review Vol. CXXI No. 490 The Author [2006]. Published by Oxford University Press.
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doi:10.1093/ehr/cej001
Plagues, Morality and the Place of Medicine in Early Modern England *

Epidemics throw into question peoples moral responsibilities to the communities in which they live, sharply emphasising the difculties of balancing public and private interest. Since the nineteenth century, the main locus of this tension in Europe and America has been the imposition of quarantines or restrictions on travel or trade to prevent the spread of disease.1 Less familiar to us now, but a crucial concern in the sixteenth and seventeenth centuries, is the question of whether a person should ee from disease to preserve themselves, or stay and help the sick. Paul Slack has given us an excellent analysis of the course of the general debate on this problem in his work on plague in early modern England. However, the specic ethical responsibilities of medical practitioners during the repeated onslaughts of epidemic disease that punctuated the sixteenth and seventeenth centuries have been less well served.2 Historians have often been reluctant to contemplate the idea that medical practitioners might have faced different obligations during pre-modern plagues than in nineteenth- or twentieth-century epidemics. As a result, condemnation has been heaped on those who left aficted towns and cities, while the small band of heroes who remained have been garlanded with praise.3
*I am grateful to Rosie Blau, Hal Cook, Lauren Kassell, Anne Murcott, Philip Mills and Margaret Pelling, and audiences at seminars in Oxford and at the Constructing Credibility symposium at the Wellcome Centre for the History of Medicine, January 2002, for their comments on earlier drafts of this paper. The research for this paper was funded by the Wellcome Trust and the Leverhulme Trust. 1. G. Rosen, A History of Public Health, expanded edn (Baltimore, 1993); D. Porter (ed.), The History of Public Health and the Modern State (Amsterdam, 1994); K. Maglen, Intercepting Infection: Quarantine, the Port Sanitary Authority and Immigration in Late Nineteenth Century Britain (Ph.D. thesis, Glasgow, 2001). 2. Throughout this paper I use medical practitioners to indicate the various physicians, surgeons, apothecaries and irregular practitioners who provided medical services in early modern England; irregular practitioners are those who worked without membership of a medical guild or the College in London, or members who overstepped the division between their functions, see: M. Pelling, Medical Conicts in Early Modern London: Patronage, Physicians and Irregular Practitioners, 15501640 (Oxford, 2003). 3. Quotation from W S. D. Clippindale, A Medical Roll of Honour: Physicians and Surgeons who Remained in London during the Great Plague, British Medical Journal (6 Feb. 1909), 3513. See also W. G. Bell, The Great Plague of London in 1665 (1924), 87, 97; Ole Peter Grell, Conicting Duties: Plague and the Obligations of Early Modern Physicians Towards Patients and Commonwealth in England and the Netherlands, in A. Wear, J. Geyer-Kordesch and R. French (ed.), Doctors and Ethics: The Earlier Historical Setting of Professional Ethics (Amsterdam, 1993), 13152; R. H. P. Crawfurd, Plague and Pestilence in Literature and Art (Oxford, 1914), 18990; F. P. Wilson, The Plague in Shakespeares London (Oxford, 1927), 103, 157; J. F. D. Shrewsbury, A History of Bubonic Plague in the British Isles (Cambridge, 1970), 448; C. F. Mullett, The Bubonic Plague and England: An Essay in the History of Preventive Medicine (Lexington, 1956), 2078; A. R. Jonsen, A Short History of Medical Ethics (New York, 2000), 456. The idea that such a notable forefather of modern medicine as Galen could have ed has even attracted denials: J. Walsh, Refutation of the Charges of Cowardice Made against Galen, Annals of Medical History, new series, iii (1931), 195208.
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PLAGUES, MORALITY AND THE PLACE OF MEDICINE
Such judgements derive from a popular history of plagues as moral earthquakes that destroy the oldest and most sacred ties, as H. Southern described them in 1823.4 From this perspective, epidemics threaten an imminent social dissolution that can only be resisted by an altruistic heroism in which the self is offered as a sacrice for society, somewhat akin to Durkheims notion of altruistic suicide.5 To cast the doctor as the gowned hero who steps forwards from the wings is an easy step. However, the assumption that crises in health, such as plague epidemics, elicit an inevitable medical response is something which is hardly true today, let alone in the period before medicine became a professionalized state-sponsored activity.6 It is tempting to judge advocates of ight harshly, and to see their explanations of their actions as tissues of excuses disguising a failure of charity and duty.7 But such a conclusion fails to address the social and cultural construction of epidemics or the divergent inuences that shaped the, predominantly retrospective, accounts which historians largely rely upon. For early modern states and cities, religious rituals to propitiate God and charitable or civic efforts to alleviate poverty and contain the threat of social disorder were much more signicant concerns than the provision of medical assistance to the sick. Admittedly, measures to establish and maintain urban cleanliness in the streets and air were often signicant, but they were driven largely by civic initiatives that circumvented medical practitioners. The scale of state-sponsored medical provision during plague epidemics in nations and cities throughout Europe, normally consisting of at most a small handful of medical practitioners employed primarily to identify cases and give advice on hygiene, underlines the marginal part medical practitioners played in plague policies. As Lawrence Brockliss and Colin Jones have noted: the plague script did not leave much room for positive action from physicians.8 It was St Carlo Borromeo, the bishop of Milan, who was the archetypal hero of early modern plague, not Dr Rieux, the physician-hero of Camus Oran. This pattern of limited state interest in medical provision during epidemics was matched by the at best ephemeral attention given to the moral obligations of medical practitioners. Contrary to some recent suggestions, the ethical obligations of English medical practitioners
4. H. Southern, Writers on the Plague, Retrospective Review, vii (1823), 21939. 5. E. Durkheim, Suicide: A Study in Sociology, trans. J. A. Spaulding and G. Simpson (1952), 21740. 6. P. Farmer, Infections and Inequalities (Berkeley, 1999). A more general discussion of the social framing of disasters is given in E. Klinenberg, Heat Wave: A Social Autopsy of Disaster in Chicago (Chicago, 2002). 7. See, for example, Grell, Conicting Duties, 138. 8. Laurence Brockliss and Colin Jones, The Medical World of Early Modern France (Oxford, 1997), 69.
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3 during plague were largely neglected in the general debate on ight.9 Nor were they elaborated in a separate literature of medical ethics; indeed, the very existence of a medical ethics in England before the eighteenth century has been forcibly questioned.10 However, this did not mean that medical discourses were free of moralistic commentary on plague and ight. To understand medical reactions to plague or indeed any other social response to it we need to situate them within the political economy of early modern medicine, while treading cautiously in our moral judgements. Moral assertions were, as Andrew Wear has noted, assertive rather than deliberative.11 On the occasions where medical practitioners were attacked for eeing plague, it was almost always as part of an institutional dispute between medical practitioners, particularly between the London College of Physicians and those who resisted its authority. Moreover, such critiques remained within the context of these internal occupational conicts and were not picked up by a wider audience. Although at the margins of mainstream debates on ight, early modern conicts over, and uses of, plague practice offer an unusual insight into the social and economic role of medical practitioners and the discursive structure of sixteenth- and seventeenth-century occupational disputes. In particular, they highlight the strategic uses of plague in occupational self-fashioning by early modern medical practitioners a process that, ironically, has some parallels with the professional concerns which shaped the nineteenth-century medical histories in which the realities of earlier plague practice were rst obscured.12 The signicance of plague to such identity work underlines the generative richness of epidemics: they were rich sources of cultural capital in a society still acutely aware of their providential signicance. In this, epidemics have clear similarities to other moments of crisis,
IN EARLY MODERN ENGLAND 9. For this account criticized here, see Grell, Conicting Duties. See also O. P. Grell, Plague, Prayer and Physic: Helmontian Medicine in Restoration England, in O. P. Grell and A. Cunningham (ed.), Religio Medici: Medicine and Religion in Seventeenth-Century England (Aldershot, 1996), 20427; O. P. Grell, Plague in Elizabethan and Stuart London: The Dutch Response, Medical History, xxxiv (1990), 42439. 10. Brockliss and Jones, Medical World, 82. Signicant contributions to the history of medical ethics have largely appeared in the last decade: R. Baker (ed.), The Codication of Medical Morality. ii. Anglo-American Medical Ethics and Medical Jurisprudence in the Nineteenth Century (Dordrecht, 1995); R. Baker, D. Porter, and R. Porter (ed.), The Codication of Medical Morality. i. Medical Ethics and Etiquette in the Eighteenth Century (Dordrecht, 1995); W. Schleiner, Medical Ethics in the Renaissance (Washington, 1995); A. Wear, Medical Ethics in Early Modern England, in Wear, Geyer-Kordesch and French, Doctors and Ethics, 98131; R. Cooter, Review Article: The Resistible Rise of Medical Ethics, Social History of Medicine, viii (1995), 25770; L. Haakonssen, Medicine and Morals in the Enlightenment: John Gregory, Thomas Percival and Benjamin Rush (Amsterdam, 1997); D. Harley, The Good Physician and the Godly Doctor: The Exemplary Life of John Tylston of Chester (166399), The Seventeenth Century, ix (1994), 93117. 11. Wear, Medical Ethics, 98. 12. W. J. Friedlander, On the Obligation of Physicians to Treat Aids: Is There a Historical Basis, Reviews of Infectious Diseases, xii (1990), 191203; J. C. Burnham, How the Idea of Profession Changed the Writing of Medical History. Medical History, Supplement xviii (1998).
