AN ESSAY FOR THE REGVLATION OF THE PRACTICE of PHYSICK. Upon which REGULATION Are grounded The Composure of all Differences Between PHYSICIANS and APOTHECARIES: AND Reasons for preferring the long accustomed Way of Practising by Prescription.

To which is added A brief Discourse concerning ARCANAS or NOSTRUMS, and another of the Deportment of Physicians towards the Sick, and one another: as also of the Apothecaries to the Sick, to Physicians, and to Members of their own Society.

By a Lover of Truth and the Good of Mankind.

LONDON, Printed for Tho. Taylor Bookseller, at the Sign of the Hand and Bible on London Bridge. 1673.

AN ESSAY FOR THE Regulation OF THE PRACTICE of PHYSICK.

MUch hath been writ to widen Differences between Doctors and Apothecaries, and to make them irreconcileable one to the other, as if upon that breach depended the better Being and Health of the Peo­ple, and the Improvement of the Art of Physick.

This has been propagated by some in­dustriously, by others incautelously: by the first because thereby is gained a liberty or convenience in practising an Art, in which, as they have a very incompetent pro­portion [Page 2]of Skill, so for the exercise thereof they have no legal, or a very questionable, authority, and therefore are concerned, to keep this Contest on foot, under whose Umbrage they shelter their intrusion, and continue confidently their illicite practice.

Others incautelously, upon injuries received, some bold af­fronts offered, their Profession against Law, and Ties of Gratitude invaded: from the sense and provocation of which wrongs, they have too suddenly preferred the ruine and extirpation of a Corpo­ration, established by the same Authority with themselves, con­siderable for Numbers, for bearing a share in the publick Charge; and very many of them eminently knowing and sk [...]lful in their Profession; before such prudent endeavours, as might have re­duced all to a just and regular establishment, contentful to both Faculties, and much conducing to the publick weal and accommo­dation of the People.

That there should be a necessity of the ruine of one or the o­ther, as some have supposed, is indeed supposed by such as are F [...]iends to neither, but as the Devil persuades men in desperati­on, that there is now no room left for repentance: So these would perswade both, that huc tandem deventum est, 'tis in vain to think of a Composure now, both parties have criminated and re­criminated, and so highly incensed one another, that there is no hope left to bring things to a due regulation, just bounds and subordination.

To obviate which purpose is the intention of this Paper, by proposing such a way of establishment as may afford full con­tent to the Reasonable of both Professions, may give the Physi­cian a full insight into all the parts of Pharmacy, both in the knowledg of all Drugs, as also in the best ways of working upon them; and yet so as not to take up too much of his time from requiring knowledg in other as necessary parts of Physick. To keep the Apothecaries within the Verge of their own Profession, upon the operative parts of which their time being wholly spent, they become very assistant to the Physician in his Improvements of Medicine. To provide in the best manner for the people, that their Medicines may be good, sound, efficacious, accoording to the prescript of the Physician; by means whereof they may be ta­ken with confidence and good expectation by the Patient, and [Page 3]secure che mind of the Physician, that his orders are well ob­served.

In doing whereof, it is not to be supposed, that any thing can be offered in this or the exercise of any other Art, that shall be wholly free from hazard, or not liable to objections in the exe­cution; no affair in the world is exempted from it; it is not therefore amply sufficient, that such a way be proposed as is ex­posed to the fewest exceptions▪ and those of smallest moment, and (which is most comprehensive of the main ends) by all to be aim'd at, the best provision for the peoples Health, and the im­provement of the Pharmaceutick part of Physick.

1. That the Apothecaries, by their Master, Warden; and As­sistants, solemnly promise, not to pra [...]ise Physick, except in case of absolute necessity, but to keep to their proper business of ma­king, dispensing and vending Medicines.

2. That the Company of Apothecaries do oblige their Mem­bers, already admitted, and to be admitted, not to practise Phy­sick: and in case they do so practise, to be liable to such fines and penalties as the Master and Wardens, for the time being, shall in such case establish:

3. That the Colledg and Company of Apothecaries joyn to­gether, in procuring, by their joint interest, such Supplements to their several Charters, as our present state of affairs shall require, to secure to each of them their several Professions, so far forth as the Common liberty and the Laws of the Land will allow.

4. That such Apothecaries as, notwithstanding the foresaid Agreement, shall of themselves practise Physick, complaint, and just proof thereof being first made before the Colledg, shall, for their first time so doing, be warn'd thereof by the Colledge, and also by the Master and Wardens of the Apothecaries Compa­ny, and be admonished to forbear the same for the future: and in case they shall, notwithstanding, persist so to practise▪ that then, upon proof made as aforesaid, they shall be declared by the Col­ledg, at a general meeting, to be practising Apothecaries; and the several members of the Colledg commanded, upon penalty of a fine, to be then declared, not to send their Bills to them, or to have to do with them in their Practice, but to leave them to themselves; as incorrigible intruders into other mens Professions.

5. That the Members of the Society of Apothecaries shall bear themselves with all due respect and subordination to the Mem­bers of the Colledg of Physicians; and that the Members of the Colledg wall have a fair and candid regard to Apothecaries, as to persons to whom they have entrusted (under their inspection) some moyety of the Manual parts of their Art, and that they both of them unite together, and hold a necessary correspondency for advancement of these two Ends;

  • 1. The improvement of Phar­macy, and
  • 2. the real promotion of the Peoples preservation, and also safe and speedy restauration from their Diseases.

6. That, for the better regulation and execution of this Ma­nual part of Physick, a view be quarterly made of the Medicines and Drugs of the Apothecaries, or oftner, as need shall require, by the Fellows of the Colledg, chosen thereunto, according to the conveniency of their several Habitations, the said Fellows, in case they find things faulty, to give an account thereof to the Censors of the Colledg, that by them such just and lawful means may be used for punishment of what is past, and prevention of future miscarriages as their Charter in that case providing shall thereun­to authorize them. And that the said Fellows in their several Divisions shall, as far as other business will permit, be present, not only at the making of those general Remedies, viz. Mithri­date, Diascordium, Venice and London Treacle; but of all others also; whereby the Apothecary may be assisted, negligence and frauds prevented; and the Physician constantly exercised in the Manual part, and thereby also enabled to ampl [...]fie, correct and improve this so necessary and considerable part of his Art, not only by his Observations made, upon these manual processes, but by drawing in all advantages from Philosophy, his own Reading and Contemplation.

7. That the Dispensatory be revised by the Fellows of the Colledg, and republished with such Alterations and Amendmen [...] as they shall judg requisite: in doing whereof, as a fair regard [...] to be had to predecessors, not to vary without just cause, so are they on the other hand principally to steer themselves, by the grea­ter probability of promoting common good, and producing such Medicines, as may, with great certainty, effect the intentions de­signed by them. For though the present London Dispensatory be [Page 5]acknowledged to be the best now extant in any part of Christen­dom, and not only to excell the Augustane, but in many particu­lars, its very amendments in the Annotations of Swelfer: yet inasmuch as Pharmacy has been these late years much improved by the great industry of Collegiates, especially by their own ma­nual operations, whereby many Discoveries have been made, of great improvement to Medicine, and benefit to the Sick: it may easi [...]y be concluded, that it is a work of great necessity, to make a new Directory to Apothecaries, leaving out very many Medi­cines that are superfluous; correcting what may with little al­teration be retained, adding such as are rationally composed, and which by much tryal and experience are approved: that so this new Dispensatory may not be clogg'd with too great a mul­titude of Medicines, nor with such as may not, for some consi­derable time, without dammage be preserved, and yet supplyed with such an armamentarium Medicum, as may most hopefully per­form all the just Indications in the method of Cure, both gene­ral and particular: By the doing whereof the Physicians of this Nation will be deservedly honoured both at home and abroad, the Apothecaries Shops not uselessly incumbred, the best provi­sion made for the Peoples Infirmities.

