Читать книгу A Book About Doctors - John Cordy Jeaffreson - Страница 17

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Baldwin Hamey, whose manuscript memoirs of eminent physicians are among the treasures of the College, praises Winston because he treated his apothecary as a master might a slave. "Heriliter imperavit," says the Doctor. The learned Thomas Winston, anatomy lecturer at Gresham College, lived to the age of eighty years, and died on the 24th of October, 1655. He knew, therefore, apothecaries in the day of their humility—before prosperity had encouraged them to compete with their professional superiors.

The apothecaries of the Elizabethan era compounded their medicines much as medicines are compounded at the present—as far as manipulation and measuring are concerned. Prescriptions have altered, but shop-customs have undergone only a very slight change. The apothecaries' table of weights and measures, still in use, was the rule in the sixteenth century, and the symbols (for a pound, an ounce, a drachm, a scruple, a grain, &c.) remain at this day just what they were three hundred years ago.

Our good friend, William Bulleyn, gave the following excellent rules for an apothecary's life and conduct:—

"THE APOTICARYE.

"1.—Must fyrst serve God, forsee the end, be clenly, pity the poore.

"2.—Must not be suborned for money to hurt mankynde.

"3.—His place of dwelling and shop to be clenly to please the sences withal.

"4.—His garden must be at hand with plenty of herbes, seedes, and rootes.

"5.—To sow, set, plant, gather, preserve and kepe them in due tyme.

"6.—To read Dioscorides, to know ye natures of plants and herbes.

"7.—To invent medicines to chose by coloure, tast, odour, figure, &c.

"8.—To have his morters, stilles, pottes, filters, glasses, boxes, cleane and sweete.

"9.—To have charcoals at hand, to make decoctions, syrupes, &c.

"10.—To kepe his cleane ware closse, and cast away the baggage.

"11.—To have two places in his shop—one most cleane for the phisik, and a baser place for the chirurgie stuff.

"12.—That he neither increase nor diminish the physician's bill (i.e. prescription), and kepe it for his own discharge.

"13.—That he neither buy nor sel rotten drugges.

"14.—That he peruse often his wares, that they corrupt not.

"15.—That he put not in quid pro quo (i.e., use one ingredient in the place of another, when dispensing a physician's prescription) without advysement.

"16.—That he may open wel a vein for to helpe pleuresy.

"17.—That he meddle only in his vocation.

"18.—That he delyte to reede Nicolaus Myrepsus, Valerius Cordus, Johannes Placaton, the Lubik, &c.

"19.—That he do remember his office is only to be ye physician's cooke.

"20.—That he use true measure and waight.

"21.—To remember his end, and the judgment of God: and thus I do commend him to God, if he be not covetous, or crafty, seeking his own lucre before other men's help, succour, and comfort."

The apothecaries to whom these excellent directions were given were only tradesmen—grocers who paid attention to the commands of physicians. They were not required to have any knowledge of the medical science, beyond what might be obtained by the perusal of two or three writers; they were not to presume to administer drugs on their own judgment and responsibility—or to perform any surgical operation, except phlebotomy, and that only for one malady. The custom was for the doctors to sell their most valuable remedies as nostrums, keeping their composition a secret to themselves, and themselves taking the price paid for them by the sick. The commoner drugs were vended to patients by the drug-merchants (who invariably dealt in groceries for culinary use, as well as in medicinal simples), acting under the directions of the learned graduates of the Faculty.

In the fourth year of James I., a charter was obtained, that "Willed, ordained, and granted, that all and singular the Freemen of the Mystery of Grocers and Apothecaries of the City of London … should and might be … one body corporate and politique, in deed, fact, and name, by the name of Warden and Commonalty of the Mystery of Grocers of the City of London." But in the thirteenth year of the same king, the apothecaries and grocers were disunited. At the advice of Theodore de Mayerne and Henry Atkins, doctors in physick, another charter was granted, constituting drug-venders a distinct company. Amongst the apothecaries mentioned in this charter are the names of the most respectable families of the country. Gideon de Laune, one of this first batch of apothecaries, amassed a very large fortune in his vocation, and founded a family at Sharsted, in Kent, from which several persons of distinction draw part of their origin; and not a few of De Laune's brethren were equally lucky.