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4 PLAGUES, MORALITY AND THE PLACE OF MEDICINE notably war or duels, as trials of character and honour.13 Through epidemics, medical practitioners were able to become moral heroes. However, such moral heroism is by denition exceptional, and it should again be emphasised need not imply an obligation for others to match their deeds.14 To understand the obligations of medical practitioners during plague epidemics in early modern England, we need to begin with the general debate on the ethics of ight from plague. This was conducted in the plague tracts that appeared in large numbers across Europe from the fourteenth to the eighteenth centuries.15 The debate centred on a moral and physical quandary. There was widespread if not total agreement that ight was the best preservative against plague, and there were clear scriptural injunctions to use all available means to preserve life (these were, after all, the gift of God). However, ight meant abandoning the sick and poor, thereby transgressing against the key Christian duty to love ones neighbour. The acceptability of ight thus presented a frustrating, probably irresolvable, question of conscience. Views on ight differed signicantly even within the protestant commentaries that largely shaped the English plague literature. Nonetheless, there were some points on which most commentators found common ground. In particular, there was nearly universal agreement that two groups, the magistrates and clergy, could not depart. As the prominent reformer and bishop of Gloucester and Worcester, John Hooper, wrote, there were such ofcers of trust [who] for no cause may ee:
the bishop, parson, vicar, and curate, who hath the charge of those that God pleaseth to infect with the pestilence [and] Such also as have places and
13. A. Walsham, Providence in Early Modern England (Oxford, 1999), 15962. M. James, English Politics and the Concept of Honour 14851642, Past and Present, Supplements, iii (Oxford, 1978); J. S. A. Adamson, Chivalry and Political Culture in Caroline England, in K. Sharpe and P. Lake (ed.), Culture and Politics in Early Stuart England (Basingstoke, 1994), 16197; M. Peltonen, Francis Bacon, the Earl of Northampton, and the Jacobean Anti-Duelling Campaign, Historical Journal, iliv (2001), 128; B. Donagan, Codes of Conduct in the English Civil War, Past and Present, cxviii (1988), 6595. 14. T. L. Beauchamp and J. F. Childress, Principles of Biomedical Ethics (5th edn, Oxford, 2001); J. O. Urmson, Saints and Heroes, in A. I. Melden (ed.), Essays in Moral Philosophy (Seattle, 1958), 198216; J. Feinberg, Supererogation and Rules, in J. J. Thompson and G. Dworkin (ed.), Ethics (New York, 1968), 391411. 15. P. Slack, Mirrors of Health and Treasures of Poor Men: The Uses of the Vernacular Medical Literature of Tudor England, in C. Webster (ed.), Health, Medicine and Mortality in the Sixteenth Century (Cambridge, 1979), 23773; P. Slack, The Impact of Plague in Tudor and Stuart England (1985); C. Jones, Plague and Its Metaphors in Early Modern France, Representations, liii (1996), 97127. See also M. Chase, Fevers, Poisons, and Apostemes: Authority and Experience in Montpellier Plague Treatises, in P. O. Long (ed.), Science and Technology in the Middle Ages (New York, 1985), 15369; J. Arrizabalaga, Facing the Black Death: Perceptions and Reactions of University Medical Practitioners, in L. Garcia-Ballester, R. French, J. Arrizabalaga and A. Cunningham (ed.), Practical Medicine from Salerno to the Black Death (Cambridge, 1994), 237 88. The context for these ethical debates is discussed in K. Thomas, Cases of Conscience in Seventeenth-Century England, in J. Morrill, P. Slack and D. Woolf (ed.), Public Duty and Private Conscience in Seventeenth-Century England (Oxford, 1993), 2956.
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IN EARLY MODERN ENGLAND
ofces of trust for the commonwealth, as the captains of soldiers in the time of war, judges and justices in the time of peace.16
At most, some authors reluctantly allowed that magistrates and clergy might arrange suitable substitutes to take their place. Nearly all writers also agreed that, just as magistrates and clergy should not abandon their positions, people must full any obligations they had knowingly undertaken by accepting ofces or entering contracts. The heart of the problem lay in deciding what should be done by the mass of people who were free of such specic ofces or contracts. For them, the problem lay in balancing their obligations of charity, neighbourliness, kinship and service against their duty of self-preservation. Most English opinion on this question was spread between the opposing viewpoints of Martin Luther and the Calvinist theologian Theodore Beza, as Paul Slack has shown.17 Luther emphasised the strength of obligations to the community.18 Those strong in their faith would stay to help their neighbours, relying on providence to protect them. Beza, by contrast, condemned rash tarrying in an infected place as wilfully tempting God.19 It was the part of the Wise-man to y peril with reason. If someone could depart without the neglect of his Dutie and Publick offence I see no cause why he may not onely not do it, but also why he is not bound to do it.20 Slack has rightly emphasised that there was no sharp antithesis between advocates of ight and its opponents.21 Beza did not condone unrestrained ight (people must provide for their neighbours and kin) and he did not condemn those who stayed usefully. Conversely, Luther accepted and understood that many would ee in fear. This was not a static picture, but, as Slack suggests, it is possible to trace cautiously among tract writers a broad shift in opinion towards Bezas position by the early seventeenth century. Nonetheless, neither position ever completely dominated. There were still some vocal opponents to ight, such as the London cleric Henoch Clapham.22 Similarly, Thomas Dekkers angry pamphlets
16. John Hooper, An Homily To Be Read In Time Of Pestilence [1553], reprinted in The Fathers of the English Church (8 vols, London, John Hatchard, 180712), v, 239. Note that Hooper does not mention physicians having a duty to stay, and gives no reason to assume that he undoubtedly thought this: cf. Grell, Conicting Duties, 138. 17. Slack, Plague, 404. Catholic views on ight seem to have been complex and deserve more study: A. L. Martin, Plague? Jesuit Accounts of Epidemic Disease in the 16th Century (Kirksville, Mich., 1996), 11523, 180. 18. M. Luther, Whether One May Flee from a Deadly Plague [1527], in Luthers Works, ed. J. Pelikan and H. T. Lehmann (56 vols, Philadelphia, 1968), xliii, 11938. 19. T. Beza, A Learned Treatise of the Plague (1665; E.S.T.C. 31585), 3. An English translation had rst been published in 1580. 20. Beza, Learned Treatise, 18. 21. Slack, Plague, 42. 22. Arguably, Clapham was even more rmly opposed to ight than Luther, even denying its efcacy against plague: H. Clapham, An Epistle Discoursing upon the Present Pestilence (2nd edn, 1603; E.S.T.C. 5339), sig. C3v; W. T., A Casting up of Accounts of Certain Errors (1603; E.S.T.C. 23632). See Slack, Plague, 2337; Walsham, Providence in Early Modern England, 15962.
