THE EDUCATION OF PHYSICIANS AND SURGEONS

Since the physicians and surgeons did make substantial charges and since the educated layman could buy his own books on medicine and practice what he read or since the uneducated could turn to a neighbor with medical knowledge or to a quack, the question arises as to why the services of professional surgeons and physicians were in such demand.

Part of the answer lies in the professional's experience, but even in a colony without a medical school it also lies in the education and training received by the professional.

There were several ways in which a seventeenth-century Virginia physician could acquire his education or training. He could have received a medical degree in England or on the continent and then gone to America. On the other hand, he might have learned without formal education--perhaps by attending lectures and by experience--and then established himself in Virginia where he was accorded professional status. A man born in Virginia could return to the Old World for training or formal education and then practice in Virginia. Also, a common manner of becoming a physician or surgeon in Virginia, which was without medical schools, was by apprenticeship. Finally, the importance of books--imported from Europe--as a means to medical education should not be minimized.

To be officially licensed for practice, the requirements in England were high--those in London especially so. The following excerpt from the statutes of the College of Physicians of London demonstrates how demanding the educational standards for seventeenth-century English physicians could be:

First, let them be examined in the physiologick part, and the very rudiments of medicine, and in this examination let questions be propounded out of the books concerning elements, temperaments, the use of parts, anatomy, natural powers and faculties, and other parts of natural medicine.

Secondly let him be examined in the pathologick part, or concerning the causes, differences, symptoms and signs of diseases, which physicians make use of to know the essence of diseases; and in this examination let questions be proposed out of books concerning the art of physick, of the places affected, of the differences of diseases and symptoms, of feavers, of the p.u.b.es, of the books of prognosticks of Hippocrates, &c.

Thirdly let him be examined concerning the use and exercise of medicine, or the reason of healing; and let that be done out of the books concerning preservation of health, of the method of healing, of the reason of diet in acute diseases, of simple medicines, of crises, of the aphorisms of Hyppocrates, and other things of that kind, which relate to the use of healing; for example sake, what caution to be observed in purging? in what persons? with what medicine? and in what vein, those things ought to be done?

Likewise, what is the use of narcoticks and sleeping medicines? and what caution is to be observed in them? what is the position and site of the internal places? and by what pa.s.sages medicines come to there? what is the use of clysters, what kind of vomits, the danger, kind and measure?

Under the London Company, the physicians and surgeons in Virginia had the same education, training, and met the same standards as their counterparts in England. This was, in part, because the Company had good reason to supply adequate medical service, and because the men sent were but Englishmen transplanted to America. Walter Russell, who came to Virginia in 1608 was a "Doctour of Physicke" and Lawrence Bohun, De la Warr's physician, had the same degree. Pott, who succeeded Bohun as physician-general of Virginia in 1621, came recommended as a Master of Arts well-practiced in surgery and physics.

After the Company's charter was annulled, few physicians or surgeons with the advanced medical degrees came to Virginia. Some of the persons, however, who practiced medicine in Virginia without medical degrees had acquired skills and knowledge in Europe or England before coming to the New World.

Patrick Napier who came to Virginia about 1655 as an indentured servant and subsequently had a large medical practice, probably learned his profession in England or on the Continent, as might have Francis Haddon, another who came under terms of indenture and who later, also, had a considerable medical practice. To these two examples of persons with training and experience acquired prior to their arrival in America might be added the similar experiences of John Williams and John Inman.

Medical knowledge and practices brought over from England were cross-fertilized with the European even in the New World. While the majority of newcomers were Englishmen, French, German, and other European physicians and surgeons came to Virginia. These European medical men appear, in general, to have prospered in Virginia and were anxious to become naturalized "denizens to this country."

George Hacke, born in Cologne, Germany, settled in Northampton County, Virginia, in 1653 and was known as a doctor and pract.i.tioner of medicine. He was typical of the European-trained medical man settling in Virginia in becoming naturalized and in leaving a considerable estate, including thousands of acres of land. Little is known of his medical activities and interests except that he was summoned to treat the victim of a duel and that he left a large library which probably included volumes on medicine.

Paul Micou, a young French physician who seems to have acquired his education abroad, settled on the sh.o.r.es of the Rappahannock river, near a place afterward called Port Micou, during the last decade of the seventeenth century. Cultured and educated, he soon won prominence and wealth as a physician (and surgeon), attorney, and merchant. County records in Virginia make numerous references to suits brought by him for nonpayment of fees, suggesting an extensive practice.

Because so many of the doctors and surgeons of seventeenth-century Virginia are given only slight mention in the records, it is impossible to know whether, in most cases, they had acquired their skills and educations before coming to Virginia, or even whether they were born in the New World. Nor is it known how many young men born in Virginia went back to England or Europe to study medicine; a reference made by the famous English surgeon, John Woodall, indicates that a Virginian named Wake may have studied under him in London.