At their first foundation as a company the apothecaries were put completely under control of the College of Physicians, who were endowed with dangerous powers of inspecting their wares and punishing their malpractices. But before a generation had passed away, the apothecaries had gained such a firm footing in society that the more prosperous of them could afford to laugh at the censures of the College; and before the close of a century they were fawned upon by young physicians, and were in a position to quarrel with the old.

The doctors of that day knew so little that the apothecaries found it easy to know as much. A knowledge of the herbals, an acquaintance with the ingredients and doses of a hundred empirical compounds and systems of maltreating eruptive fevers, gout, and consumption, constituted all the medical learning of such men as Mayerne or Gibbons. To pick up that amount of information was no hard task for an ambitious apothecary.

Soon the leading apothecaries began to prescribe on their own responsibility, without the countenance of a member of the College. If they were threatened with censure or other punishment by a regular physician, they retorted by discontinuing to call him in to consultations. Jealousies soon sprang up. Starving graduates, with the diplomas of Oxford and Cambridge and the certificates of the College in their pockets, were embittered by having to trudge the pavements of London, and see the mean medicine-mixers (who had scarce scholarship enough to construe a Latin bill) dashing by in their carriages. Ere long the heartburnings broke out in a paper warfare, as rancorous and disreputable as any squabble embalmed in literature. The scholars called the rich tradesmen thieves, swindlers, and unlettered blockheads. The rich tradesmen taunted the scholars with discontent, falsehood, and ignorance of everything except Latin and Greek.

Pope took the side of the physicians. Like Johnson, Parr, and all men of enlightenment and sound scholarship, he had a high opinion of the Faculty. It is indeed told of him, on questionable authority, that on his death-bed, when he heard the bickerings of Dr. Burton and Dr. Thompson, each accusing the other of maltreating his patient, he levelled with his last breath an epigram at the two rivals—

"Dunces, rejoice, forgive all censures past— The greatest dunce has killed your foe at last."

To Dr. Arbuthnot he wrote—

"Friend to my life, which did not you prolong,

The world had wanted many an idle song."

His feeble health, making his life a long disease, never allowed him vigour and confidence enough to display ingratitude to the Faculty, and illustrate the truth of the lines—

"God and the doctor we alike adore,

But only when in danger, not before;

The danger o'er, both are alike requited,

God is forgotten, and the doctor slighted."

His habitual tone, when speaking of the medical profession, was that of warm admiration and affection. In the "Imitations of Horace" he says—

"Weak though I am of limb, and short of sight,

Far from a lynx, and not a giant quite,

I'll do what Mead and Cheselden advise,

To keep these limbs, and to preserve these eyes."

It is true that he elsewhere ridicules Mead's fondness for rare books and Sloane's passion for butterflies; but at the close of his days he wrote in a confidential letter to a friend of the Faculty, "They are in general the most amiable companions and the best friends, as well as the most learned men I know."

In the protracted dissensions between the physicians and the apothecaries Pope was a cordial supporter of the former. When he accused, in the "Essay on Criticism," the penny-a-lining critics of acquiring their slender knowledge of the poetic art from the poets they assailed, he compared them to apothecaries whose scientific information was pilfered from the prescriptions they were required to dispense.

"Then Criticism the Muse's handmaid proved, To dress her charms and make her more beloved: But following wits from that intention stray'd. Who could not win the mistress, woo'd the maid; Against the poets their own arms they turn'd, Sure to hate most the men from whom they learn'd. So modern 'Pothecaries, taught the art By Doctors' bills to play the Doctor's part, Bold in the practice of mistaken rules, Prescribe, apply, and call their masters fools."