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6 PLAGUES, MORALITY AND THE PLACE OF MEDICINE about the lites abandonment of London seem to have found a ready audience.23 More generally, ight would always raise murmurings among those unable or too poor to depart. It is not hard to imagine the jealousy, fear and sense of abandonment that those left in the city would have felt. Popular criticisms of ight were often numbered among the popular errors attacked in plague sermons and tracts. Indeed, many tracts were palpably defensive about ight, suggesting that they aimed to shield from criticism those who had ed and thereby help keep order among those left behind.24 It is no coincidence that works condemning the ight of magistrates and clergy often come from authors outside the established Church, such as Quakers and Catholics. How, then, did medical practitioners fare in these discussions? Ole Peter Grell has argued that ight was among the most important ethical problems facing early modern Dutch and English physicians. He suggests that over the sixteenth century opinions on physicians ight shifted from opposition to acceptance, as the preservation of doctors for the good of the commonwealth began to be valued over the help they could give to the sick.25 Grells main thesis rests, however, on the problematic assumption that the callings of priests and physicians were intimately intertwined and that they therefore had identical obligations during plague.26 The evidence for opposition to the ight of medical practitioners in England evaporates if we look only at comments which do actually refer to physicians.27 In the advice on ight given in the general run of plague tracts, doctors were not numbered alongside clergy and magistrates as being bound to stay, even by opponents of ight such as Luther.28 However, there is little to suggest that this was because of a desire to preserve medical practitioners for the good of the commonwealth: most of the authors, largely clergymen of various hues, simply did not bother to comment on the duties of physicians. Medical practitioners were
23. T. Dekker, The Wonderfull Yeare (1603, E.S.T.C. 6534); idem, Rod for Runawayes (1625; E.S.T.C. 6520); idem, London Looke Back (1630; E.S.T.C. 16755). 24. Jones, Plague and its Metaphors. 25. Grell, Conicting Duties, 135. 26. Ibid., 134. 27. In Conicting Duties, Grell cites eight sources as evidence that English physicians were obliged to remain during plague. However, only one of these sources, by Stephen Bradwell (p. 141), explicitly opposes the ight of medical practitioners (see below). One, Clapham, Epistle Discoursing (p. 136), opposes ight in general, but includes no specic mention of medical practitioners duties. None of the other six sources states that physicians who were not city physicians contracted for that job (see below) should stay. On these sources: for John Hooper, see n. 17; for Gideon Harvey, see n. 45; for Martin Luther and Andreas Osiander, see n. 29; Johann von Ewich, see n. 36; and Francis Herring, see n. 46. My concern here is with the English side of Grells argument. 28. Luther mentioned city physicians, but offers no message for the individual physician (Conicting Duties, 1356): Luther, Whether One May Flee. The Lutheran theologian Andreas Osiander (Conicting Duties, n. 13) also ignores physicians: A. Osiander, How and Whither a Chrysten Man Ought to Flye the Horryble Plague of the Pestilence, a Sermon, trans. M. Coverdale (1537; E.S.T.C. 18878), especially sig. E7rE7v.
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7 ignored. Authors worried about poverty and disorder, not medical desertion. The emphasis was on the souls of the sick and their physical well-being, much as John Henderson found in renaissance Florence.29 In contrast, the lack of advice in the general literature suggests that contemporaries did not see medical practitioners as facing a decision which was any more difcult than that of other person. In this, England mirrored much of continental Europe, where a comparatively high level of state involvement focused concern on the more numerous city or town physicians rather than private practitioners.30 This neglect was nothing new: medical practitioners seem to have been ignored in medieval discussions of ight, despite Amudsens optimistic suggestions to the contrary.31 Similarly, in classical texts there are equally few signs that medical practitioners were thought to have a duty during plagues, to the embarrassment of some more modern commentators.32 Statements encouraging charity are common, but are balanced with the duty to care for ones own self .33 The only medical practitioners who did feature prominently in early modern plague tracts were town or city physicians. A number of tracts note that, as public employees, these civic physicians had a duty to stay during plague. Indeed, they were often specically employed to work during plagues. The employment of medical practitioners by magistrates during plagues was common throughout early modern Europe, although England was somewhat backward in comparison with much of the continent. Johannes von Ewich, himself a town physician
IN EARLY MODERN ENGLAND 29. J. Henderson, Epidemics in Renaissance Florence: Medical Theory and Government Response, in N. Bulst and R. Delort (ed.), Maladies et Societe (Paris, 1989), 16586. 30. For France, ight was only an issue for state physicians: Jones, Plague and Its Metaphors, 11415; Brockliss and Jones, Medical World of Early Modern France, 1314, 69. In Italy, problems centred on recruiting town physicians, not eeing private doctors: G. Calvi, Histories of a Plague Year: The Social and the Imaginary in Baroque Florence, trans. D. Biocca and B. T. Ragan (Berkeley, 1989), 6270. In Barcelona Miquel Parets anger about ight focused only on magistrates and clergy: J. S. Amelang (ed.), A Journal of the Plague Year: The Diary of the Barcelona Tanner Miquel Parets, 1651 (New York, 1991), 1819, 22, 56. Discussing Jesuits (who themselves mostly ed), Martin notes some criticism of physicians for ight, but it is unclear if this is directed at town physicians or physicians in general: Plague?, 11718. 31. D. W. Amundsen, Medicine, Society, and Faith in the Ancient and Medieval Worlds (Baltimore, 1996), 289309. Amundsens argument that fteenth-century physicians considered ight unethical has weak foundations. His crucial assertion, that ight was viewed as acting shamefully (p. 294), relies on three dated secondary works (listed 294, n. 15) which themselves cite only two overlapping sources, both Italian, neither of which in fact explicitly condemns ight by physicians. 32. Hippocrates, trans. W. H. S. Jones (1923), xviiixix. The translator W. H. S. Jones attempted to defend the apparent callousness of Epidemics. His suggestion that we must not suppose that the fatally-stricken patients of the Epidemics received no treatment or nursing contradicts the lack of comment on this in the text, and underlines his discomfort with the notion that the physician might feel no duty to care. 33. Precepts, in Hippocrates, 319. Grell takes another part of the same passage to imply an obligation and implies that there are other passages where ight is a problem (Conicting Duties, 134 and n. 10). However, I nd nothing in the works cited to suggest that physicians had a duty to serve during epidemics (Epidemics I, II/III or the Hippocratic Oath). More generally, see V. Nutton, Beyond the Hippocratic Oath, in Wear, Geyer-Kordesch and French, Doctors and Ethics, 1037.
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8 PLAGUES, MORALITY AND THE PLACE OF MEDICINE in Bremen, argues at length for such provision in a book that was translated into English in 1583, with the addition of a pointed dedication to the Mayor and Aldermen of London. Ewich suggests that once the magistrates who were to remain as preservers of health had been selected, their rst task should be to
provide the common wealth of Phisitions, Chirurgians, and such as they commonlye call Apothecaries, such as for yeares, fame, experience, honestie of manners, virtue, and the feare of God, they shall iudge to bee best liked and tte
They should be hyred for a convenient stipend, & bound by oth unto the common wealth, that they take no occasion to start away, for feare of the sickness greatly increasing, and supervised by the magistrates.34 It is signicant that unlike the magistrates and pastors whom Ewich also advises selecting these medical practitioners were not substitutes for those who normally worked in the city. Rather, they were contracted as a special provision for the duration of the epidemic.35 Medical practitioners omission from ethical discussions in most plague tracts reects the distinction between their position and that of the clergymen and magistrates who were bound to remain. For priests and magistrates, remaining in a town or parish during plague was a duty inherent to their ofce. A priest explicitly accepted the care of a parish just as a magistrate accepted his appointment. Both ofces were a matter of general concern to the public and carried important responsibilities to order the spiritual and physical life of the community during epidemics. They had weighty callings, the essence and foundation of any society, as the theologian William Perkins described them. This position stood in sharp contrast to most medical practitioners work, and the understanding of their vocation as an ordinary calling.36 Medical practitioners typically contracted with individual patients for specic cures. Few had a well-dened, long-term relationship with their patients.37 Even fewer had a contract with the state or locality, something
34. J. Ewich, Of the Duetie of a Faithfull and Wise Magistrate, in Preserving and Delivering the Commonwealth from Infection, in the Time of the Plague or Pestilence, trans. J. Stockwood (1583, E.S.T.C. 10607), fos 13v14r. 35. Grells claim that Ewich thought physicians should stay is weak (Conicting Duties, 140). The moral axiom Grell cites (He greatlie offendeth against the rule of charitie, whosoeuer according to his abilitie doth not seek and bring some ayde, as it were a preseruative) is part of an argument that the care and charge of the commonwealth belongs to the magistrate, as the chapters title states. The axiom sentence continues: it is the Magistrate most of all, who in this common calamitie or miserye both can and ought incomparison of others to do most: Duetie, fo. 4r. 36. P. Marshall, A Kind of Life Imposed on Man: Vocation and Social Order from Tyndale to Locke (Toronto, 1996), 43. 37. Pelling, Medical Conicts; G. Pomata, Contracting a Cure: Patients, Healers, and the Law in Early Modern Bologna (Baltimore, 1998).
