Medical Practice, Urban Politics and Patronage: The London 'Commonalty' of Physicians and Surgeons of the 1420s.

Justin Colson,Robert Ralley

doi:10.1093/ehr/cev261

Abstract

Medical practice in fifteenth-century England is often seen as suffering from the low status and unregulated practice of which Thomas Linacre later complained. Unlike in many European cities, the provision of physic was uncontrolled, and while urban guilds oversaw surgery as a manual art, no comprehensive system of medical organisation or regulation existed. However, in a remarkable episode of the 1420s, a group of university-trained physicians and elite surgeons associated with Humphrey, Duke of Gloucester, briefly established just such a system. While their efforts initially secured approval for a national scheme, it was only in the City of London that they succeeded in implementing their plans. The detailed ordinances of the collegiate ‘commonalty’ they founded provide a unique insight into their attitudes. Drawing on continental models, they attempted to control all medicine within the city by establishing a hierarchy of practitioners, preventing illicit and incompetent practice, and offering treatment to even the poorest Londoners. Yet they failed to appreciate the vested interests of civic politics: achieving these aims meant curtailing the rights of the powerful Grocers and the Barbers, a fact made clear by their adjudication of a case involving two members of the Barbers’ Company, and the Barbers’ subsequent riposte—a mayoral petition that heralded the commonalty’s end. Its founder surgeons went on to revitalise their Surgeons’ Fellowship, which continued independently of the Barbers until a merger in 1540; in contrast, the physicians withdrew from civic affairs, and physic remained entirely unregulated until episcopal licensing was instituted in 1511.

Highlights

Medical practice in medieval England has long been seen as diverse and largely unregulated, in contrast to continental Europe, where it was frequently tightly controlled by universities, or by guilds
In England there was no unified oversight of medical practice, or of the relationship between physicians, surgeons and apothecaries
Thomas Linacre was said to have been motivated by the low status of the medical profession, which was ‘engros’d by illiterate monks and Empiricks’, to extend this system of regulation by establishing the College of Physicians of London in 1518

Summary

Introduction

The Parisian system was centred on a university, which provided the infrastructure so conspicuously lacking in England.[36] In contrast, the 1423 petition sought to regulate only medical practice in London, and, in the absence of a university in the city, the commonalty had to establish an alternative forum within which to govern medicine.

Results

Conclusion