Thus may the most considerable objections be answered against the present method of Practise, which have only force from the defect of some necessary provisions, which may hereby (and by other suggestions from Physicians of greater abilities) be sup­plyed: This being intended but as an Essay towards such a Sup­plement and Regulation as is clearly wanting; whereby also may be prevented that ruine to either Physicians or Apothecaries, which by some is vainly supposed to be unavoidable: Confusion and great disorder is often, and always ought to be the produ­cer of Order; when prudent men discovering the defects and inconveniences of what is irregular, and the artifices of such as design, out of private concernment to keep it so, do set them­selves to contrive such expedients, as may preserve all just Rights and Interests, and endeavour the establishment of an Art so ne­cess [...]ry as Physick, from running out into confusion, where e­very man may, without controll, do what he pleases, which is not allowable in any other Trade or Faculty whatsoever. The [Page 6]first intention of making a Dispensatory, was to bring Medi­cines to some certainty, that Apothecaries might have a known Rule to make their Medicines by, and not fluctuate and be left a [...] liberty to make them by the uncertain guide of many and forreign Dispensatories, and the Physicians also, not left doubtful of their Medicines, as not knowing by what rule the Apothecaries would make them: And this was done by the Colledg, at the intima­tion and command of King James, in the year 1618 Some years after a discovery being made of some defects therein, the Colledg thought fit to give a timely stop thereunto, by publishing a new Dispensatory then so called, which they did in the year 1618. No­thing then hinders, but that upon a greater acquisition of knowledg, the present Colledg (whose Members, by many instances have ap­proved themselves not to have neglected the advantages of Suc­cession, but rather abundantly to have imp [...]oved them) may pro­duce their Dispensatory also; in many things exceeding the for­mer, as that did what was first published, by how much their ad­vantage is greater both in coming after them, and not contenting themselves with a bare traditional Knowledg, but most of them personally and practically exercising themselves in the production of Medicines, and gaining thereby those discoveries, which Learn­ing meerly notional and bookish could never attain unto. Here­by approving themselves to be truly studious of publick good, and as well in this as in other parts of their Art, to bring to light, whatsoever upon serious deliberation they conceive may promote the same.

If then a new Dispensatory were now made, and the other par­ticulars above mentioned effected, it would give general satis­faction to the People, answer the Scruples of doubtful, and obvi­ate the artifices of crafty men, who design to disturb the whole Faculty, to divide not only Physicians and Apothecaries, but the Members of the Colledg themselves, that amidst such a Confu­sion they may catch at a share of business, which their own abili­ties, nor the regular way of Pract [...]ce does entitle them to.

Physicians making their own Medicines declining the Apothe­caries, and using them only in their Practice, has had, as all other Novelties, a specious reception, but time discovers many inconve­niences that could not be foreseen: and the most prudent Physi­cians, [Page 7]though they do not decline making of Medicines, for their own satisfaction, yet do much decline that way of Practise:

If Physick were now in its first dawn and infancy, to be be­gun in the world, (before also Luxury and Intemperance had multiplyed Diseases, and increased the number of Practitioners, and before those Regulations in its practice were by our prudent Ancestors established) all that applyed themselves to this Art, must necessarily fall into that way of making Medicines themselves, but the case is now far otherwise, and therefore they are much beside the matter; who handle this Question without due consi­deration of its state, as it is now constituted. Where first,

1. Violence is offered to the Laws and Orders in being for its present Regulation, which doubtless were made not without serious deliberation and wise foresight of inconveniences, and therefore those who would innovate in this particular, may well be supposed either to design for themselves, or that they have not so fully considered the matter as they ought to have done.

2. I see not with what justice they can pass over the ruine of 7 or 800 persons and their Wives and Children, the Apothecaries, I mean, who are established by Law, who make up no inconsidera­ble Company of the City of London, bear a share in all publick Charges, and who may vie with the Apothecaries of any part of Christendom, for solid Skill in their Profession, who also, from the encouragement the Law hath given them, have declined all other way of livelyhood, and depend only upon this for the maintenance of themselves and Families: To strike at the foun­dation of such a society, is, I say, very inconsistent with the rules of Justice and common Charity, which ought to be visible in all the purposes of mankind.

3. That Medicines should be better made by Physicians, than Apothecaries is not likely, it being not barely the Theory that enables thereunto; the one has served seven years Apprentice­ship, and been daily employed upon the operative part: the the other from a speculative knowledg confidently thrust, him­selt upon that which he finds much different from the Notions and Ideas thereof he had comprehended in his mind: The one makes it his sole and only business to make Medicines, to the other it is but a small part of his Employment, he having be­sides [Page 8]many and intricate parts of Study; as namely, the Physiolo­gical, Anatomical, Pathological, and Therapeutick part of his Art, each of which are very comprehensive, and therefore it must be presumed, that either he cannot give full time to buy select Drugs, and make Medicines enough to furnish the whole of his Practice, especially if it grows to be any thing considerable, or that otherwise he must neglect other parts of his Art equally ne­cessary with that of Pharmacy, either of which are of ill conse­quence to the Sick. Hence, I suppose, it was, that our Fore­fathers, foreseeing this inconvenience, did entrust this part of their business to Servants, who afterwards, growing skilful and numerous, were incorporated for the better regulation of the Fa­culty, and grew up by degrees to the Port they are now at: yet were the Physicians so prudent as to be the Dictators to them, and frequent Inspectors of their Operations, and Searchers of their Shops, that so they might be the better ascertain'd of their faith­ful dispensing and making their Medicines: Which custom being tetianed and faithfully discharged, according to the method be­fore advised, would very much prevent oversights and frauds, and give the Physician opportunity of improving Pharmacy, by ma­king observations and conclusions from the process of Medicines. All which notwithstanding he retains his liberty to make Medi­cines at his pleasure, either at home, or to be present whilst they are made by his order at the Shops of Apothecaries, which is much the same thing; so that as to the improvement of his Know­ledg full respect is had in this method, without other inconveni­ences, which is an answer to the grand objection that seems to bear most weight for Physicians making their own Medi­cines.

4 It is also plausibly urg'd, that now Phisicians are forced to trust Apothecaries, and that their whole Cure depends upon his fidelity: whereas in the other way the Physician is sure of his Medicines, they being made with his own hands.

I answer, that it is all one if they are faithfully and truly made by the hands of other men, who have good skill to make them. In the matter of Fidelity, the defect may be in the want of such an establishment as is mentioned; where, if the Physician were some­times authoritatively present, and more often friendly, as a neigh­bour; [Page 9]or as having a mutual relation & correspondency in the art, there would be little ground left for such suspicions. Besides the Apothecary is concern'd to be faithful both in point of Profit and of Reputation, which are obligations of no small moment, nor have we reason to judg but that the Tie of Conscience is of equal force with them as with other men: In point, I say, of Reputation and Profit; for they are apparently hazzarded in making bad Medicines, when the Physician comes to view and tast the Me­dicine, and finds it another thing than he prescribed, his inten­tion thereby frustrated, his Cure retarded, his opportunity lost, his own credit at stake; how can he chuse but lay the fault where it is, and place the Saddle upon the right Horse; and if through the Apothecaries default such a thing should happen, how would it spread? what prejudice would it do him? He would be in dan­ger of loosing not only this but other Customers also, to his ve­ry great dammage and disrepute. This the Apothecary very well knows, and therefore is as much concerned as the Physician can be, that it may be said, that he has made his Medicines well, discharg'd his duty faithfully, whereby he not only fixes that Fa­mily he then deals withal, but probably gains thereby several others also.

If you will suppose men wretchless, and to have no Conscience, 'tis a weak reflexion, and can no more be charged upon Apothe­caries than any other sort of men: There are good and bad in all Professions: Here are, however, considerable engagements upon the Apothecary, and the miscarriages and oversights, not to say unfaithfulnesses, may more probably be found in those who dispense their own Medicines, where there is no body to oversee or judg them than in those who have others, and those persons able and concerned, to inspect what they do.

5. If it be urg'd that Apothecaries, engaging in Practice, neg­lect the making of Medicines, and trust much to their Servants, whereby oversights are oftentimes committed of no small hazzard to the Sick: I answer, that the Objection is very considerable, and is no other ways to be answered, than by establishing such a Regulation as is above mentioned, where Apothecaries are re­strained to their particular business of making Medicines: But [Page 10]then on the other hand, the objection is much more cogent against Physicians, especially those who have daily and competent busi­ness, for having his Patients to visit abroad, and they to visit him at home, having his Studies likewise to attend, how is it possible he should give time to the making of Medicines; which requires much attendance and consequently begets a necessity of leaving much to the care of his Servants, and that not only in the making but in the dispensing of his Medicines; whereas the Apothecary, reduced to his particular Occupation, would have nothing else to do but to attend the business of his Shop, and so more hopeful­ly prevent the inconvenience urg'd in the Objection.