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9 which was particularly rare in England by European standards. It is no surprise, then, that much of the medical advice published during early modern epidemics assumes that most people, especially the poor, would look after themselves just as they did normally.39 Moreover, the dangers and divine associations of plague often aroused the physicians traditional caution about accepting hard and dangerous cases.40 Private medical practice simply did not constitute a public ofce. It therefore did not carry a specic obligation to stay during plague. The signicance of ofce-holding in differentiating the duties of clergy and magistrates from those of physicians is apparent in one of the few, perhaps the only, tract not written by a doctor which expressly discusses medical practitioners. In 1603, James Balmford, the vicar of St Olaves, Southwark, whose own controversial failure to visit the sick during plague perhaps attuned him to such issues, wrote that
38
As for Phisitions, I onely propound this question: Whether they be bound in conscience to be resident, in regard of their profession, and ability to do good, or [if] they may use their liberty to shift for themselves, & (as they thinke) for their lives, in regard they are no publicke persons, and live (not by a common stipend, but) by what they can get. But howsoever this question be answered, I dare say thus much, that a Phisition, who may do much more good than a keeper, hath a great interest in Gods promise and providence.41
Balmfords own opinion was clear: physicians ability to do good should constrain them even if their ofce did not. However, he left the question open, perhaps unwilling explicitly to judge medical practitioners against the weight of common opinion. A handful of other traces of opposition to the ight of physicians suggest that he was not alone. In April 1630, members of the College of Physicians were in bad repute because they did not go out in their gowns in the streets, an avoidance of public recognition which may have been linked to the growing epidemic.42 Similarly, Dr Goddards explanation of his absence during the 1665
38. Margaret Pelling, The Common Lot: Sickness, Medical Occupations and the Urban Poor in Early Modern England (1998); Andrew Wear, Caring for the Sick Poor in St Bartholomews Exchange: 15801676, in R. Porter and W. Bynum (ed.), Living and Dying in London, Medical History, Supplement xi (1991), 4160. More generally: A. W. Russell (ed.), The Town and State Physician in Europe from the Middle Ages to the Enlightenment (Wolfenbuttel, 1981), 4761. 39. See W. Boraston, A Necessarie and Briefe Treatise of the Contagious Disease of the Pestilence (1630; E.S.T.C. 3372), sig. A5r; Thomas Sherwood, The Charitable Pestmaster (1641; E.S.T.C. 6113), sig. A2r; T. Cocke, Advice to the Poor by Way of Cure and Caution (1665). 40. D. E. J. Linden, Gabriele Zerbis De Cautelis Medicorum and the Tradition of Medical Prudence, Bulletin of the History of Medicine, lxxiii (1999), 26. Cf. Wear, Knowledge and Practice, 2778. 41. James Balmford, A Short Dialogue Concerning the Plagues Infection (1603; E.S.T.C. 1338), 72. Balmfords arguments on clergy were rebutted by W. T., A Casting up of Accounts. 42. This was the College meeting during which plague regulations were considered: Royal College of Physicians, London, Annals, iii, 283. I am grateful to the Royal College of Physicians for permission to cite their records.
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10 PLAGUES, MORALITY AND THE PLACE OF MEDICINE epidemic received short shrift from Samuel Pepys, who had himself remained in the city during the plague, probably because of his duties as a public servant.43 Nonetheless, the scarcity of comment argues against the existence of a widespread perception that medical practitioners had particular obligations during plague. Signs that many medical practitioners would have disagreed with Balmfords view of their obligations during plague can be found in a number of sources. Most of these date from the seventeenth century, and thus, as might be expected, share in the consensus that ight was acceptable for those without public ofce. Perhaps most telling is that most of the numerous medical practitioners who wrote about the plague simply ignored the subject of moral obligations. Of the few who did mention a duty to the sick, several only did so in order to claim that by publishing medical advice they had fullled it. When the irregular physician Gideon Harvey commented in 1665 that Physicians can never discharge their Duty with greater Applause, than by contributing their aid to popular Diseases, the aid he had in mind was his tract, not his presence.44 Francis Herring, a prominent gure in the College of Physicians, had made a similar claim in his successful book on plague in 1603.45 Similar opinions about the very limited duties of physicians seem to have been common. For example, several times during and after the 1665 epidemic, medical practitioners, some connected with the College of Physicians, suggested that their responsibilities extended only to their existing patients: once these were provided for, they might leave. Even Nathaniel Hodges, head of the College physicians employed in London during the epidemic, agreed. Although hardly enthusiastic, Hodges was clear that other physicians were perfectly proper to retire, sweetening this with the suggestion that they did so not so much for their own Preservation, as the Service of those whom they attend.46 Hodges articulated the position implicitly adopted by the College of Physicians throughout this and earlier epidemics, as can be seen from their unenthusiastic responses to suggestions that they should provide
43. S. Pepys, The Diary of Samuel Pepys, ed. R. Latham and W. Matthews (11 vols, 1970), vii, 21. 44. G. Harvey, A Discourse of the Plague (1665; E.S.T.C. 9710), 1. Although Harvey is the source of Grells openning quote (Conicting Duties, 131), he does not suggest that physicians should stay and recommends ight as a preservative. 45. Francis Herring, Certaine Rules, Directions, or Advertisments for this time of Pestilentiall contagion (1625; E.S.T.C. 13242), sig. B2v. Another example is T. Lodge, Treatise of the Plague (1603; E.S.T.C. 16676). Herrings tract was rst published in 1603, and reprinted in 1625, 1665 and 1757. Grell suggests that Herring advocated against ight (Conicting Duties, 141). However, Grells quote is, in fact, a commonplace warning against ight without penitence (So long as they carie their sinne with them, the Lord will nd them out: ibid., sig. A3v). Elsewhere, Herring assumes that ight is the norm and makes a plea for charity to support those left behind (ibid., sig. Br). He seems to have regarded listing prescriptions as fullling his own duties: Ibid., sig. Br. 46. N. Hodges, Loimologia, or an Historical Account of the Plague in London in 1665, trans. J. Quincy (1720), 23.
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11 physicians to work for the city. The physician William Kemp, a supporter though not a member of the College, was even rmer, warning his readers to: Think well then of your Doctor, and oblige him whilest you are in health, to venture his life to preserve you when you are sick.47 The mixed feelings surrounding ight were better expressed by the author of A Touchstone for Physick (1667). He left London during the plague because of obligations of tenderness. However, before departing he had provided for the needy, made sure his medicines were available and had long declined Practice, visited none, nor had then so much as one Patient under my hand.48 He therefore met the criteria of contrition, neighbourliness and freedom from obligations of contract that made ight acceptable. Ironically, if medical practitioners had a durable moral responsibility to anyone, it was, as Hodges had implied, to those patients who were most likely to depart the wealthy. Where an ongoing responsibility for patients did exist, it seems to have been restricted to physicians practising at the very top of society, where they could exist in a quasifeudal dependence upon their patrons.49 This is born out in other contemporary discussions of physicians moral responsibilities. These focus almost exclusively on their obligations to individual patients and other practitioners, rather than to the community at large.50 Even in the more developed continental literature on medical ethics, ight does not appear to have been discussed.51 There is little indication that early modern English physicians faced a greater weight of ethical duties than did the practitioners of any other craft or art, even during plagues. Thus far, we have been examining what medical practitioners were obliged to do during plagues. However, having a sense of the moral minimum, the aim of much of the debate about ight, did not preclude people acting in an exemplary manner. For medical practitioners, their freedom from generally recognised obligations during plague did not close debate about their actions during epidemics. Nor did it remove the irony of healers eeing disease, which Bradwell and others recognised. Instead, it shifted the issue to the register of exceptional, courageous and signicant behaviour. As a symbolic token, plague thus became
IN EARLY MODERN ENGLAND 47. W. Kemp, A Brief Treatise of the Nature, Causes, Signes, Preservation from, and Cure of the Pestilence (1665; E.S.T.C. 6407), 73. 48. W.W., A Touchstone for Physick (1667; E.S.T.C. 9839), 81. W.W. has been tentatively identied as the Leveller leader and medical practitioner William Walwyn. George Castle reected this cautious, uncourageous, but effectively unembarrassed, stance in offering ight as the reason why his book had been delayed: The Chymical Galenist (1667; E.S.T.C. 21752), sig. A3v. 49. Pelling, Medical Conicts; N. D. Jewson, Medical Knowledge and the Patronage System in 18th Century England, Sociology, viii (1974), 36985. 50. M. Fissell, Innocent and Horrible Bribes: Medical Manners in Eighteenth Century Britain, in R. Baker, D. Porter and R. Porter (ed.), The Codication of Medical Morality (Dordrecht, 1993), 1945; Harley, The Good Physician, 93117; D. Harley, Ethics and Dispute Behaviour in the Career of Henry Bracken of Lancaster: Surgeon, Physician and Manmidwife, in Baker, Porter and Porter, Medical Morality, 4771. See also: Wear, Medical Ethics, 98130. 51. Schleiner, Medical Ethics; Linden, Zerbis De Cautelis.
