Physicians to the fore – creating a new medical hierarchy in the Early Modern Period

People with only a minimal knowledge of the history of medicine might be forgiven for automatically thinking of doctors when talk turns to medical consultation, diagnosis and treatment in earlier ages. However in the High Middle Ages and down into the Renaissance physicians, barber surgeons, apothecaries, midwifes, herbalist all competed with each other for patients, in particular the university educated physicians and apothecaries were rivals. In the Early Modern Period the physicians set a campaign in motion to create a medical hierarchy with themselves at the top able to dictate to the other practitioners. Historian of medicine Hannah Murphy has written an excellent volume describing this process of social change in the world of medicine in Reformation Nuremberg, A New Order of Medicine: The Rise of Physicians in Reformation Nuremberg[1]

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The introduction to Murphy’s is titled Inventing Medical Reform and starts with Joachim Camerarius’ Short and Ordered Considerations for the Formation of a Well-Ordered Medicine (1571) outlining his proposed reform of medicine in the city of Nuremberg in which physicians would be authorised to oversee the work of apothecaries and only physicians would be permitted to undertake diagnosis. As a brief side note this is the physician Joachim Camerarius the younger, the son of the much more famous Joachim Camerarius the elder, classicist, colleague and biographer of Philipp Melanchthon.

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Joachim Camerarius the younger Source: Wikimedia Commons

The programme set out by Camerarius in his Short and Ordered Considerations was not immediately accepted and put into practice by the Nuremberg city council but over the next few decades something similar was gradually put into place in Nuremburg; a process that involved a major political, cultural and social war between the physicians and the apothecaries. This gradual development is the subject of Murphy’s book. The rest of the introduction is devoted to a general road map of her work.

The book is divided into six chapters or perhaps, better said sections, each one of which deals with an aspect of the life and work of Early Modern physicians and how they relate to the changes in the role and status of the physicians that were taking place. These topics are initially handled for a given individual, and then developed for the city of Nuremberg in general with parallels being drawn for other cities and regions within the Holy Roman Empire. So what initially appears to be a very narrow and specialised study widens to cover a substantially area of Europe.

The opening chapter looks at a new, contemporary pharmacopeia, the Dispensatorium of Valerius Cordus, i.e. a catalogue of recipes for medical remedies. This area would become central in the dispute between the apothecaries and the physicians who could prescribe the remedies and which remedies should or could be prescribed.

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The second chapter takes a detailed look at the position, role, and status of the city physician and how it differed from that of other sections of society in particular from that of the apothecaries. Moving on Murphy deals with the subject of anatomy, another area where the role of the physician would undergo a major change especially following the work of the century’s greatest anatomist, Andreas Vesalius. Turning away from the practical Murphy next addresses the role that books played in the life and work of the physician. We remain, for the next section, in the realm of the written word. In the absence of journals, which today play a major role in transmitting medical and related information, the early modern physicians had their correspondence. I personally am constantly amazed at just how many letters early modern scholars exchanged in their lifetimes with their colleagues throughout Europe. Thankfully, for the historian, some of these collections of correspondence have survived down the centuries and provide us with as valuable a source of information, as they once provided their authors and recipients. The final chapter returns to the starting point and a closer detailed look at Camerarius’ New Order of Medicine. Moving on Murphy now shows how the status and function of the physicians and apothecaries did change over time and the moves and disputes that accompanied those changes.

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The book closes with a brief conclusion summarising what had been achieved by the Nuremberger physicians, I quote:

In their legal and civic battle with apothecaries, in their claim to profession primacy over surgeons and midwifes, in their bid to establish themselves as the arbiters of legitimate medicine, early modern physicians were decisively victorious.

They had succeeded in establishing a new order, one that basically still exists today. This leads to a, for historians, very interesting epilogue in which Murphy outlines how these not insignificant changes in the medical landscape of Europe became forgotten and at the same time mythologised down the succeeding centuries.

The book is pleasantly illustrated with the, in the mean time standard for academic publications, grey in grey prints. It has extensive endnotes, which largely consist of bibliographical references to the even more extensive bibliography of primary and secondary literature. The academic apparatus is rounded off by a good index.

Despite extensive historical research resulting in a highly detailed and dense text with intensive historical analysis, Murphy’s book is well written and a comparatively light read. Murphy has written an excellent book that delivers up a masterful demonstration of how a narrowly focused piece of historical research can be worked and presented so that it shines a light on a wide ranging historical development. The book should be of interest to anybody involved in the history of European medicine over the last five hundred years but will also make an interesting read for any early modern historian interested in going beyond the boundaries of their own discipline.

[1] Hannah Murphy, A New Order of Medicine: The Rise of Physicians in Reformation Nuremberg, University of Pittsburgh Press, Pittsburgh, 2019

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Filed under History of medicine, Renaissance Science

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