6. It may be urg'd, in the sixth place, that Physicians in business making their own Medicines, must necessarily keep several Ser­vants, which being bred up in making Medicines, and being apt, as being conversant in Physick, to read Physick Books, there will arise a new stock of out-of-course Practitioners, which in little time will be exceeding numerous: almost all mankind when they grow up toward mans estate, think of living in the world, of marrying and having a Family, these then having no other way of maintenance, thrust themselves upon the practice of Phy­fick; and venture, from the impulse of necessity, to attempt any thing that offers it self, which they will with more c [...]nfi­dence do from the Reputation of living, and being bre [...] up, as they will say, under such a Doctor. By means whereof the num­ber of indirect Practitioners (who swarm too much already) would increase to a vast bulk, Physicians of great Pract [...]ce being, in this way, forc'd to keep many Servants, which would strange­ly overstock a Profession that is too much overcharged alrea­dy, and which is now the general complaint of all that relate to it.

7. Consultations, which are often necessary, and desired by the Sick and their Friends, cannot so well be managed in this way, as in what is already establish'd: unless there coald be supposed a willingness in all Physicians to communicate their Nostrums, as they are call'd, to every Physician they are to consult withal. For who will give his consent to the use of that be does not under­stand? or practise by an implicit faith? It is not to be supposed that Physicians should always meet with those who are in particu­lar [Page 11]friendships and unions, or that all have that communicative spirit to impart, what they have with great labour acquired, to e­very one, especially where they think there will not be a Retri­bution.

These and many other inconveniences there are in this way of Practice, which cannot at first view be foreseen, but may well be presumed to be the motives that made those who have gone before us to reduce the method of Practice into the way 'tis now in: Nor is their wisdom to be slighted as not done upon good and praise worthy grounds: They did think it likewise necessary to reduce Medicines to some reasonable bounds, which else would swell to an infinite bulk, leaving a liberty, however, to the Studies of men to superadd what they could find more effi­cacious, to answer known intentions, or to obviate new occurring Diseases.

Here I purposed to end, for long Discourses are irksom both to the Author and Reader: The multitude of Books considered, every man should make a conscience of further pestering the world with more, unless they can produce something new and profi­table to mankind: Some things however I have thought neces­sary to be superadded, the present posture of affairs considered, which may conduce somewhat to the main scope of Reconcile­ment and Settlement: I shall therefore subjoyn some Sentiments briefly, upon these Subjects, viz. of Arcana's or Nostrums; of the ancient and becoming Deportment of Physicians, of the decent Carriage of Apotheceries towards the Sick, towards Physicians, and also towards the members of their own Fraternity. Some­thing I mean to subjoyn concerning the Practice of Midwisery, and so to conclude.

1. Of Arcana's, or Nostrums.

Such are Medicines either by great Industry and manual expe­riment found out, traditionally delivered, or collected out of Au­thors, not common, and by frequent use approved: All of these may be called in a large sence Arcana, but the first only are properly Nostrums, as being of each Physicians own Inven­tion.

He who said his Nostrum was his Knowledge in the patholo­gical part of Physick, and in a good method of Curing, spake certainly much to the purpose in this particular: For fince there is so great variety of Diseases and their symptomes, and these sometimes of great resemblance one to the other, and yet in their nature very different, and consequently requiring a differ­ing method of Cure; since also they are often of nice and intri­cate complication; and yet the one requiring preference and priority in Cure; The principal hinge of Practice depends upon accurateness in distinguishing Diseases, where there is so great likeness, in well understanding and weighing the complication, and in a prudent and sagacious conclusion of what is first to be done, especially where there are apparent contraindications. That it is necessary every Physician should have the knowledg of good and effectual Medicines, that may answer every Inten­tion, especially such as are generally occurring in practice, is not to be denied: but to averr, that the main stress of his bu­siness depends upon them, is as if we should account the ex­cellency of a Carpenter to consist in the goodness of his Tools, which every one is to have, and not in his Skill to model, draw forth and contrive Platforms of his Work, and in his ability to effect in good sort, what he hath so modell'd and contrived: So in Physick every part of the Art is necessary, though the know­ledg in the variety and nature of Diseases, and in a true method of Curing them, may justly have priority and preeminence, as be­ing more copious and intricate; and which do therefore give the greater value and esteem to Physicians, because from them do flow his more constant and more certain successes, by which chiefly the people have reason to make their Conclusions.

In consideration of the necessity of Skill in all the parts of Physick, to make a compleat Physician, and consequently the difficulty in the acquisition thereof, it requiring, besides a good Indoles, and natural inclination thereunto, great Learning, fit place and conveniency for Study, Time well employed therein from youth upward, and great Industry: as the good Hippocrates hath suggested, upon consideration whereof, I say, Physicians of best note and ability, have not thought their Art so exposable to popular invasion, as to judg their Reputation concerned in con­cealing [Page 13]of Medicines, but rather swayd by a common regard to the good of mankind, and a desire to profit and improve their Brethren of the Profession, have been very forward to commu­nicate their Knowledg in all parts of Physick, knowing well that Life is short enough to acquire requisice Skill in so noble and copious an Art: and though, different from this antient candour in Physicians, some, who boast themselves to have gained more than ordinary ability, especially some of the more precisely Chy­mical way, and of Wits as volatile as their beloved Mercury; have either communicated little, or in such canting terms of their own invention, the common artifice of arrogance and impo­sture, as amounts almost to a concealment: yet do I not hence judg that such reservation is from any superexcellence in their Medicines so conceal'd; for that would appear from the note and frequency of ther Cures, the contrary whereunto, by much obseavation, can be abundantly instanced, but rather from the necessity of such reservation, that being the principal Basis up­on which they build their desired Fame, (for what is not known may be boasted at pleasure, and what is known may as easily be vilified) That indeed which has begot the necessity of some Reservations, contrary to the custom of former Physicians, is the ill use that is made by Apothecaries of their publication: who aiming at Practice, and putting their sickle into others Corn, invading our Art, injuriously reap the fruit of other mens labour. This is one consequence of that irregularity things now stand in, which by a settlement may be remedied; when Physicians shall have encouragement to communicate what by their Study and manual labour they can produce for common good, being ascer­tain'd that they may trust the same to Apothecaries, without being abused in the irregular use thereof, to their so great and ap­parent detriment.

For in this way of settlement, as there will not arise any restraint upon Physicians productions, they being at full liberty either to make Medicines themselves at home, or to oversee and put too their helping hand at the Shops of Apothecaries (which is far from being any dishonour to them) so will the candor, in gennity and liberal Education of a Physician oblige him to for­bear making any unhandsom profit of Medicines: either by enhan­sing [Page 14]their prices, or by unworthily consederating with Apothe­caries; but matters being composed, to let the Apotheca­ry have them either as an encouragement to his Fidelity, or at such reasonable rates not exceeding the cost of the Ingredients and the charge of making them: since the Physician will be well recompenced by the Reputation of an excellent Medicine of his own invention, his customary Fees also keeping him from having the need of such mean traffick: and likewise concerned in point of Reputation to lay an injunction upon the Apothecary, he has so gratified, not to design more than a competent and rea­sonable profit, whether he vends his Medicine to Patient or A­pothecary: that so it may to all appear, that the Physician has no other end in the pains he has taken in producing such Arca­na's then improving his Art, and providing the best Medicines he possibly can invent, for the curing of the most contumacious and turbulent Diseases.