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12 PLAGUES, MORALITY AND THE PLACE OF MEDICINE entwined with the combative construction of identity. Because of this, ight or its rejection were an issue within certain structural and economic tensions within medicine, chiey in the late sixteenth and seventeenth century. In particular, practising during plague was a regular feature of the active self-fashioning of public and political identities by various irregular practitioners, especially those who resisted the authority of the College of Physicians in London. There were several reasons for this. Epidemics were, most obviously, rich opportunities for medical practitioners seeking to prove their character and skill. An individuals reputation was of crucial importance to their success in medical practice. While it may have been widely accepted and practised, prudent ight was hardly a source of social or cultural capital. By contrast, a heroic, and successfully survived, stand against plague was something to be cried around town. After all, there could be little suggestion that medical practitioners were tarrying wastefully. The combination of bravery and charity involved in plague practice made it particularly signicant as a trial of character. Equally, plague had an unusual force as a trial of ability. The deadliness of plague and the difculties of curing it were widely acknowledged by medical practitioners of all theoretical orientations barring the few who, like Theophilus Garencires, were making even more ambitious claims by suggesting they had the secret of its cure.52 As the Galenic physician Thomas Lodge noted, plague was worthily called pernicious, because there can be nothing more dangerous then the same, which by the malignity and violence thereof inforceeth sodaine death.53 Plagues value as a test was of particular importance in 1665 for the chemical physicians, who had an entire medical system to justify. But the same incentive of proving skill could hold for all manner of practitioners, such as William Sermon.54 An interesting twist to this was practitioners publicising their own survival of plague as evidence of skill and embodied knowledge.55 In regulated environments, like early modern London or the corporate towns and cities of Europe, the chance to establish a reputation which epidemics presented was of particular importance for those irregular
52. Wear, Knowledge and Practice, 28898; T. Garencires, A Mite Cast into the Treasury of the Famous City of London (3rd edn, 1666, E.S.T.C. 28669), 23. Garencires dismissed the chemists claims (89). J. Longrigg, Epidemics, Ideas and Classical Athenian Society, in T. Ranger and P. Slack (ed.), Epidemics and Ideas: Essays on the Historical Perception of Pestilence (Cambridge, 1992), 22. On the futility of medicine during the Black Death: A. M. Campbell, The Black Death and Men of Learning (New York, 1966), 3; D. Palazotto, The Black Death and Medicine: A Report and Analysis of the Tractates Written between 1348 and 1350 (Ph.D. thesis, University of Kansas, 1973), 159, 2456. 53. Lodge, Plague, sig. B1v. Dekker was equally cynical about the efcacy of medicine: Wonderfull Year, 1617; Thomas Dekker, Newes from Graves-End (1604; E.S.T.C. 12199), sig. C2vC3r. See Slack, Plague, 2430. 54. H. J. Cook, The Decline of the Old Medical Regime in Stuart London (Ithaca, 1986), 47. 55. As Simon Forman and George Thomson both did: L. Kassell, Simon Formans Philosophy of Medicine: Medicine, Astrology and Alchemy in London, c.15801611 (D.Phil. thesis, University of Oxford, 1997), 64; G. Thomson, Loimotomia: Or the Pest Anatomised (1666; E.S.T.C. 1148).
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13 practitioners who worked without proper licence as regular physicians well knew.56 In 1583, Ewich warned against experimenting Jews, Paracelsists, alchemists and jolly brave fellows seeking to prot from plague.57 However, as he feared, such cautions were repeatedly ignored. Among prominent English irregulars from the earlier part of the seventeenth century, the reputations of the Dutch immigrant physician Raphael Thorius, the troublesome apothecary-turned-doctor John Buggs and the astrological physician Simon Forman were all based in part upon their work during plagues.58 In London, numerous irregular medical practitioners even received ofcial patronage during plagues.59 Reputations earned during plague were easily translated into political claims in the aftermath of epidemics. In the seventeenth century, London-based irregular practitioners who had practised during epidemics repeatedly presented their work as a justication for subsequently continuing to practice without the necessary permission from the College of Physicians, which possessed a corporate monopoly on medical practice within the city and seven miles around.60 The absence of the College physicians was repeatedly highlighted in these arguments, underlining the continuing ambiguities about ight and charity. As early as the 1630s, the Society of Apothecaries claimed a right to practise physic on the basis that the willinge absence of the Physicians during the recent plague had compelled the apothecaries to supply the general necessities of the Kings subjects, a claim its supporters reiterated following the 1665 epidemic.61 More dramatically, in 1647, William Trigge sent a petition signed by 3,000 people to the House of Lords, in which he describes his service during the 1630 and 1636 plagues in London when most of the College doctors deserted us. Trigges reputation and his remedies were still remembered in 1665.62 John Buggs had earlier anticipated Trigges strategy when pursued by the College. As Trigges example suggests, memories of plague practice could remain potent for years. In 1678 the Colleges pursuit of
IN EARLY MODERN ENGLAND 56. The importance of character is brought out in H. J. Cook, Good Advice and Little Medicine: The Professional Advice of Early Modern English Physicians, Journal of British Studies, xxxiii (1994), 131; Harley, The Good Physician, 93117; Fissell, Innocent and Horrible Bribes, 1945. 57. Ewich, Duetie, fos 16v17r. 58. Pelling, Medical Conicts; Guildhall Library, ms 8285, fo. 26; Kassell, Formans Philosphy, 645, 92, 118, n. 1. 59. Bell, Great Plague, 356, 389; T. Cocke, Advice to the Poor by way of Cure and Caution (1665; E.S.T.C. 15569). Thomas Lodge sought this for his Treatise: Plague, sig. A3v. For cases from Florence: Calvi, Histories, 97104. 60. On the defences employed by irregulars, see: Pelling, Medical Conicts. 61. Cecil Wall, H. Charles Cameron and E. Ashworth Underwood, A History of the Worshipful Society of Apothecaries of London (1963), 47; P. H. J. Wallis, Medicines for London: The Trade, Regulation and Lifecycle of London Apothecaries, c.1610c.1670 (D.Phil. thesis, University of Oxford, 2002). 62. Cook, Decline, 13. For Trigges reputation in 1665: Robert Barker, Consilium Anti-Pestilentiale (1665), sig. B4r; Dr. Triggs Secrets, Arcanas & Panaceas (1665; E.S.T.C. 221780).
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14 PLAGUES, MORALITY AND THE PLACE OF MEDICINE one Mr Russell for unlicensed practice was halted when they received a letter from the Lord Chamberlain informing them of the kings favour towards Russell, who had remained in the time of the great plague doing great good to the public at that time.63 A few years earlier, Mary Trye, daughter of the chemical physician Thomas ODowde who had died during the epidemic, had made equally good use of his plague practice to defend his memory and her own practice against the aspersions of Henry Stubbe.64 These claims were based on more than the good name that plague practice could bring. The plague practices of irregular practitioners served as a defence against the College because it allowed them to exploit the one gaping legal loophole in the rights of the College. It was commonly accepted that there were two substantial reasons for practising physic without licence: charity and emergency. These two Christian imperatives had long existed in tension with the monopolistic structures of organized medicine in London, as Andrew Wear has argued.65 Despite the opposition of the medical corporations, they had been articulated in a Statute of 1543, and were repeatedly employed in arguments against the College through the sixteenth and seventeenth centuries.66 By appealing to them, irregular practitioners could avoid appearing to be innovators or upstarts against the Colleges privileges. As they repeatedly claimed, they did not seek to practice, rather they were forced into it by the needs of those abandoned by the physicians. Plague worked particularly well as the context for such an argument: it was easily represented as the most extreme manifestation of these conditions, as the denitive emergency, when charity was most stretched and physicians were often absent, and when the needs of the poor and sick were undeniable. The sheer horror of the disease and its judgmental associations gave the stricken city the potential to be refashioned as a theatre of ability and providence, an arena where spiritual necessity overcame everyday norms. Plague thereby legitimated behaviour which would be illegal in normal times. And because they, and not the physicians, had responded to the poor, the irregular practitioners who remained in London during the plague could claim to have earned the right to practise even in non-epidemic times as a reward for valour. In contrast, they could suggest that the College had failed its own city. This political and providential discourse of disaster was not restricted to medical conicts. In the aftermath of the 1665 epidemic, the nonconformist clergy who had recently been ejected from their parishes
63. Cook, Decline, 12931, 191. 64. M. Trye, Medicatrix; or the Woman-Physician (1675; E.S.T.C. 25832), 55, 65. 65. Wear, Medical Ethics. 66. Wallis, Medicines for London; Society of Apothecaries, Reasons, Humbly Offered to the Honourable House of Commons ([1695], E.S.T.C. 220601), sig. Ar; Society of Apothecaries, Considerations Humbly Offered to the Lords Spiritual and Temporal ([1695]; E.S.T.C. 231367).