The origin of the memorable Dispensarian Campaign between the College of Physicians and the Company of Apothecaries is a story that can be briefly told. The younger physicians, impatient at beholding the prosperity and influence of the apothecaries, and the older ones indignant at seeing a class of men they despised creeping into their quarters and craftily laying hold of a portion of their monopoly, concocted a scheme to reinstate themselves in public favour. Without a doubt many of the physicians who countenanced this scheme gave it their support from purely charitable motives; but it cannot be questioned that as a body the dispensarians were actuated in their humanitarian exertions by a desire to lower the apothecaries, and raise themselves in the eyes of the world. With all its genuine and sterling benevolence, the medical profession, by the unworthy and silly conduct of its obscure members, has repeatedly laid itself open to the charge of trading on its reputation for humanity. In Smollett's time, as his novels show, the recognized mode employed by unknown doctors to puff themselves into notoriety and practice, was to get up little hospitals and infirmaries, and advertise to the charitable for aid in the good task of ameliorating the condition of the poor. And half the peddling little charitable institutions, infirmaries, dispensaries, or hospitals, that at the present time rob the rich and do harm to the poor in every quarter of London, originated in "the friends" of young physicians and surgeons conspiring together to get them "the position of being attached to an hospital staff." In 1687, the physicians at a college-meeting, voted "that all members of the College, whether Fellows, Candidates, or Licentiates, should give their advice gratis to all their sick neighbouring poor, when desired, within the city of London, or seven miles round."

To give prescriptions to the very poor, unaccompanied with the means of getting them dispensed, is of little use. Sir Astley Cooper used to see in the vicinity of his residence the slips of paper, marked with his pen, which it was his wont to distribute gratuitously to indigent applicants. The fact was, the poor people, finding it beyond their means to pay the druggist for dispensing them, threw them away in disgust. It was just the same in 1687. The poor folk carried their prescriptions to the apothecaries, to learn that the trade charge for dispensing them was beyond their means. The physicians asserted that the demands of the drug-venders were extortionate, and were not reduced to meet the finances of the applicants, to the end that the undertakings of benevolence might prove abortive. This was of course absurd. The apothecaries knew their own interests better than so to oppose a system which at least rendered drug-consuming fashionable with the lower orders. Perhaps they regarded the poor as their peculiar field of practice, and felt insulted at having the same humble people—for whom they had pompously prescribed and put up boluses at two-pence apiece—now entering their shops with papers dictating what the two-penny bolus was to be composed of. But the charge preferred against them was groundless. Indeed, a numerous body of the apothecaries expressly offered to sell medicines "to the poor within their respective parishes, at such rates as the committee of physicians should think reasonable."

But this would not suit the game of the physicians. "A proposal was started by a committee of the College, that the College should furnish the medicines of the poor, and perfect alone that charity which the apothecaries refused to concur in; and after divers methods ineffectually tried, and much time wasted in endeavouring to bring the Apothecaries to terms of reason in relation to the poor, an instrument was subscribed by divers charitably disposed members of the College, now in number about fifty, wherein they obliged themselves to pay ten pounds apiece towards the preparing and delivering medicines at their intrinsic value." Such was the version of the affair given by the College apologists. The plan was acted upon; and a dispensary was eventually established (some nine years after the vote of 1687) in the College of Physicians, Warwick Lane, where medicines were vended to the poor at cost price.

This measure of the College was impolitic and unjustifiable. It was unjust to that important division of the trade who were ready to vend the medicines at rates to be fixed by the College authorities—for it took altogether out of their hands the small amount of profit which they, as dealers, could have realized on those terms. It was also an eminently unwise course. The College sank to the level of the Apothecaries' Hall, becoming an emporium for the sale of medicines. It was all very well to say that no profit was made on such sale—the censorious world would not believe it. The apothecaries and their friends denied that such was the fact, and avowed that the benevolent dispensarians were bent only on underselling and ruining them.

Again, the movement introduced dissension within the walls of the College. Many of the first physicians, with the conservatism of success, did not care to offend the apothecaries, who were continually calling them in, and paying them fees. They therefore joined in the cry against the dispensary. The profession was split up into dispensarians and anti-dispensarians. The apothecaries combined and agreed not to recommend the dispensarians. The anti-dispensarians repaid this ill service by refusing to meet dispensarians in consultation. Sir Thomas Millington, the president of the College, Edward Hulse, Hans Sloane, John Woodward, Sir Edmund King, and Samuel Garth were amongst the latter. Of them the last-named was the man who rendered the most efficient service to his party.