I may end this Paragraph de Arcanis, with what the prudent Septalius suggests l. 1. Animadversione 14. in these words: As it becomes a Physician to have always in readinefs choice and tryed Me­dicines, confirmed by frequent experience: yet it does not become him so to reserve them his Arcana, as not to be willing to communicate them to others also. I may add that a real and very considerable benefit redounds thence to himself, since thereby inviting others to the same promptness of communication, every one of the So­ciety so qualified, is furnished not only with his own inventions, but the products and effects of others labours, to the no small improvement of Knowledg, and benefit of the Sick. Not does any thing conduce more to the Honour of a Colledg, or the improvement of an Art, than such a candid communication, and participation of one anothers Knowledg, an Argument that eve­ry member thereof, besides his own concernment, has a fair regard to his great and principal end, the welfare of the People, a just respect to his Collegues, and in order to these a noble design of clearing what is dubious, and supplying what is defective in his art.

In pursuance whereof it is to be subjoyned, that as there is no better means to improve Physick to a greater degree of per­fection, than by the united endeavours of every member of the Society, so is there no Society whatsoever, in England, in [Page 15]the capacity of such an Improvement as the Colledg of Phy­sicians.

As to the first, though many things very considerable have, to the honour of this Nation, been brought to light, by particular members of the Colledg, so well known, as that neither the subjects, nor the persons need to be enumerated: yet is it to be supposed, that those persons have in their productions taken to their assistance, some of their more intimate associates, espe­cially in Anatomy, where most has been done, and where the single endeavours of one man, without assistance can effect little: Yet may it well be presumed, that the improvements had been, and might yet be, abundantly more; and that in all parts of Phy­sick, had or would the Colledg make it their business, to subdi­vide the members thereof into several Classes, disposing to each of them such parts of the Art as their particular Genius, and bent of Study, did encline them to: By means whereof every head and every hand would be at work, and accounts might at fit times be rendred to the whole Society, and this fettled upon much the same rules as have been with great judgment invented, and practi­sed in the establishment and continuance of the Royal Society: With this universal Rule, superadded, that as the great and noble End of the Colledg, is, the Conservation of human Life and its restauration, when endangered by Sickness, so should they, as persons worthy of such an undertaking, decline and discourage all nice, useless and superfluous Subjects, fixing themselves only up­on such particulars as have an apparent tendency to the accom­plishment of so excellent an End.

Secondly, I have said that there is no Society in England so ca­pable of improving the Art, as the Kings Colledg of Physicians. There are none that can pretend to any competition, but the Uni­versities and the Royal Society.

As to the first, I humbly conceive, that they are in no such ca­pacity: 1. as being the most of them young men, and therefore wanting that which evinces the certainty and establishment of Knowledg, frequent experience. Study and the Learning there­by acquired is a good induction and preparation to Knowledg, but without long practise, which very few in the Universities are capable of; and observations skilfully and carefully made there­upon, [Page 16]neither eminent natural parts, nor the assistance of the best Libraries can produce more than common Notions, which have been 1000 times printed and reprinted, and which, by ta­king up the precious time of young Students, have made them lose those advantages and profitable productions, which the con­stant exercise of their own understandings and assiduous practice would have exerted from them. But in the main, want of years and continuance in practice are an undeniable disadvantage to the Physicians of the Universities, and which cannot be said of most of the members of the Colledg.

2. Though the Universities have frequent Physick Exercises, the best Libraries, solemn Dissections, a good Physick Garden, and a few eminent Practitioners, yet though these be allowed, as good preparatory helps to bring a Physician into the world, to qualifie and initiate him for Practise (especially being first ad­mitted to the society of other long experienced Physicians, to­gether with a view and attendance upon their Practice, a thing much wanting and very desirable in England, as of singular use both to young Physicians and to the Sick;) yet as to the great propagations and improvements of the Art, there is absolutely necessary (besides long experience) a union, incorporation, fre­quent association and communication, which, as it is wanting in the Universities, so is it well established in the Colledg of London, and I doubt not but when restauration is made of what the Fire consumed, it will evidently appear by those designments, which are as yet but in Embryo, that in the improvement of every part of Physick, such earnest and prudent endeavours will be used, as shall well satisfie the world, that nothing can well be expected, or hoped for, in the Medicinal Art, but will in just and competent time be by them effected.

2. As to the Royal Society, their ends being more general and diffusive as aiming at the improvement of universal knowledg; they are rather adapted and qualified for the advance and perfection of the Mathematicks and Mechanicks than of Physick; and such have most of their Productions been: and though there may be many Physicians amongst them, however few compared to the rest; yet are these Physicians, in justice and prime establishment, rather ob­liged to honour their own Society, with what they shall produce [Page 17]in Physick, and being of chief note in the Colledg, rather to use their interest, that it may be so settled, that all the improve­ments in Physick may be placed upon the account of that Founda­tion: And it seems to be some ingratitude placed upon that Bo­dy of which they were first members, not to have used their utmost endeavours for such a Settlement as may bring to pass those worthy ends in their own Colledg they would patronize in this other Establishment: besides there are in the Colledg, and belonging to the Members thereof, some things which cannot be said of the Royal Society: as

  • 1. that all the members thereof are principally, if not solely, devoted to the Study & improvement of Physick.
  • 2. There is to be considered, that the use that might be made of the Hospitals, which are under the Care of Mem­bers of the Colledg.
  • 3. That the Physicians in the Colledg, be­ing more numerous, are in better capacity of being so divided and taxed with several Charges in Physick, as to comprehend all its parts: and lastly, the occurrences extraordinary in Pra­ctice must of necessity be much more numerous, than when the number does not rise to a fifth part, were the Colledge so esta­blished as to oblige all the members to give just and frequent accounts of the same.

This is not spoken with any derogati­on to the Honour and Ends of that Royal Society, but to evince the Reputation of the more antient Foundation of Phy­sicians, to retrive into themselves one of the great works and chiefest ends of their Establishment, in which the Royal Socie­ty may be collateral, and fairly assistant, but not principal.

Of the antient and becoming Deportment of Physicians.

I consider it either in reference to the Sick, or to one another. My purpose is not here to comprehend all the particulars that concern the regular carriage and behaviour of Physicians, that having been plentifully done in several Authors of good note, but only to take notice of some few particulars of greatest moment, to the good of the Sick and to the Reputation of Phy­sicians.

1. Then it is just, that the Physician should have in his re­gard the Health or Restauration of his Patient, as what is most [Page 18]his duty, and what being really implanted in his mind, will make him very intent upon all his occasions, and in reasonable time a great proficient in his Art: in order to which it is expedient, that he keep a Register of all the remarkable occurrences of his Practice, and as well his own defects and failings as his apposite practice and good successes: For by the one he will be warned for the future to avoid any precedent mistake, by the other re­ceive great hints and information of what in like cases is to be intended: using his best reason to consider and distinguish the variety of Bodies, symptoms and other circumstances. As to his profit let it come in, sua sponte, he need not be solicitous about it, for whosoever does faithfully and conscientiously in­tend the main, viz. the Recovery of his Patient, can never want encouragement sufficient to recompence his honest labour: and 'tis one of the most inglorious things in the world to see a a covetous Physician, earnest for Fees, and using poor and little art to raise the esteem of his own worth, or suggest the earnest­ness of his expectation. In order to which great End he ought to be a a Lover of mankind, as being the chief of Gods mundane Works, of near relation to himself; coequal in Gods regard, and this as well from the natural tie which God has implanted, and a due regard of the excellency and admirable frame and texture of mans body, and the extensive abilities of his mind, as from a sense of that duty which is incumbent upon him, from the time he engaged in the Profession: where, besides the conside­rations mentioned, he undertakes a Trust, a Trust of mighty mo­ment of the Lives of men committed to his care, of which great regard is had as well by the Laws of our Country, as by the de­clared pleasure of God in his divine institutions. This universal Love to his kind, which should be the common bond of Amity, and good will to men, will engage him in the care of particulars: And this I would have more expresly the eminent mark of our Profession; namely, that Physicians are indeed Lovers of man­kind, and of all the works of the Creation, as being daily con­versant in the contemplation of the infinite Wisdom of God, ma­nifested in the never enough to be admired contexture, order, variety ond curiosity of the parrts of the Creation, as likewise in imitation as far as his ability extends, of the great Physician [Page 19]both of Body and Soul, our blessed Saviour, who went about, doing good and healing all that were sick.