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15 in large numbers by the restored crown constructed an almost identical argument against those conformist priests who ed their posts. As Richard Baxter recounted, after most of clergy ed, nonconformist ministers pitying the dying and distressed people chose to defy their exclusion and preached, visited the sick and relieved the poor. In terms which echo the claims of the irregulars, he portrays the nonconformists breaking earthly laws only when overwhelmed by the clarion call of divine imperative: no law could justify the neglecting of Mens Souls and Bodies in such extremities. As a result, he claimed that the authority of the conformists was fundamentally compromised insomuch that to this Day the freedom of Preaching, which this occasioned, cannot, by the daily Guards of Soldiers, nor by the imprisonment of Multitudes be restrained. But this popular acclaim was not the end that the nonconformists sought. Their ambition which again parallels that of the chemical physicians was to overturn the religious settlement that had led to their ejection. Plague tted neatly into a conservative discourse, allowing them to circumvent, not overthrow, the established order.67 It should be emphasised that, as with all such arguments, the irregular medical practitioners appealing claim to be answering popular need in the absence of physicians should be treated with caution perhaps more caution than the claims of the nonconformists. This formula owed more to the legal signicance of charity and emergency than to reality. Presumably, epidemics produced an upsurge in customers for medical advice. But the departure of College physicians was unlikely to have affected the medical assistance available to most Londoners. There were too few learned physicians to meet the needs of the City even in normal times, and most of those who normally employed learned physicians themselves ed plague.68 Equally, irregulars had probably already embarked on practice before the epidemic, although plague may, admittedly, have made them more open about their work.69
IN EARLY MODERN ENGLAND 67. R. Baxter, Reliquiae Baxterianae (1696; E.S.T.C. 16109), iii, 2. See also R. Tatnall, An Antidote Against the Sinfull Palpitations of the Heart (1665; E.S.T.C. 24099), sig. A3r; M. M., Solomons Prescription For the Removal of Pestilence (1666; E.S.T.C. 18395), 4161, 723; T. Vincent, Gods Terrible Voice in the City (1667; E.S.T.C. 22252), 1923. Like the College, Anglican clergy resisted the nonconformist interpretation: British Library, Harleian ms 3785 fos 24, 26. See also J. W., A Friendly letter to the Flying Clergy (1665; E.S.T.C. 217620), 4; Defoe later disagreed: Journal of the Plague Year (New York, 1992 [1722]), 26. A. G. Matthews (ed.), Calamy Revised (Oxford, 1934), 43, 543; Bell, Plague, 2259; R. Hutton, The Restoration (Oxford, 1985), 2323; David Harley, The Politics of Plague, Providence, and Natural Causation in Restoration England (unpublished paper), 56; Spurr, From Puritanism to Dissent, 16601700, in C. Durston and J. Eales (ed.), The Culture of English Puritanism, 15601700 (1996), 2404; H. J. Cook, The Society of Chemical Physicians, the New Philosophy, and the Restoration Court, Bulletin of the History of Medicine, lxi (1987), 6177. 68. J. A. I. Champion, Londons Dreaded Visitation. Historical Geography Research Series, xxxi (1995), 401. 69. The numbers of College actions against irregulars dipped during epidemics and surged in their aftermath: M. Pelling, Medical Conicts, 479.
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16
PLAGUES, MORALITY AND THE PLACE OF MEDICINE
This broad tradition of opposition to the College of Physicians through arguments centred on plague practice was manifested principally in petitions and legal disputes. However, during and after the epidemic of 1665, it was articulated in print at greater length, and with more ambition, than ever before, as it was appropriated by the organised and vocal medical opposition which had emerged to the College. In large part, this can be seen in protestations of a group of chemical physicians, advocates of a new theory of medicine derived from the writings of Paracelsus and van Helmont, who were campaigning to replace, or at least co-exist with, the College of Physicians. Their discursive use of plague and ight in some of the urry of printed tracts they produced allows us to see in more detail how some of the representations of plagues in this period were shaped for very pragmatic purposes. The chemical physicians had incorporated plague into their dispute strategy even before it arrived in England. Early in 1665, while plague remained restricted to the Low Countries, their chief pamphleteer, George Thomson, correctly predicted that the College physicians would run out if plague appeared in London. His claim provoked vigorous denials from William Johnson, the chemist who ran the Colleges own laboratory.70 These proved futile, however: when plague arrived, the majority of the College physicians departed. Thomson therefore dedicated much of Loimologia (1665), his next pamphlet, to an attack on the ight of medical practitioners. In Loimologia, Thomson offered his own decision to remain in London as an exemplary alternative to ight, the option Galen had himself advised and taken:
although I could enjoy my ease, pleasure, and prot in the Country, as well as any Galenist; yet I would rather chuse to loose my life, then violate in this time of extreme necessity, the band of Charity towards my neighbour, and dedecorate that illustrious profession I am called to, in hopes to save myself according to that infamous, and insidious advice which Galen hath given his Disciples.71
Thomsons evocation of charity, responsiveness to emergency and Christian neighbourliness drew upon the standard irregular framing of plague practice. He linked this to several of the most commonplace tropes of anti-Galenist polemic: the pagan origins of Galenic medicine,
70. George Thomson, Galeno-Pale: or a Chymical Trial of the Galenists (1665; E.S.T.C. 33830), 11; William Johnson, Agurto-Mstix. Or, Some Brief Animadversions Upon Two Late Treatises (1665; E.S.T.C. 43321), 12. See Grell, Plague, Prayer and Physic, 204; W. R. Newman, Gehennical Fire (Cambridge, Mass., 1994), 2035. 71. George Thomson, Loimologia, a Consolatory Advice, and Some Brief Observations Concerning the Present Pest (1665; E.S.T.C. 220876), 2.
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17 the greed of physicians and the questionable civic loyalty of the College were charges of long standing.72 In presenting plague practice as a moral norm rather than a sign of exceptional virtue and skill, Thomson set out an unusual vision of the ethical obligations of medical practitioners that conicted with the general acceptance of their freedom to ee plague. Thomsons position imitated van Helmonts own deance of plague, just as his medical practices followed his theoretical model.73 Signicantly, by drawing a parallel between physicians and priests, it also allowed him explicitly to extend plague practice from a strategy to improve his own reputation into a weapon against the reputation of the College of Physicians. Thomson was not entirely isolated in articulating this position on ight and calling. Simon Forman, who thought his future success had been indicated by his own survival of the 1592 plague in London, condemned the ight of physicians who were note zelous for their profession to save the lives of the sicke and diseased in his early sixteenth-century plague writings.74 In 1625 the irregular physician Stephen Bradwell argued that:
Physitians, Chyrugians, Apothecaries, Midwifes, Keepers, and Searchers, whose callings are to be helpful to the sicke and weake (though not of the Plague, yet of other griefes) they ought (at least a convenient number of them, for the number of people remaining) to tarry and follow those Christian employments which they have undertaken, not for their owne benet only, but for the Commonwealth chiey.75
Physicians who abandoned the poor to devouring blunt fellows were also attacked in 1665 by William Boghurst, an apothecary in the parish of St Giles, who protested that ministers must preach, Captains must ght, Physitians attend upon the sick.76 Like Thomson, Forman, Bradwell
72. See, for example, R. Godfrey, Various Injuries & Abuses in Chymical and Galenical Physick (1674; E.S.T.C. 21846), 1445. A. Wear, Knowledge and Practice in English Medicine, 15501680 (Cambridge, 2000), ch. 8 and 9; C. Webster, The Great Instauration: Science, Medicine and Reform, 16261660 (1975), 2767, 2828; Pelling, Medical Conicts. For medieval examples of stereotypical greedy physicians: C. Rawcliffe, Medicine and Society in Later Medieval England (Stroud, 1995), 11519. 73. On van Helmont and plague: Godfrey, Various Injuries & Abuses, 1447. Writing in a Flemish environment in which town physicians were a well-established response to plague, Van Helmont centred his plague tract The Plague Grave on the failure of the Galenic physicians leadership and remedies, rather than their ight: J.-B. van Helmont, Oriatricke or Physick Rened, trans. J. Chandler (1662 [1648]; E.S.T.C. 15308), 10801, although see 1144. 74. Kassell, Formans Philosophy, 118. 75. S. Bradwell, A Watch-Man for the Pest (1625; ES.T.C. 3537), sig. A2r. Bradwell did not suggest that these practitioners would cure the plague which he considered too difcult. They were needed to preserve the healthy and treat the other sicknesses that proliferated at the same time as plague. During the next epidemic in London, eleven years later, Bradwell rejected ight and suggested that plague was curable: S. Bradwell, Physick for the Sicknesse Commonly Called the Plague (1636; E.S.T.C. 106184), sig. A3 rv. 76. W. Boghurst, Loimographia: Or an Experimentall Relation of the Plague [1666], ed. J. F. Payne, Transactions of the Epidemiological Society of London, Supplement to vol. xiii (1894), 5960, 745. See also Barker, Consilium, sig. A3rv.