Garth is perhaps the most cherished by the present generation of all the physicians of Pope's time. He was a Whig without rancour, and a bon-vivant without selfishness. Full of jest and amiability, he did more to create merriment at the Kit-Kat club than either Swift or Arbuthnot. He loved wine to excess; but then wine loved him too, ripening and warming his wit, and leaving no sluggish humour behind. His practice was a good one, but his numerous patients prized his bon-mots more than his prescriptions. His enemies averred that he was not only an epicure, but a profligate voluptuary and an infidel. Pope, however, wrote of him after his death, "If ever there was a good Christian, without knowing himself to be so, it was Dr. Garth." Pope had honoured him when alive by dedicating his second pastoral to him.

"Accept, O Garth, the muse's early lays,

That adds this wreath of ivy to thy bays;

Hear what from love unpractised hearts endure,

From love, the sole disease thou canst not cure."

A good picture of Garth the politician is found in the "Journal to Stella." "London, Nov. 17, 1711," writes Swift—"This is Queen Elizabeth's birthday, usually kept in this town by apprentices, &c.; but the Whigs designed a mighty procession by midnight, and had laid out a thousand pounds to dress up the pope, devil, cardinals, Sacheverel, &c., and carry them with torches about and burn them. They did it by contribution. Garth gave five guineas; Dr. Garth I mean, if ever you heard of him. But they were seized last night by order from the Secretary. … The figures are now at the Secretary's Office at Whitehall. I design to see them if I can."

A Whig, but the friend of Tories, Garth cordially disliked Sir Richard Blackmore, a member of his own profession and political party. Blackmore was an anti-dispensarian, a bad poet, and a pure and rigid moralist. Naturally Garth abominated him, and sneered at him for his pomposity and bad scholarship. It is to be regretted that Garth, with the vulgarity of the age, twitted him with his early poverty, and with having been—a schoolmaster. To ridicule his enemy Garth composed the following verses:—

"TO THE MERRY POETASTER, AT SADLER'S HALL, IN CHEAPSIDE.

"Unwieldy pedant, let thy awkward muse

With censures praise, with flatteries abuse;

To lash, and not be felt, in thee's an art,

That ne'er mad'st any but thy school-boys smart.

Then be advised and scribble not again—

Thou'rt fashion'd for a flail and not a pen.

If B——l's immortal wit thou would'st decry,

Pretend 'tis he that wrote thy poetry.

Thy feeble satire ne'er can do him wrong—

Thy poems and thy patients live not long."

Garth's death, as described by William Ayre, was characteristic. He was soon tired of an invalid's suffering and helplessness, the ennui and boredom of the sick-room afflicting him more than the bodily pain. "Gentlemen," said he to the crowd of weeping friends who stood round his bed, "I wish the ceremony of death was over." And so, sinking lower in the bed, he died without a struggle. He had previously, on being informed that his end was approaching, expressed pleasure at the intelligence, because he was tired of having his shoes pulled off and on. The manner of Garth's exit reminds one of the death of Rabelais, also a physician. The presence of officious friends troubled him; and when he saw his doctors consulting together, he raised his head from his pillow and said with a smile, "Dear gentlemen, let me die a natural death." After he had received extreme unction, a friend approached him, and asked him how he did. "I am going on my journey," was the answer—"they have greased my boots already."

Garth has, apart from his literary productions, one great claim on posterity. To him Dryden owed honourable interment. When the great poet died, Garth caused his body to be conveyed to the College of Physicians, and started a public subscription to defray the expenses of the funeral. He pronounced an oration over the deceased at the College in Warwick Lane, and then accompanied it to Westminster Abbey.

Of the stories preserved of Garth's social humour some are exquisitely droll. Writing a letter at a coffee-house, he found himself overlooked by a curious Irishman, who was impudently reading every word of the epistle. Garth took no notice of the impertinence, until he had finished and signed the body of the letter, when he added a postscript, of unquestionable legibility: "I would write you more by this post, but there's a d—— tall impudent Irishman looking over my shoulder all the time."

"What do you mean, sir?" roared the Irishman in a fury. "Do you think I looked over your letter?"

"Sir," replied the physician, "I never once opened my lips to you."