2. It follows then in the next place, that he should keep his mind in a just and even temper, that as it should not be tainted with Covetousness, and low desires; so neither puffed up with Pride or Disdain; as if his poor and indigent Brother were not a fit object of his care, but too mean and contemptible for his tenderness and visits: a notorious argument of ignorance and self conceit, since God esteems no man as he is rich or poor, high or low, these being accidental distinctions, and of mans ma­king, not intrinseck and consubstantial, and 'tis fit that Physicians who are Natures Ministers, and consequently Gods, should see as God sees, and not be deluded in their understandings, by these slight veils, which crafty and designing men have thrown over the face of human nature: yea as a true Servant of our great Ma­ster and chief Physician, he should, with most delight, be con­versant among the poor, to compensate their sufferings, raise their drooping spirits, and make them some amends for the want they have of the good things of the would, whereof they enjoy so small a proportion. 'Tis not our own worth, that procures for us from God, the universal Bestower, these various mercies human nature stands in need of; but his own frank and distribu­tive Goodness: in imitation whereof, we ought to make not me­rit, but need the subject of our endeavours; to recover lost inno­cence or health was the great design of our Master, who was to that end conversant with Publicans and Sinners: Though there­fore the Practice among the Rich may be more profitable, yet is the helping of the Poor as much our duty, and more, since the Rich are every where courted, and their Practice with much at­tendance, and many little stratagems procured, because of pre­sent pay, and a mean distrust of him who has past his word for whatsoever shall be done for any of his little ones, giving it an equal esteem, and consequently no less recompence then if done for himself. This ought therefore conscntieiously to be performed by Physicians, not to acquire same, (though that will unavoidab­ly attend it) but ex sensu officii & beneficii, from a true sense of duty and a certain recompence of reward: a reward beyond the Sti­pend of Princes, the Fees of the most liberal Nobles; viz. Com­fort of mind here, and Gods favour both here and hereafter.

3. It becomes a Physician, to be curteous and pliable to the Sick, to be of easy access, ready and willing to give a full hear­ing to them and their friends, that so he may receive full infor­mation of the nature and state of the Disease: This is both a more certain way and more satisfactory to the Sick, than to de­fign a Reputation, by being thought able, uno quasi intuitu, pre­sently to discern the quality, difference and accidents of Disea­ses, in the Knowledg whereof (it being very easy to mistake, and those mistakes being of no small consequence) a Physician cannot be too sagacious and circumspect An observation of such care is no small encouragement to the Sick, and by being so, is a considerable advantage in the expulsion of a Disease. To be morose and magesterially conclusive, argues that a Physician has more care to please himself then his Patient: that he overweens his own knowledg, that he takes that for certainty, which, at the best is but rationall conjecture: assisted by rules of Art not infallible: That he shews himself more a Master than a Physician; which is opposite to that candor and affability, which are set down by the most ingenuous who have writ upon this Subject as the characteristical note of a true PhysicianHippocrates therefore in his Chapter de Me­dico has (according to his comprehensive Wis­dom) most excellently advised in this particular, [...]. That a Physician be of good and honest manners, and that to all he joyn together gravity and humanity, or love to man­kind: for an inconsiderate yielding and over­easie promptitude, though it sometimes pro­fit, yet is it indeed contemptible: and again, [...]. As to his Gesture; let him have consideration and Wisdom in his Countenance, not asperity and sowerness, least he appear to be a pleaser of him­self, and a hater of mankind. That although it may be necessary in some cases, to Patients humorous, conceited and opini­onative of their own knowledg, to be posi­tive and enforce a com­plyance, by overruling arguments, and manife­station of danger: yet is this but seldom, and only to such to be done: no­thing being more plea­sing and profitable to the Sick than a gentle comportment, joyned with diligence, and real ability, with sin­cerity and unseined affection. With real ability, I say, and un­feigned [Page]affection: for without these to use glozing and flatte­ring speeches, and to substitute them with hopes to pass them cur­rent, instead of what the Patient expects and his Disease requires, is a piece of imposture, no less criminal than to cover ignorance with austeer severity, and to daunt the Patient from considering his Physicians true worth, by his assumed arrogance and conn­dent promises. In this as in all other the bufiness of mankind, just and sincere dealing is ever the best, most satisfactory to others, most contentful to the Consciences of those who use it, most commending a Physicians worth and advancing his Practice: For all the little arts that are otherwise used of obliging, engra­tiating, or other contrivances of insinuation, are upon their discovery extreamly prejudicial to them who use them, and produce a quite contrary effect to what they were desig­ned.

4. It becomes a Physician as well to bear himself with just respect towards other Physicians, as toward the Sick: the only means to to maintain that fair and friendly correspondence, which should be between Professors of so noble a Faculty: and in order to this, Modesty and Ingenuity are the worthy qualities which have been the grace and ornament of the best Physicians and by which regular Professors have been distinguished from boasting and vain-glorious Mountebanks: Real worth commends it self, and the frequent benefit the people find by the Counsels of those who are well versed in their Art, takes off the necessity of any other stratagems. Boasting (whatever it is in other Professions) has been always accounted by the best able to judg, to be an effect either of weakness of mind, joyned, as it often is, with arrogance; of want of real ability, or of little Practice: for where there is modesty, worth and competent business, such irre­gular courses are declined, and despised. It is also observable, that whoever is so vain as to cry up himself, rests nor there, but is so injurious also as to decry and vilifie others They steal from others fame to patch up their own: This though they do not always do in open and express terms, least they should be cal­led to account for it, (that being one great end of the Law, that one mans fame may not be at the mercy of another) yet are [Page]there many sly expressions used, as abusive and damageable as if they had said it in terminis; as, that he could, wish he had been sooner called: That he worders such a course was not taken: that he believes all things were intended for the best, but it had been well, if such a thing had been done, or such a thing omitted: Tha [...] he does well for a young Physician, but age and experience is yet wanting, and very necessary: Then there are dislikes without words, as the shaking of the head, expressing wonder or other passion at the relation of what has been done▪ All which, with many more of the like kind, if generally pra­ct [...]sed, would impress a greater dishonour upon Physicians, and more certainly ruine the whole Faculty, than all the united en­deavours of all adversaries whatsoever: For persons so injured, upon a just sense, cannot but be so true to their own Reputa­tion, as either to take the benefit of Law, where words will bear it, (which however would be of ill fame to the Faculty) or else in the like kind retaliate; by means whereof there would arise continual revilings and recriminations, by which the Pra­ctice of Physick would be rend [...]ed to all ingenuous men most detestable, though, in it self it be, of all others the most free, generous and independent, and in fine for mutual candidness towards its Professors the most desirable. There are therefore, as I have been informed, such excellent Rules and Statutes, made in the Colledg for the Regulation of the Practice of Physick, both with the highest regards and greatest sincerity, in reference to the Sick, and with the most knowing candor and ingenuity to be exercised amongst the Professors thereof, as cannot well be exceeded by the prudence and contrivance of Man with just pe­nalties for the breach & violation thereof the publication whereof; for so far as concerns these two particulars, would surely be very necessary, as well for the benefit of the Sick as the infor­mation and security of all legal Physicians; by consideration whereof, it is to be hoped, that they would all become so just in their deportment, and so regardful of the Reputation of one another, that, by this very candid and just demeanour, it should be easy for the people to distinguish a Physician regularly bred, especially a Collegiate, from those who are not such, and there­fore [Page 23]are enforced to cry up themselves, and publish their feigne Cures with the exercise of many other long practised and easily discoverable impostures, only necessary, where true worth and legal breeding are wanting. It is further expedient, that he ob­serve those other Rules of ancient Physicians, left to us as an instance of their Prudence; and especially of the learned Septae­lius: as that a Physician should regard comliness and cleanliness, which is to the Body as Virtue is to the Mind: A negligent and affected slovenliness, to be thought it may be so earnestly stu­dious, as to be careless of those external things, is as much a saulton our hand as softness, delicacy, and the being over folici­tous by spruceness and bravery to acquire regard, is a vanity on the other: Those little Politicks are despicable, and imply, reconsciousness of defects in real worth, or failer of integrity. No, let it be, says Persius, — incoctum generoso pectus honesto.

A mind concoct in noble honesty, which will carry it beyond all the artifices of inventive man.