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18 PLAGUES, MORALITY AND THE PLACE OF MEDICINE and Boghurst sought to present their presence during plague as a sign of virtue; as we might expect, they also shared the status of irregulars. However, in the hands of Thomson and his fellow chemical physicians, this relatively unusual view of medical practitioners ethical obligations became the basis of an extension of their campaign to create a Society of Chemical Physicians as an alternative or replacement to the College. Having argued that a physicians presence during an epidemic was inherent to his particular calling, just as ghting was to a soldier, Thomson extended the metaphor to conclude that physicians who ed should be punished as deserters:
If Straglers, Desertors, and Runnaways in an Army (when they are to go upon service) ought to suffer loss of life and Estate; I see no reason why these men, whose function obliges them to stand out to the last, should deserve less punishment if they deliver such a vast populous City to the fury of so implacable a Foe
This punishment was deserved not just because physicians withdrew their aid: by spreading fear they made people more vulnerable to the sickness and destroyed lives.77 It was an argument echoed by another chemical physician, George Starkey, who proposed that each deserterphysician should stand publiquely in some eminent place of Great Concourse, with a Collar of broken Urinals about his Neck, with a note of his Fault, Name, and place of abode.78 Starkeys suggestion aside, it is clear that, above all, the chemical physicians wanted the College to pay an institutional penalty for its members ight. As Thomson commented, if the Fugitives failed to return to do their duty, he hoped the sage Magistrate will be pleased hereafter to favour signally the true Artists.79 In exchange for such commission, encouragement and countenance, the chemical physicians were even willing to undertake the risky business of becoming a corps of plague physicians to visit the infected in this City.80 This plague corps does seem to have existed for a time, giving the Society of Chemical Physicians a short-lived reality, although it appears that it did not survive the epidemic.81 Indeed, the ultimate failure of the chemists plan may have resulted from their high-risk strategy: several of those involved died during the epidemic.82
77. Thomson, Loimologia, 2. 78. George Starkey, An Epistolar Discourse to the Learned and Deserving Author of Galeno-Pale, in George Thomson, Plano-Pnigmos, or, a Gag for Johnson (1665; E.S.T.C. 24128), 567. 79. Thomson, Loimologia, 11. 80. Ibid., 2, 1517. 81. See: An Advertisement from the Society of Chymical Physitians, Touching Medicines by them prepared, in pursuance of his Majesties Command for the Prevention, and for the Cure of the Plague ([1665]; E.S.T.C. 213124); Thomas, Society, 56. 82. N. Hodges, An Account of the First Rise, Progress, Symptoms and Care of the Plague: Being the Substance of a Letter from Dr. Hodges to a Person of Quality, in A Collection of Very Valuable and Scarce Pieces Relating to the Last Plague in the Year 1665 (1721), 35.
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19 The chemical physicians decision to make their (almost) last stand on the issue of ight from plague was relatively unusual in attempting to use the experience of plague to bolster their collective reputation and in articulating a coherent alternative to the usual position on ight. However, their effort to use the epidemic as proof of their right to practise medicine echoed the arguments of many earlier irregular practitioners, as did their use of plague as a trial of the effectiveness of their theories, something which they had frequently demanded before 1665.83 Obviously, they were unusually aggressive, both in their condemnations of the College and in their formation of a corps of plague physicians. Yet it was still essentially the same attempt to justify their usurpation of the Colleges privileges on the grounds of popular need that had been made many times before by other irregulars, albeit pushed to its furthest extent. Indeed, despite Thomsons heated rhetoric, more College physicians were present on an ofcial and voluntary basis in London during the 1665 plague than in any earlier epidemic. The different form and desperate edge of the chemical physicians proposal, seeking corporate endorsement as city physicians and thereby emphasising subservience to the authorities, may have been driven by the widespread fear of disruptions to the body politic in the 1660s and the related problems that their plan for a Society had encountered. When it was rst mooted early in 1665, the Society had attracted signicant patrons, including the Archbishop of Canterbury.84 However, on the eve of the plague it was in trouble at court.85 The College was rebutting chemical physicians claims to practise a more Christian and effective medicine with potent accusations of fanaticism, anarchism and enthusiasm, and dismissing their ambitions to change the legal structures surrounding medicine in London as a republican, levelling initiative.86 These charges were deeply troubling for their cause, even though few
IN EARLY MODERN ENGLAND 83. Thomson, Loimologia, 16. See also ibid., 186; Thomson, Galeno-Pale, 6; T. ODowde, The Poor Mans Physician (1664; E.S.T.C. 218541). On Helmontian theory: Wear, Knowledge and Practice, 36887; W. Pagel, Van Helmonts Concept of Disease to Be or Not to Be? The Inuence of Paracelsus, Bulletin of the History of Medicine, xlvi (1972), 41954. 84. T. ODowde, The Poor Mans Physician, 3rd edn (1665; E.S.T.C. 219420). For a clear description of the plan, see Cook, Society of Chemical Physicians, 6177. See also H. Thomas, The Society of Chymical Physitians, in E. A. Underwood (ed.), Science, Medicine and History (2 vols, Oxford, 1953), ii, 56; P. M. Rattansi, The HelmontianGalenist Controversy in Restoration England, Ambix, xi (1963), 123; C. Webster, English Medical Reformers of the Puritan Revolution, Ambix, xiv (1967), 1641. 85. Thomson, Galeno-Pale, 1037; Thomson, Loimotomia, 1739. This is reinforced by William Johnsons comment that the patent for a Society had been a Monster stied in the birth: Agurto-Mstix, 85. See Cook, Society of Chemical Physicians, 745. 86. R. Sprackling, Medela Ignorantiae (1665; E.S.T.C. 219132), 159; N. Hodges, Vindicae Medicinae & Medicorum (1665; E.S.T.C. 13220), sig. A3r. On this, see Hunter, Science and Society; M. Jenner, Quackery and Enthusiasm, in Grell and Cunningham (ed.), Religio Medici, 31339; Cook, Decline, 1589. Similar strategies were employed in other medical disputes: C. T., Some Papers Writ in the Year 1664 (1670; E.S.T.C. 220666), 1213; H. J. Cook, Physicians and the New Philosophy: Henry Stubbe and the Virtuosi-Physicians, in R. French and A. Wear (ed.), The Medical Revolution of the Seventeenth Century (Cambridge, 1989), 253.
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20 PLAGUES, MORALITY AND THE PLACE OF MEDICINE chemical physicians sought complete liberty from regulation in medicine. It should be noted that attempts to locate this medical opposition to ight within a broader theological context are problematic. In a recent essay, Grell has argued that the chemical physicians articulated a resurgent religious opposition to ight that was obviously a direct consequence of their religious and natural philosophical outlook with few supporters outside their ranks.87 The relationship between physic and theology has been much debated, and, irrespective of whether a particular sectarian position is involved, it is clear that many chemical physicians saw themselves as pursuing a more pious medicine than the Galenists.88 This may plausibly have pushed them towards an idea of medicine more akin to a clerical vocation. However, Grells assertion that the chemical physicians opposed ight because they shared a Christian spirituality manifest in their natural philosophy with many of the early reformers, relies on his earlier conclusion that these reformers opposed ight by physicians, ignores the plurality of Christian positions on ight, underplays the sectarian diversity of the chemical physicians, neglects other irregular deployments of plague practice, and fails to consider that despite the slandering of Galenism apparent in the chemists tracts there is little sign that they were, in practice, signicantly more religious than the College fellows: we should expect members of both groups to have reacted to a genuine theological imperative to stay.89 The contestable nature of the arguments that irregulars built around ight can be seen in another of the occasions on which the events of the 1665 plague were used against the College of Physicians. In the late 1660s and 1670s, the physicians ight surfaced in a pamphlet war between the London apothecaries and a faction of College physicians who were proposing that physicians should verse themselves in experimental philosophy and make their medicines themselves, cutting apothecaries out of learned medicine.90 It was a controversial project
87. Grell, Plague, Prayer and Physic, 218. 88. Webster, Great Instauration; P. Elmer, Medicine, Religion and the Puritan Revolution, in French and Wear, Medical Revolution, 1045. 89. On the religious beliefs of fellows of the College see H. J. Cook, Institutional Structures and Personal Belief in the London College of Physicians, in Grell and Cunningham, Religio Medici, 91114; W. J. Birken, The Dissenting Tradition in English Medicine of the Seventeenth and Eighteenth Centuries, Medical History, xxxix (1995), 197218; idem, The Fellows of the Royal College of Physicians of London, 16031643: A Social Study (Ph.D. thesis, University of North Carolina at Chapel Hill, 1977). 90. J. Goddard, A Discourse Setting Forth the Unhappy Condition of the Practice of Physick (1670; E.S.T.C. 18769); [D. Coxe], A Discourse wherein the Interest of the Patient in Reference to Physick and Physicians is soberly debated (1669; E.S.T.C. 225419). See Cook, Decline, 16282; Cook, Physicians and the New Philosophy, 256; Wallis, Medicines; Wall, Society of Apothecaries; R. S. Roberts, The London Apothecaries and Medical Practice in Tudor and Stuart England (Ph.D. thesis, University of London, 1964). Physicians making medicines had been threatened before: Roberts, London Apothecaries, 204; Hodges, Vindicae Medicinae, 54.