"Ay, but you have put it down, for all that."

"'Tis impossible, sir, that you should know that, for you have never once looked over my letter."

Stumbling into a Presbyterian church one Sunday, for pastime, he found a pathetic preacher shedding tears over the iniquity of the earth.

"What makes the man greet?" asked Garth of a bystander.

"By my faith," was the answer, "and you too would greet if you were in his place and had as little to say."

"Come along, my dear fellow," responded Garth to his new acquaintance, "and dine with me. You are too good a fellow to be here."

At the Kit-Kat he once stayed to drink long after he had said that he must be off to see his patients. Sir Richard, more humane than the physician, or possibly, like the rest of the world, not disinclined to be virtuous at another's expense, observed, "Really, Garth, you ought to have no more wine, but be off to see those poor devils."

"It's no great matter," Garth replied, "whether I see them to-night or not, for nine of them have such bad constitutions, that all the physicians in the world can't save them; and the other six have such good constitutions, that all the physicians in the world can't kill them."

Born of a respectable north-country family, Garth was educated first at a provincial school, and then at Cambridge. He was admitted a Fellow of the College of Physicians on June 26, 1692, just when the quarrel of the Physicians and Apothecaries was waxing to its hottest, i.e. between the College edict of 1687, ordaining gratuitous advice, and the creation of the dispensary in 1696. As a young man he saw that his right place was with the dispensarians—and he took it. For a time his great poem, "The Dispensary," covered the apothecaries and anti-dispensarians with ridicule. It rapidly passed through numerous editions—in each of which, as was elegantly observed, the world lost and gained much. To say that of all the books, pamphlets, and broad-sheets thrown out by the combatants on both sides, it is by far the one of the greatest merit, would be scant justice, when it might almost be said that it is the only one of them that can now be read by a gentleman without a sense of annoyance and disgust. There is no point of view from which the medical profession appears in a more humiliating and contemptible light than that which the literature of this memorable squabble presents to the student. Charges of ignorance, dishonesty, and extortion were preferred on both sides; and the dispensarian physicians did not hesitate to taunt their brethren of the opposite camp with playing corruptly into the hands of the apothecaries—prescribing enormous and unnecessary quantities of medicine, so that the drug-venders might make heavy bills, and, as a consequence, recommend in all directions such complacent superiors to be called in. Garth's poem, unfair and violent though it is, seldom offends against decency. As a work of art it cannot be ranked high, and is now deservedly forgotten, although it has many good lines, and some felicitous satire. Johnson rightly pointed to the secret of its success, though he took a one-sided and unjust view of the dissensions which called it forth. "The poem," observes the biographer, "as its subject was present and popular, co-operated with passions and prejudices then prevalent; and, with such auxiliaries to its intrinsic merit, was universally and liberally applauded. It was on the side of charity against the intrigues of interest, and of regular learning against licentious usurpation of medical authority."

Sir Samuel Garth (knighted by the sword of Marlborough) died January 18, 1718–19, and was buried at Harrow-on-the-Hill.

But he lived to see the apothecaries gradually emancipate themselves from the ignominious regulations to which they consented, when their vocation was first separated from the grocery trade. Four years after his death they obtained legal acknowledgment of their right to dispense and sell medicines without the prescription of a physician; and six years later the law again decided in their favour, with regard to the physicians' right of examining and condemning their drugs. In 1721, Mr. Rose, an apothecary, on being prosecuted by the College for prescribing as well as compounding medicines, carried the matter into the House of Lords, and obtained a favourable decision. And from 1727, in which year Mr. Goodwin, an apothecary, obtained in a court of law a considerable sum for an illegal seizure of his wares (by Drs. Arbuthnot, Bale, and Levit), the physicians may be said to have discontinued to exercise their privileges of inspection.

Arbuthnot did not exceed Garth in love to the apothecaries. His contempt for, and dislike of, the fraternity, inspired him to write his "Essay on an Apothecary." He thinks it a pity that, to prevent the country from being overrun with apothecaries, it should not be allowed to anatomize them, for the improvement of natural knowledge. He ridicules them for pedantically "dressing all their discourse in the language of the Faculty."