That he boasts not his own Cures o [...] Actions, but represent all things with Truth, Candor and Integrity, giving every man his due, to the utmost, sparing rather to spread his own Fame than that of others; for Practise, honest, skilful and conscientious will commend it self, and is the basis of its own inseparable Re­pute.

In converse, that he be grave, without affectation, ready in his answers to give fair and just satisfaction to all: where contests are, to be gentle, yee constant for Truth, and resolute, but with strength of Reason, not vehemency of speech: easy and affable to all, but of intimate friendsh [...]p with few, and those se­lect for Prudence and unspotted Honesty. Let him so modest­ly correct the errors of others, as not to have in his regard Re­prehension, but Tru [...]h and the good of others.

That in knowing and taking all fair occasions of doing good to the Sick he be very perspicatious which cannot be done but by diligence in Pract [...]ce and making d [...]yly observations, especi­ally of the most remarkable occurrences.

That he be not too curions in his diet, hard to be pleased, contented with what is wholsome, and in moderation, for he [Page 24]that is too solicitous for his Belly, and a Gormondizer, can never so seriously intend his business, as the weightiness of the Subject requires. On the other side Physicians should not be sordid, greedy of gain, Bargain-makers, Beggars, but frank and liberal, forward to take, at least, equal care of their Patients coming into want, as they used to have of them when in plenty: placing their felicity in moderate competency, and the minds content­ment, rather than in abundance of Wealth.

That he be patient and watchful over a Disease, neither ob­stinate in his own opinions, because he as once taken them up, nor too easy in yielding to the importunities of the Sick, or their assistants, against the convincing Reasons of his own mind: but making the health and recovery of the Sick, the true North Pole, guiding all his actions, and preferring it, even beyond his own Reputation, where it may not viciously suffer, for 'tis in this sense, that according to Socrates, we are to consult our Conscience rather than Fame.

Let him be neither morose and difficult of speech, nor talkative; in the first he offends the Sick, in not giving them that satisfaction they may reasonably expect: In the second he exposes his own Reputation, and is judg'd inconsiderate, sudden, not giving just time, and ponderation of mind to in­form himself; proceeding tongue and hand before head: which leaves him far short of speaking with that Convincement and Demonstration, Physicians should be always eminent for: A­bove all things let him avoid hard and Latine Words to his Pati­ents, the Guise of Empericks and the most ignorant Chirurgions: who having no real worth to gain solid Reputation by, use bar­barous and canting expressions, to amuse their Patients, and to be thought learned: Let this be left to them, whilst true Physicians speak to the Sick and their Assistants, plainly, per­tinently, and in significant expressions, and amongst themselves always in Latine: which; being brought into Custom, would be inoffensive, and in which they may more freely express themselves without discouragement to the Sick, and argue mildly and rationally any thing in difference, shewing no sign of disagreement before the Sick or his Friends.

He should not be ambitious, there being, indeed, no Honour beyond his Doctorship, well put on and worn: others are En­signs, external Trappings, which the vicious and undeserving may obtain: But this is real and intrinseck worth: and there­fore preferrable.

Vainglorious he is not to be, nor beyond just reason a self Lover; for by the first he excludes himself, through shame of be­ing thought ignorant, from learning what he knows not: By the second he thinks himself arrived to that he is but making a progress to, and by overweening his Knowledg, his very imperfect knowledg, for such is that of all mankind, yea of the most learned, he gives stops and checks to his own Pro­gression.

Let him keep himself entirely the Disciple of Truth, devo­ting himself to no party, or opinion, by which the Members of a Profession are disunited, and divide into faction, to the breach of Amity, and mispending of time, in defence of Te­nets unadvisedly taken up, and too earnestly maintained: This is spoken in the general, for as to the Collegiate Physicians of England, it may to their Honour be spoken, that those Wri­tings they have produced (which their worth considered, are of much more use and value than the Rapsodical Volumes of former times, and other Countries) are grounded upon re­iterated experiments, are new and elaborate, disengaged from party and faction, industriously aiming at verity, and profita­ble Knowledg, insomuch that scarce any thing that has by them been written; but has found fair acceptance in the world, and very little opposition from other men.

Let him be facile to entertain Consultations with other Phy­sicians, and in difficult cases prompting the Friends of the Sick thereunto; ready to give a fair account of what he has done, that so it may appear that nothing has been done indi­rectly or unadvisedly: Let him take care however, that such consultations be manag'd among Physicians themselves, neither the Apothecaries nor the Friends of the Sick being present, that so they may proceed with the greater freedom, both of exami­ning what has been done, and of proposing what is further [Page 26]to be done, where candor and ingenuity are much to be regar­ded, the good of the Sick chiefly to be respected, and in or­d [...] to that, care is to be had, that nothing be insisted upon that is superfluous, meerly for shew, or contended for, because of the prerogat [...]ve of seniority, or desire of contradiction: but that according to the method of Consults, proposals be rationally urg'd, and candidly admitted, preferring in all things, as I said, the good of the Sick, before any other respect or advantage whatseover.

He is to be always provided with Medicines to answer all in­tentions in whatsoever Disease, good, safe and experimented: nor to judg himself a competent Physician, until he is furnish­ed with such an apparatus, as may obviate all accidents and occurrences, he may in any case meet withal. Nor to judg himself concerned to conceal any Arcana's, but to communi­cate and invite communication, whereby Amity may be pre­ferred, and every one improve each others Knowledg, for the Benefit of the Sick and Advance of the Art: leaving it to Empi­ricks to boast of their secret Medicines, which indeed have no other Reputation, but because they are secret.

The best Induction into Practice, besides preparatory Know­ledg, Education from youth in those particulars, that are ne­cessary, as Preliminaries to the Art, is the being brought up under an expert Physician: and therefore it is much better, that beginners in Physick should betake themselves to the great Cities, and acquaint themselves with antient Physicians of good note, that they may be guided by them in their Studies, fre­quent the Shops of Druggists and Apothecaries, see the Pra­ctice of Hospitals, be frequent in Dissections and constant at all publick Anatomies, be admitted to the visits of the most eminent Physicians; which course is much better, and safer for the Sick, than that they should settle in little Towns or in the Countrey Villages, and venture upon Practice, upon their own little stock of Knowledg, to the great hazard of the Sick, and the improbability of ever gaining good and justifi­able Skill in the Art they profess. It is also very reasonable, that, besides their University Priviledges, they should submit [Page]to the Examen of the Colledg, which enforces them to acquire reasonable S [...]ill in the whole Body of Physick, and gives them the right hand of Fellowship with that Honourable Society, and Credit with the People, which though University men have sometimes stumbled at, yet if they rightly consider it, they will find their Interest therein included, and the Gate of Practice thereby reserved for them, which otherwise would come out, at large, without Order and Regulari­ty.

Let him modestly bear himself in all places he visits and when his occasions are with Matrons, or Maidens, l [...]t him so manage himself and his discourses, as to treat of their Matters with decency in words and actions, that the Profession may thence receive no Scandal nor no sort of persons any offence.

With the unskilful, Nurses, Women, or others, let him not discourse vainly and impertinently of the Causes of Diseases, or of other things not necessary for the performance of what is to be done for the Sick; but give them good and plain instructions of what each of them are on their part to execute: shaming to raise a fame by such like little Arts, but by the able and consciencious performance of their duty in the Cure of the Sick.