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21 even within the College, with clear parallels with the chemical physicians campaign against the College. Like the chemical physicians claims, it was founded on a contested philosophy. Moreover, as the apothecaries defenders charged, it would destroy the very being of a Corporation of the City of London.91 Making such a difcult case needed every scrap of argument which could be brought to bear. Plague was rst mentioned by the physician Christopher Merrett in his initial contribution, A Short View of the Frauds and Abuses Committed by Apothecaries, published in 1669. Attacking apothecaries for illegally practising physic one of the main reasons he and his associates put forward for circumventing them he argues that their most serious encroachments had occurred in the last decade, in particular since the Plague time, when, (most Physicians being out of Town) they took upon them the whole Practice of Physick, which ever since they have continued.92 It was an attempt to position the apothecaries as recent invaders in physic, and is probably the source of the mistaken commonplace linking the 1665 epidemic to the transition of the apothecary into a general medical practitioner.93 In fact, as Merrett would have known, apothecaries were practising physic long before 1665.94 However, his comment made sense as part of an angry polemic that portrayed apothecaries as radicals and innovators dangerous labels in Restoration London, as the chemical physicians had earlier learnt. Unfortunately, by haphazardly incorporating the plague into his diatribe, Merrett gave the apothecaries an easy opportunity to retaliate and defend their irregular practice. In their responses, Merretts critique is transformed into a defence. Without the work of apothecaries during the plague:
its well known the Kings Subjects (then much distressed) [would] had been in a worse and deplorable condition: The Doctors, with their Worships Greatness, being ed: May the wisdom of our nation, the Parliament, never forget to encourage such Men; neither the Citizens of London to value their friends
Plague illustrated their citizenship, signicant because citizens of London could pursue any trade they chose, and their importance in treating ordinary people a reminder of the excessive charging often blamed on physicians. In its evocation of neighbourliness and charity,
91. Medice Cura Teipsum! (1671; E.S.T.C. 8209), 1. 92. C. Merrett, A Short View of the Frauds and Abuses Committed by Apothecaries (1669; E.S.T.C. 4693), 44. 93. See, for example, T. D. Whittet, The Sydenham Lecture of 1965 (Epsom, 1970), 23; R. ODay, The Professions in Early Modern England, 14501800 (Harlow, 2000), 228. 94. Merrett was no stranger to the apothecaries, having been made an honorary freeman of the Society in 1659.
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22 PLAGUES, MORALITY AND THE PLACE OF MEDICINE the argument echoes earlier claims by irregulars. Although the tract avoids the military metaphor adopted by the chemical physicians, it gives a similar warning about the future: who knows (but providence) when we may be belonging to the like assistance.95 In his embarrassed response, Merrett substantially revised his comments, protesting that:
few Apothecaries that were able to maintain themselves abroad, stayed in London. Neither did any Physician leave the City till the College had made choice of as many of themselves as the City thought meet to attend that service. Besides, many Seniors of our College remained, as many I dare say, as there did of the better sort of Apothecaries in proportion, and doubtless, twas as acceptable service to the Citizens of London (whom he here Claws) to have City Physicians in the Country with them, where they might have some employment also; as to stay in the City to the hazard of their lives, when they had scarce any Patient that remained there.96
Merret now minimised the apothecaries role, suggesting that it was forced on them by a lack of alternatives. He also stressed the work of the College physicians. They did not ee willy-nilly. Rather, in line with the advice of most plague tracts, they left with decorum after arrangements had been made for London. Indeed, in an echo of Nathaniel Hodges assertions, they largely went in the service of those citizens who were their regular patients, thus protecting the head of the body politic, preserving the recently re-established order of society and continuing their normal style of work. Plague was only a minor theme in this dispute, but Merretts clumsy change of tack is nonetheless striking. As he had quickly discovered, the apothecaries presence during the plague reinforced the grounds on which they could exculpate their medical practice as being justied by the imperatives of charity and emergency. However, Merrett had clearly not anticipated this. The absence of the physicians during plague was, in his opinion, perfectly reasonable. He had himself left London. Merretts slip hints that while the ight of physicians might be becoming more controversial in the 1660s, as the efforts of the chemical physicians suggest, opposition had yet to displace the traditional acceptance of their departure.97 For medical practitioners in early modern England, the decision to ee from plague was a moral problem which they resolved on an individual basis in the same way as most of their contemporaries. Unlike clergymen and magistrates, they faced no generally recognised special obligation to remain at work during an epidemic. However, during the
95. Lex Talionis (1670; ESTC 26266), 18. See also Medice Cura Teipsum!, 34. 96. C. Merrett, Self Conviction (1670; E.S.T.C. 1984), 16. 97. In 1722, Defoe commented on the reproach faced by physicians who ed: Journal, 1823.
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23 seventeenth century, practitioners, particularly those outside the corporate system, were increasingly using plague practice as a way to establish a reputation and, within London, as a strategy in regulatory disputes with the College of Physicians. Even if ight could be justied, the polemics of irregulars could easily exploit the gap between cautious departure and heroic staying. The place of the plague in such disputes derived from its potential as a moral test and an excuse from legal restriction: it extended a more general political and economic discourse which subverted the privileges of the College of Physicians. Because of this, the division between regular and irregular seems more prominent than any more profound differences of religion or philosophy in dening the boundary between the supporters and opponents of ight in the seventeenth century. Londons corporate medical system gave plague a particular kind of leverage in these cases. However, the transformation of public reputation into rights could, in a different form, be appropriated by more orthodox practitioners. In France, for example, the ofcial service of French physicians in the plague of Marseilles in 1720 which occurred on an unprecedented level on this occasion was carefully presented as evidence to strengthen their professional authority, in a deliberate echo of the signal labours of Catholic priest-heroes, such as St Carlo Borromeo. As Brockliss and Jones have noted, this eighteenth-century use of plague promoted a new ethic of personal presence and visual surveillance which was deliberately linked to [physicians] public utility, as well as to the progress of their discipline; A new image of the physician was being constructed and its ingredients included the lives and deaths of medical men as well as their words and boasts.98 Plagues use within political and legal appeals in English medicine suggests that rejecting ight had some resonance among the lite as well as the poorer sorts. But its failure to enter the plague tract literature or provoke extensive commentary indicates that it remained a minor concern; if such criticisms were made outside the medical world, they were made quietly, and did not coalesce into a widespread opposition to the ight of medical practitioners. Thomsons view that ight was a breach of their vocation remained marginal. Plague was an unstable signier. It might be presented as an emergency. But it could also be understood as a time apart, when responsible and wise men saw to their affairs, arranged substitutes if necessary and then departed. This was, as we have seen, how Merrett countered the apothecaries; indeed, it is why he made his slip in the rst place. Flight could be justied, and was the preferred choice for most of those, the rich and powerful, with the ability to leave. It is signicant that the chemical physicians and nonconformists received no reward from the Crown or City, despite their claims.
IN EARLY MODERN ENGLAND 98. Brockliss and Jones, Medical World, 356.
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24 It was not until the early nineteenth century that the idea of physicians having an ethical duty to care for the sick during epidemics became generally diffused, let alone accepted, in the English-speaking world as part of the creation and dissemination of an ideal-type of moral professional capable of self-regulation and deserving of concomitant respect and rewards.99 With this development, the history of plague epidemics was reinterpreted to provide examples of virtuous doctors who could exemplify the new ethics. The analysis of ight presented here underlines the great differences which separate modern ethical responses to epidemics from those of the early modern period. Retrospective moral diagnoses are all too easy, and all too treacherous, as was underlined in recent attempts to sift the records of early modern plague for guidance on ethical duties in the face of a more modern epidemic AIDS.100
London School of Economics
PATRICK WALLIS
99. A. R. Jonsen, A Short History of Medical Ethics (New York, 2000), 47. 100. For example, A. Zuger, Physicians, AIDS, and Occupational Risk: Historic Traditions and Ethical Obligations, Journal of the American Medical Association, cclviii (1987), 19248; C. G. Petrow, Letter to the Editor, Journal of the American Medical Association, cclix (1988), 13256.
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English Historical Review Vol. CXXI No. 490 The Author [2006]. Published by Oxford University Press.

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Plagues, Morality and the Place of Medicine in Early Modern England *

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IN EARLY MODERN ENGLAND

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