Within the Virginia county records, however, can be found evidence indicating that a common method of learning the profession was by apprenticeship. One interesting example of the contract between apprentice and surgeon survives in the records of Surry County, Virginia; made in 1657, it bound Charles Clay to Stephen Tickner, surgeon, for a term of seven years. Clay swore to serve his master in whatever surgical or medical duties he was a.s.signed, and Tickner promised to use his best skill and judgment to teach his apprentice whatever he knew of the art. Another contract for apprenticeship was made between Richard Townshend and the London Company's well-known Dr.

Pott. This relationship included a breach of contract that occurred not infrequently between master and apprentice: Townshend argued in court that Pott was not teaching him the "art & misterye" for which he was bound.

As an apprentice, the would-be physician or surgeon could gather herbs for his master and a.s.sist him in treating the sick. If the apprentice could read, or if the master would teach him, then the novice could study the medical books in the doctor's library. Not only were volumes on medicine available, but in the libraries of the better-educated medical men, the apprentice could also familiarize himself with other fields of learning.

Dr. Pott had a reputation for knowing Latin, Greek, and Hebrew, and must have imparted much of his learning to Richard Townshend, his apprentice. Such would seem to be the case in view of the facts of Townshend's life. He became an apprentice to Pott in 1621 and by 1636 he was a member of the colony's highest political body, the council, and at the time of his death he possessed a considerable amount of land. In a day when schooling was hard to come by, apprenticeship to an educated man held great advantages.

Unfortunately catalogues of the libraries of medical men have not survived. There is proof, however, that physicians and surgeons did not neglect opportunities to collect volumes on medicine published in England and Europe. If utilized, these books could have helped offset the lack of a formal education in a university or medical school. Dr.

Henry Willoughby of Rappahannock County, Virginia, left forty-four books on "phisick" in his estate. Dr. John Holloway, a leading physician of Accomack County, Virginia, from 1633 until his death in 1643, left thirteen books on surgery and medicine, all in English or Latin. Dr. Henry Andrews of York County had twenty books in Latin on medicine.

A great number of Virginians--some of them prominent--who did not practice medicine had, nonetheless, large collections of books on the subject. This would indicate that many persons resorted to medical treatment without the help of a professional. With fees high, distances great, and well-trained doctors scarce, self-reliance is not surprising. Many planters and their wives must have made a superficial study of medicine; certainly the mistress of the house visiting sick servants and slaves is a familiar historical picture.

Among the medical books in such libraries were volumes on the general subjects of medicine (physick) and surgery, anatomy, gout, scurvy, distillation, and natural magic. Common in the libraries of the laymen were books recommending specific drugs for various symptoms of diseases. The long t.i.tle of one volume in a Virginia library read, "Method of physick, containing the causes, signes, and cures of inward diseases in man's body from the head to the foote. Whereunto is added the forme and rule of making remedies and medicines, which our physitions commonly use at this day, with the proportion, quant.i.ty, and names of each medicine."

The importance of medical volumes to the lay library is indicated by the inclusion of two in the supplies provided by a London agent for a Virginia plantation in 1620-21. William S. Powell, in a recent study of books in Virginia before 1624, found that the agent chose _The French Chirurgerye_, published in English in 1597, and the _Enchiridion Medicinae_, first published in 1573.

In spite of medical books, the apprenticeships, training in Europe or England, and the demand for medical services despite a high fee, it is possible to overestimate the competence of the seventeenth-century Virginia doctor even by the standards of his own century. An observation made by William Byrd II early in the next century tends to reduce the stature of the medical man.

"Here be some men," Byrd wrote, "indeed that are call'd doctors; but they are generally discarded surgeons of ships, that know nothing above very common remedys. They are not acquainted enough with plants or other parts of natural history, to do any service to the world...."

Byrd may have been prejudiced by his father who, although believing himself facing death, still did not call a physician.

CHAPTER FIVE

Conclusion

PORTRAIT OF A SEVENTEENTH-CENTURY VIRGINIA PHYSICIAN

Historical evidence does not support Byrd's description of the typical physician as a discarded ship's surgeon. In contrast, the physician, whatever his competence may have been, emerges from the sources as a respected member of the colony who, besides his medical practice, engaged in farming sizable holdings of land and took part in the civic life of the colony. His private life was not unlike that of the other planters who enjoyed some wealth and professional standing. The reputable surgeon, who could also supplement his income from farming, probably enjoyed an existence not unlike that of the physicians, considering that the distinction between them in the New World was slight.