He is very prudently and worthily to bear himself in the matter of fees & reward; and therefore he is to make no Compact for the Cure (the mode of some Chirurgions and Empiricks) and especially not to make advantage where the case is difficult and dangerous; losing thereby often the opportunities of Cure, not to be recove­red: They who do so, gain to themselves the name of Sordid, and blem [...]sh the noblest Profession Hence is it, that most So­cieties and Colledges of Physicians have made By Laws a­gainst the way of Compact for Cure, occasioned, I suppose, by the many litigations thereupon, to which such Compacts give frequent occasion. Secondly, Even the ungrateful he is not to leave in their necessities, since it is better, out of a sense of humanity, to preserve the ungrateful, than in humanity to leave them through fear of their ingratitude. Thirdly, His allowed Fees he may freely take, and that not with aversation, [Page]or blushing, as if the obligation were on the fick mens part: If he has done well and honestly, he may with confidence receive his reward, since it is his Profession and livelihood; to enable h [...]m whereunto much time and great expence was required: If at any time be refuses, it should be where he knows necessities are, where overmuch liberality is shown, or where the case is deplora­ble: Confident acceptance encourages the Patient, and makes him hope well, that the Physician has done his part, which upon ref [...]s [...]l he may be diffident of, since he finds the Physician scarce thinks himself worthy of his Fee: whence contempt often fol­lows, and loss of Fame, although the Physician himself did it for no ignoble end: To gain Repute and Practice by it, is one of the little Arts sometimes used, but proves to the detriment of the doer, since if he continues not so to do, and crumbles at ingratitude, he becomes ridiculous and deserted: But in this particular a latitude is to be left, for the manifestation of friend­ship for the recompence of Kindnesses received; or a desire upon the sense of worth to lay an obligation.

'Tis not prudent in a Physician to promise too much, since he cannot promise himself he shall perform it: from his non per­formance arises two imputations, one of Ignorance that he was so mistaken, the other of, at least, vain arrogance, whereby his future promises and prognosticks will have the less credit: Let him manage his business with Prudence, Skill and good Care, and not to be too positive in his Prognosticks, since there is no case but is so far liable to accidents, as may frustrate the clear­est and most apparent grounds of a good prediction.

Lastly, Let not a Physician advise with too much respect to his own customs, pallat or inclinations: for that is not only empirical, but irrational, and may prove destructive: but let him ever have regard to the present case, with due consideration of all material circumstances, of the difference in age, constitution, quality, and state of the Disease, that so satisfying his own mind, that he does all things rationally, and on justifiable grounds (and that alone is to do it secundum artem) he may be able to satisfie others whatever the success be, and likewise retain a calm and serene Conscience; since God Almighty has not allowed [Page 29]mankind a certainty of knowledg, or infallibility in rebus Me­dicis, but having given him a rational Soul, with all its facul­ties, whereby he may acquire competent knowledg in the for­mation of mans body, as to its constitutive and organical parts, the nature of Health, the Diagnosis and difference of Diseases; and furnish him likewise with a copious ma­teria Medica, to supply Medicines that may answer all indi­cations in whatsoever Disease; it is most agreeable to the wise conduct of humane affairs, that should not cure Dis­eases by instinct, or infused knowledg, but use his Rea­son in the best manner he can for that so noble end, as the Conservation or Restitution of mans Health.

And thus much concerning the behaviour of a Physician, both with regard to himself in the satisfaction of his Consci­ence: with respect also to the Sick, and to other Physicians▪ In reference to himself, his demeanour is to be virtuous and▪ honest, to the Sick it is to be with Care, good Consci­ence and Ability: To other Physicians with Candor and In­genuity: In the next place I proceed to discourse concerning Apothecaries, in doing whereof, I will consider the excel­lency and various parts of their Art. That it is abun­dantly sufficient, to take up their time, that medling in any other Profession, especially in giving Physick them­selves, it must necessarily hinder them from being so skilful in their own Art, as they might and ought to be. Some­thing also shall be superadded of their Deportment in refe­rence to the Sick, to Physicians, to the Brethren of their Faculty.

In our first consideration we will look upon the Art as it is now established by the Law, In a Fraternity incorporated, allowed certain priviledges, and bearing a proportionable part of the publick charge. No body ever questioned, but that this part of the Art was originally in Physicians, who, at first, made their own Medicines, by the assistance of Ser­vants, and sometimes also propriis manibus, both that they might be assured of the well making them, where there was difficulty, as also for the pleasure and contentment there­in; [Page 30]and that by observations made from the process of the work, and many little accidents that would sometimes inter­vene, they might enable themselves, and collect new Apho­risms and conclusions. This might properly be said to be in the infancy of the Art of Physick, when Knowledg therein was comparatively very little, Intemperance, Luxury and Disea­ses nothing so frequent, the business of Physicians but small, and therefore allowing good time for these manual opera­tions. But when, in process of time, and by the great pains and endeavours of Learned men, the Science of Physick came to be much improved, and in all its parts augmented, Physicians, for several weighty reasons, did think fit to en­trust the making of Medicines to a certain number of men in some measure scholastically bred, to whom they gave rules, directing the manner and method of each operation, and of­ten inspecting the performance thereof, that so they them­selves might more intirely intend the anatomical and patho­logical part of their Art, and give full time to their Practice and Methods of Curing.

Now forasmuch as in the Art thus divided, there is abun­dantly sufficient to take up the whole time both of the Physi­cian and of the Apothecary, and that therefore by such a Division it may well be concluded, that both the business of the one and of the other, may be the better discharged, there is no reason, in this particular, to blame the Wis­dom of our Ancestors, but rather to approve and applaud the same, as a matter of good regard to the Weal of Man­kind.

Take we then the Apothecaries Art as thus, assigned to a certain number of men incorporated into a Fraternity, with necessary and convenient Rules and Orders for the Re­gulation and Government of the members thereof, for the prevention and Government of the members thereof, for the prevention of fraudulent and male operations, and it is to be acknowledged to be a very excellent and praise-worthy Art, especially if we duely weigh and consider the several Bran­ches and parts thereof, and in how many particulars the Members thereof ought to be conversant, and well skil­led.

For, first of all, he ought to be knowing in all sorts of, at least, domestick Plants, and of the several parts thereof, the Seeds, Roots, Leaves, Flowers, Sprouts, Barks, Woods, Fruits, Gums, Rosins, concreted and liquid Juices; with all other the appendices to Plants: And in order to this, I shall take liberty in this place to advise, that whosoever designs his Son to be an Apothecary, he should, beside writing well, the being a good Arithmetician, and the acquisition in good measure of the Latin Tongue; he should let him spend a good part of his time, viz. from twelve to fifteen, in gaining the knowledg of what is above specified, which with a little in­struction and encouragement, be will at these years be very apt unto, whereby will be gained not only the preserving him from more trivial business, or time-wasting pleasures, but make him much more desirable, and with less money, by any ingenuous Apothecary and very well prepar'd for that Employment.

Secondly, An Apothecary is to be very well skilled in the knowledg of all forreign Drugs, the place of their growth, the best way of bringing them over, he is to know when they are well cured, genuine, free from all adulteration: to learn all the ways how others adulterate them, that he may discover them, and not be imposed upon: The best ways of preserving them, whether in Boxes, Glasses or Pots, and of what mettle. This is a matter of great comprehension, the Materia Medica being of vast extent: and therefore requires much time and great pains.

Thirdly, He is also and which is the choicest part of his Art, to understand well the way and best Methods of making up Medicines as well external as internal, which being of very various sorts, to keep in a readiness most of which he is obliged: the greatest part of his time taken up therein, will be but little enough. So that although he be a very serious and industrious man, and used to no extrava­gancies of any kind, he shall not complain for want of busi­ness, this part of his Art being abundantly competent and copious: the making of all sorts of distilled Waters, simple [Page 32]and compound; of the last of which (not to say any thing of the first, most of them being superfluous,) there are in the Dispensatory 38 besides these Magistrales, which they make either by order of Physicians or others 10 Tinctures, 9 medicated Wines, 8 Vinegers, 100 Syrups, 17 compound Honies, 12 Robs or thickned Juices, several Loochs, Con­dits, Conserves and compound Sugars 33 compound Powders, 38 Electuaries and Confections, beside 24 that are purging, 28 sort of purging Pills, 3 Opiats, 32 Trochises. Abundance of compound Oyls, 29 Unguents simple, so called, and 20 more compound, 52 Cerats and Emplaisters: in the making of which (the Ingredients being at several times of the year ripe, brought over or fit for use) there is scarce any sea­son but, their time is required for one or other part; the former two particulars being once well acquired, are always ready in the mind, by the help of dayly practise, and con­versation. But the Medicines of their Shops being daily in decrease, or decay, there is a necessity of a constant supply, which requires a constant labour and attendance.

