The Doctors vs. the Druggists: Early Professional Rivalries in Health Care

The English medical profession first began asserting itself as such in the 15th century, and finally succeeded in obtaining protectionist legislation some 90 years later. The Royal College of Physicians of London was founded in 1518, and legislation passed early in the reign of Henry VIII (specifically, 1525) first restricted English medical practice to those with approved licences, making it technically illegal for apothecaries to offer more than drugs to their customers. Then in 1540, a statute was passed empowering 4 members of the London College of Physicians to examine the premises of all London apothecaries and remove any corrupted medicines.

Battles with the apothecaries raged at least through the early 18th century, as apothecaries sought to regain their autonomy along with the right to define and police themselves (as had long been the case in France and Italy), especially concerning quality control of prescribed pharmaceuticals. In 1617, James I (at the instigation of his physicians, who felt that it was not really workable to have only 4 overseers from the Royal College of Physicians supervise all London apothecaries) chartered the new “Society of the Art and Mystery of Apothecaries.” Since the apothecaries tended to be quite successful competitors in the marketplace (in many cases, serving the same wealthy clients as the doctors) there was particular acrimony between the two groups, and each was concerned with expanding, then protecting, professional bounds and privileges.

For example, in the 17th century, there was a lengthy public exchange following the apothecaries’ petition to be exempted (as were physicians and surgeons) from jury duty and the obligatory holding of public office. One of the arguments used by the doctors in their responding Parliamentary petition was to appeal to members’ self-interest in protecting the social status and career interests of the oligarchy’s younger sons:

It is tedious to pursue these Gentlemen [petitioning apothecaries] in the rest of their very presumptuous Allegations. In short, what they pretend, is Charity, unwearied diligence to the Sick, and Publick Good, like generous and disinterested Men; whereas pull of the Mask, and you’ll find a Liberty of Practice is all they aim at; the rest is Sham and Banter: And indeed the only way to make that plausible Pretence of theirs real Charity, was to find out some means to regulate their unreasonable Bills, which are both burthensom to the Rich, and ruinous to the Poor; which may easily be done, by giving the President and Censors of the Colledge of Physicians power to Tax them, or by some other methods the Parliament shall think more fitting according to the Custom of other Foreign Countries. It is hoped, for the encouragement of the Science of Physick, and for the sake of their Younger Sons, (many of which may have a Subsistence from this Faculty) the Parliament will not think fit to give them this their dear Liberty of Practice, the very Diana of all their Hopes.

(from the anonymous broadside, A Vindication of the Colledge of Physicians, from the Reflections Made upon Them by the Apothecaries in Parliament, printed at London between 1694 and 1712?)

For the most part, the apothecaries embraced the taint of the trades, seizing on opportunity as it presented and defending their “art” with the usual nationalistic appeals to economic growth. Attacked by both “Galenical” and “Hermetick or Chymical” physicians, the apothecaries fought back by adapting to changing circumstance, and carving out a lucrative niche for themselves within both medical camps. Traditionally aligned with the Galenists, whose medicines they were tasked with making, the apothecaries were also quick to add spagyric medicines to their stock of prescriptions once Helmontian chemical and medical theories took hold.

Professional rivalries were popularized in verse, with hack writers hired to churn out ballads attacking one another, the lyrics (without the accompanying music) printed as “Revenging” broadsheets which were cheap, entertaining, and widely disseminated.

Thus did “T.C. Philo-Pharmacopeiae” justify the druggists’ trade in the ballad Vindiciæ Pharmacapolæ, or an Answer to the Doctors Complaints against Apothecaries (London, 1675?):

     ’Tis true, this latter age has far out-done
What former did, or rather but begun.
Great Helmont is reviv’d, and who can be
More Volatile, and full of Salt than he.
He’s try’d by Fire; and thence it seems to some,
Gallen’s but Physick’s Caput Mortuum.
     What if Gallenick Doctor (Eying Pelf)
Doth send for Simples, simple as himself,
And order Antique Compounds, which Innure
To Dissolution, rather than to Cure.
     What if their Bills [i.e., prescriptions] upon our Files do meet,
Till theirs and ours make Patients Winding-sheet:
We’re not in Fault, we rather are excus’d,
Good Druggs by us are sold, by them abus’d.
We in the Common Fate of Trade do stand;
Buying and Selling doth support the Land.
We but Prepare, Great Doctor doth Advise,
He puts the Stuff in that puts out the Eyes.
We hear not Paracelsian disagree,
Though we should know his Art as well as he.
     Perhaps some Mandat-Doctors poor are grown,
And now would Marr our Trade, to mend their own.
What would the Innes of Court say, if they see,
One person Counsel, Clerk, Atturney be.
Like the Welsh Parish, without more ado,
Had one man Curate, Clark, and Sexton too.
I thought the Club-Divines had been forgot,
Let Club-Physicians have Smectymnuan’s lot.
     But oh intollerable! Doctor cryes,
He sees too much, pray put out both his eyes;
He practise Physick, sans Physicians Aide,
Learned PROFESSION is outfac’d by Trade:
He’s grown a Chymist too, and so despise
Our great Diana whence our Profit rise.
     To this we Answer, Good Sir Methodist,
This is no Eye-sore to the Spagarist;
Nor to those Sons of Art, whose Care and Pains
Regard the Publick, not their Private gains:
Who in the greatest search of Nature’s Deep,
Revive Mysterious Truths, long layn asleep.
We know that Pyrotechny bears a part,
As well in our Trade, as in your Art.
’Tis that which ALL of us are taught to do;
Let half the Doctors in the Town say so.
Nay let them say, after their Bills [i.e., prescriptions] search’d be,
If half th’ Ingredients they did ever see:
So that if ’Pothecaries must go down,
You’le banish half the Doctors from the Town.

(excerpt from T. C.’s ballad, Vindiciæ Pharmacapolæ, or an Answer to the Doctors Complaints against Apothecaries)

As Carole Rawcliffe pointed out in Medicine & Society in Later Medieval England (1995), in most areas of medical activity during this early period, “the English lagged far behind their continental neighbours” in terms of regulation, developing and enforcing professional standards, law, and institutionalization. E.g., from the outset, the Parisian faculty of medicine (which was larger and better organized than its English counterpart) showed much greater zeal “in defending its monopoly against women.” And “the struggle against freelance practitioners continued in France throughout the Middle Ages, with ‘literacy’ or the possession of recognized academic or craft qualifications as the principal test of professional competence.” (Rawcliffe, 187)

From the later middle ages, English medicine was plagued by a great gap between theory and practice, relating to the somewhat unique place of the physician in English society. English medical training at Oxford and Cambridge focused entirely on the “speculatif” aspects of medicine because the majority of students belonged to the priesthood, and the Church expressly forbade senior clergy — subdeacons, deacons, or priests — from participating in acts (such as “manual surgery”) likely to cause bloodshed, including operations requiring cautery or incision. So someone else (including women, of all classes) took on these roles. This was not the case elsewhere in Europe. In late-15th-century Padua, for instance, the majority of medical students were laymen, and university training included the option of pursuing a 3-year course in surgery.