Dr. Blanton, in his volume on medicine in Virginia, created a lively portrait of what he imagines from his researches to be the seventeenth-century Virginia doctor. The doctor is seen:

dressed in knee breeches and jerkin, perhaps adorned with periwig and cap; not given to church-going, but fond of ale, horse-racing and cuss words; husband of a multiparous wife; owner of a log cabin home or at best a frame cottage which he guarded with gun, pistol and scimitar; his road a bridle path and his means of conveyance a horse or boat ... reading ... by candle light, without spectacles; writing with a goose quill pen; sitting on a rough stool or bench; eating at a crude table from pewter dishes, without fork or table knife; having no knowledge of bath tubs; keeping his clothes in trunk or chest; sleeping, night-capped, on a flock bed in a bedroom shared by others; dividing his time, which he measured with hour-gla.s.s and sundial, among medicine, politics and farming; often in court, often a justice, member of Council or Burgesses, and subject, like his neighbors, to military service.

SUMMARY

Englishmen and Europeans planted Virginia in the New World and brought the Old World's medical knowledge and medical practices with them. In Europe and England, the seventeenth century witnessed the perfection of new and scientific theories in medicine--it was the century of Harvey--but little original and fruitful in the field of practice--Dr.

Sydenham might be considered an exception.

In Virginia, the prior occupants had acc.u.mulated medical knowledge, too, and the Indians practiced in a manner not completely unlike that of the whites: bloodletting, purging, and sweating (all to the end of relieving the body of ill humors or morbid matter). The Indians, however, did not believe it right or good to impart their knowledge to the layman, Indian or European; therefore, cross-fertilization between the two schools of medicine was limited.

In planning for the colony, the London Company took into account that health would influence the fortunes of the new settlement. The Company warned the original settlers to choose a site in a healthful location, but the colonists elected Jamestown Island which was low and moist.

Provided two surgeons by the Company, the original settlers needed not only more surgeons but physicians as well: the surgeons could treat the wounds, sprains, and breaks of a military-colonizing expedition, but physicians were needed to meet conditions that developed in Jamestown.

In subsequent boatloads of settlers, physicians did come--and some were well-trained and experienced--but the small number that arrived during the period when the London Company administered the colony (1606-24) could not meet the demands of disease and famine. During the first summer more than one-half the original settlers perished: during the Starving Time (1609-10) the population dropped from 500 to 60 and in the spring these 60 almost abandoned Virginia. A deadly combination of new environment, famine, and epidemic disease, such as typhoid, played a major part in determining the course of events during the first two decades of the colony's life, and near death.

After Virginia became a Crown colony, famine and disease no longer influenced affairs so greatly, not because of the wise administration of the Crown, but because the colonists had better learned what was necessary to cope with health conditions in the New World. No longer did they consider disease and famine minor threats compared to those from the Indians and Spaniards. They planned their ocean voyages so as to arrive in the fall and thus avoid the dread summer sickness while still too weak from the voyage to resist it; they located their outer settlements on higher and drier land, at the end of the century even moving their capital to Williamsburg, known for its temperate and healthful climate.

The physicians and surgeons, however, who came later in the century were not as distinguished as their earlier counterparts. As the century pa.s.sed, many men trained by apprenticing themselves in Virginia.

Whether immigrant or indigenous, the medical men used orthodox European techniques: they bled and purged, sweated and dispensed drugs, to obtain these ends. Some of the drugs were native to Virginia and the colonists exported them for a profit, but the more expensive--and efficacious--had to be imported. There is evidence that the level of medical excellence in Virginia lowered during the century; many of the planters avoided the expensive visits and drugs, even pa.s.sing laws to regulate fees and chastise lax and inadequate pract.i.tioners.

Women, clergymen, and laymen all treated the sick and wounded of the period, with the women especially active as midwives; with the clergy producing such an outstanding medical man as the Reverend John Clayton; and with the laymen acquiring enough information, perhaps from a few medical books, in order to practice, themselves, in case a doctor were unavailable or undesired.

ACKNOWLEDGEMENTS AND BIBLIOGRAPHICAL NOTE

Dr. Wyndham B. Blanton kindly gave permission for the use, in the preparation of this booklet, of his definitive and authoritative volume on the history of seventeenth-century Virginia medicine. Dr. Blanton's work--based on extensive research in the sources--has proved of great value, but he should not be held responible for any weaknesses in this essay, as the author a.s.sumes full responsibility. The author also wishes to take this opportunity to express his appreciation for the numerous suggestions and improvements made by his wife who spent many hours a.s.sisting in the preparation of the ma.n.u.script.

The books and articles that proved most helpful were:

Allen, Phyllis, "Medical Education in 17th Century England," _Journal of the History of Medicine and Allied Sciences_, I (January, 1946), 115-143.