"At meals," he says, "they distributed their wine with a little lymph, dissected a widgeon, cohobated their pease-porridge, and amalgamated a custard. A morsel of beef was a bolus; a grillard was sacrificed; eating was mastication and deglutition; a dish of steaks was a compound of many powerful ingredients; and a plate of soup was a very exalted preparation. In dress, a suit of cloaths was a system, a loophole a valve, and a surtout an integument. Cloth was a texture of fibres spread into a drab or kersey; a small rent in it was cutaneous; a thread was a filament; and the waistband of the breeches the peritoneum."

The superior branch of the Faculty invited in many ways the same satire. Indeed, pedantry was the prevalent fault of the manners of the eighteenth century. The physician, the divine, the lawyer, the parliament-man, the country gentleman, the author by profession—all had peculiarities of style, costume, speech, or intonation, by which they were well pleased they should be recognised. In one respect, this was well; men were proud of being what they were, and desired to be known as belonging to their respective vocations. They had no anxiety to be free from trade-marks. The barrister's smirk, the physician's unctuous smiles, the pedagogue's frown, did not originate in a mean desire to be taken for something of higher mark and esteem than they really were.

From the time when Bulleyn called him the physician's cook, down to the present, generation, the pure apothecary is found holding a very subordinate position. His business is to do unpleasant drudgery that a gentleman finds it unpleasant to perform, but which cannot be left to the hands of a nurse. The questions to be considered previous to becoming an apprentice to an apothecary, put in Chemberlaine's "Tyrocinium Medicum," well describe the state of the apothecary's pupil. "Can you bear the thoughts of being obliged to get up out of your warm bed, on a cold winter's night, or rather morning, to make up medicines which your employer, just arrived through frost and snow, prescribes for a patient taken suddenly or dangerously ill?—or, supposing that your master is not in sufficient business to keep a boy to take out medicines, can you make up your mind to think it no hardship to take them to the patient after you have made them up?" &c., &c. When such services were expected from pupils studying for admittance to the craft, of course boys with ample means, or prospects elsewhere, did not as a rule desire to become apothecaries.

Within the last fifty years changes have been affected in various departments of the medical profession, that have rendered the apothecary a feature of the past, and transferred his old functions to a new labourer. Prior to 1788, it is stated on authority there were not in all London more than half-a-dozen druggists who dispensed medicines from physicians' prescriptions. Before that time, the apothecaries—the members of the Apothecaries' Company—were almost the sole compounders and preparers of drugs. At the present time it is exceptional for an apothecary to put up prescriptions, unless he is acting as the family or ordinary medical attendant to the patient prescribed for. As a young man, indeed, he sometimes condescends to keep an open shop; but as soon as he can get on without "counter" business, he leaves the commercial part of his occupation to the druggist, as beneath his dignity. The dispensing chemists and druggists, whose shops, flashing with blue bottles (last remnant of empiric charlatanry), brighten our street corners and scare our horses at night, are the apothecaries of the last century. The apothecary himself—that is, the member of the Company—is hardly ever found as an apothecary pur et simple. He enrolls himself at "the hall" for the sake of being able to sue ungrateful patients for money due to him. But in the great majority of cases he is also a Fellow or Member of the College of Surgeons, and acts as a general practitioner; that is, he does anything and everything—prescribes and dispenses his prescriptions; is at the same time physician, surgeon, accoucheur, and dentist. Physic and surgery were divided at a very early date in theory, but in practice they were combined by eminent physicians till a comparatively recent period. And yet later the physician performed the functions of the apothecary, just as the apothecary presumed to discharge the offices of physician. It was not derogatory to the dignity of a leading physician, in the reign of Charles the Second, to keep a shop, and advertise the wares vended in it, announcing in the same manner their prices. Dr. Mead realized large sums by the sale of worthless nostrums. And only a few years since, a distinguished Cambridge physician, retaining as an octogenarian the popularity he had achieved as a young man, in one of our eastern counties, used to sell his "gout tincture"—a secret specific against gout—at so many shillings per bottle. In many respects the general practitioner of this century would consider his professional character compromised if he adopted the customs generally in vogue amongst the physicians of the last.