Fourthly, Add to all this the Dispensing of Medicines, and giving them according to order, injecting of Clysters, and, as they have now ordered the matter, applying of Lee­ches, raising and dressing of Blisters: Let us consider all these together, and then let any reasonable man judg whe­ther there be not enough to take up the whole time of an Apothecary? whether a man that shall be ingeniously and industriously conversant about all these, can fail of good re­pute, and be other than very desireable amongst men? whe­ther such a one can want a good livelihood? and lastly, whe­ther by medling with the business of a Physician, and pra­ctising Physick, he does not draw a perplex'd trouble, and disquiet of mind upon himself; by engaging where he has neither a legal Call nor competent Ability, injuring there­by not only the Physician, but the Sick, and his own Con­science, if the vain hope of a little profit, and that but imaginary neither, has not made it insensible: when especi­ally, and of necessity, he must, by so interfering, neglect some considerable parts of his own Professions, and by his [Page 33]much absence from home, being engaged with (at he calls them) his Patients, give opportunity to his Servants to be slight and negligent in the performance of their duties, and liable to many omissions and mistakes, which might have been prevented by the presence and oversight of a diligent Master: This doubtless deserves a serious consideration, when both Profit and Conscience are concerned, when by intermedling with what they have no just right to, they neglect that duty which is incumbent upon them, and the acquisition of Skill necessary for the discharge of their Pro­fession.

As the Apothecaries think it high injustice to have their Profession taken from them by others not bred thereunto, or having no lawful authority to use their Art: So is it no less injury, for them to practise Physick, thereby in­vading the Profession of Physicians, to which they are bred at vast charge, long expence of time, and under the en­couragement of the Law. In so doing, the Apothecaries, besides the unpleasantness of living out of their Sphear, and the injustice towards those Physicians that are in being, they hinder, and, in great measure, shut up that passage, which should be kept open for University men, to plant themselves either in this or in other Cities, or great Towns of the Kingdom, as the end of their Labours or Studies: This passage, I say, is shut up by practising Apothecaries, except it be to some very few, whose Fame hath gone before them, and usher'd them into the World: so that the Uni­versities are no less injured than the Colledg here: and e­ven posterity, the Successors of both: Upon consideration of which, if both the Colledg here and the Physicians of the Universities should resolve to take the matter of Phar­macy into their own hands, it were but just retaliation, who notwithstanding, out of great Moderation and Pru­dence, have aim'd at reducing the overflowing streams within their just bounds, desiring much rather, that the Apothecaries should be sensible of the exorbitancy, and timely draw back into their proper station, without forc [...]ng [Page 34]unwilling, persons to the utmost remedy.

This the Apothecaries excuse, by urging a necessity of so doing, least they lose their Patients: A necessity of their own creation, and within the capacity of their own Com­pany to restrain. If this necessity had been brought upon them by Physicians, there would appear some shew of Justice in their Plea: but since it is apparently otherwise, they have only themselves to condemn for their transgression, and no less to accuse themselves for the feigning a pretended necessity, to salve an unlawful Intention, They are seriously to lay this to heart, and in case they shall not resolve upon a Forbearance and Regulation herein, they must justly blame themselves for any Resolutions that may be taken, though never so much to the dammage of that Fraternity, for the Remedy thereof. It may he the most of that Society may be well resolved in this particular; but that is not enough; for, if a considerable number shall persist from the Sweet­ness they find therein, in this unlawful practice, they in­volve all the rest therein, and in what may be suffered thereby, and therefore are concerned not only to conform to what is Reason themselves, but to carry it at their Hall against the minor number opposing, or to protest against them, that so the Colledg may know how to make their Distin­ction.

Concerning their Deportment, besides the common Ju­stice and Honesty that ought to be in all men; for as Dodo­naeus observes, praestat virum bonum esse Pharmacopoeum quam Socratem, forasmuch as the Health and Lives of Men de­pends very much upon his Skill and Fidelity: he is also fair­ly to demean himself towards the Sick, with regard al­so to Physicians, and the Brothers of his Faculty.

Toward the Sick, first, in well preparing their Medicines, according to the Physicians order, with good Ingredi­ents, not adulterated, not decayed with age, without sub­stitution of one thing for another, at his pleasure, either for cheapness, or his present want thereof: In that case he ought to look out for it, or if it cannot be had, he is [Page]to acquaint the Physician therewith, that so he who knoweth the reason, order and dependency of his own Prescription, may substitute what he conceives most con­venient.

Secondly, He is to take care; that Medicines be timely made, that they may be given seasonably, according to or­der, much depending thereupon: besides that the Sick and their Friends are usually veay earnest and solicitous for what they judg will be helpful in their distress, and the Physician does place much in the seasonable exhibition of what is pre­scribed.

Thirdly, He is not to interpose Medicines of his own, unless in a case of absolute necessity, where the Physician cannot be consulted; forasmuch as he cannot be ascertained of the Physicians intentions, and may therefore frustrate and invalidate what is prescribed by his interposition.

Fourthly, He is to make a Conscience in the prices of his Medicine, designing his profit to arise, not from o­vercharging any one Patient, but from his gaining of ma­ny, by his care and conscionable dealing towards all. And though in this case, some respects are to be allowed to his Charge, to the greatness of that apparatus he is required to maintain in his Shop, to the loss and decay of Medicines, yet all this is to be done, with such prudent regard to­ward the Sick, that, placing his Interest in the multipli­city of Patients fairly acquired, he may give none distast, by shewing himself covetous of Gain, or craftily dealing with any.

Fifthly, His Charity to the Sick that are poor is not to be wanting, he will be recompenced for it, in the Con­tents of his Mind, in the Obligation he lays upon the Poor, which, by reflection, will pass to the Rich, or if this last fails (which he is not to be too solicitous a­bout) he may trust God Almighty for his Paymaster, who never fails to recompence good actions, as not to pu­nish evil.

2. In reference to Physicians the Apothecaries ought to [Page]be ful of fair and just respect, forasmuch as they entrusted to their management, one of the prime and considerable parts of their Art: by means whereof the Apothecaries came to be a Company, and to have esteem and repute in the world: And though they may be apt to urge that the Physicians did not do this for the sake of the Apothecaries, however since they reap the profit of it, their Gratitude should oblige them to make a fairer Interpretation.

2. They cannot but know, at least, their experimental sufferings will make them understand, that their Concern­ments depends upon the Credit and Reputation of Physicians, and therefore for them to use any practices to the diminution thereof, is not only to undermine the Credit of the Art, and of the legal Professors thereof, but therein also to subvert the foun­dation of their own Interest. I might here enumerate the ma­ny little Arts, that have to this purpose been used upon a great mistake that they do therein better consult their own Profit, but supposing that time and experience had made them better to understand themselves, I pass it over, no proofs or discoveries being more convincing than their own sufferance, which is acknowledged almost by them all.

In the third place I am to mention some particulars con­cerning their Deportment one towards another.

First, It ought to be full of Kindness and common Justice; and therefore they are to avoid all undue undervaluations and supplantings one of another: Concordiâ res parvae cres­cunt. If some take a liberty to defame the Credit of o­thers, it may be retaliated, and then what will this beget but criminations and recriminations, to the prejudice of the whole: The Rules of common right should steer them all, and where disingenuity transgresses, the good and whol­som orders of the Fraternity should take place, and be strictly put into execution. Severity restrains Injuries, remissness gives them encouragement.

Secondly, Their particular crying up of a Physician, on whose Practice they design to depend, is not only injuri­ous to other Physicians, but little less than a Confederacy [Page]against their Brethren Apothecaries: It begets Factions in the little Commonwealth of Physick, since it enforces o­thers to do the like: besides the private insinuations they must here use, of crying up some and decrying others, a very great and injurious license being here often used, in their private and subtil suggestions, which redounds also to the detriment of one another.

A third inconvenience is their setting too great a rate upon such Nostrums as Physicians have placed amongst some of them: By means whereof other Apothecaries, who are by prescription to provide those Medicines, are forced to charge the Sick with unreasonable rates, to their great discredit, and yet it may be to be no gainers thereby, it may be losers, or to endanger the loss of their Custo­mers. This is a considerable evil, and is to be rectified, if not by the ingenuity of the Apothecaries, yet by the prudence of Physicians, who, for the preventing of such excortions, ought rather to communicate their particular Medicines to several Apothecaries,

This shall suffice to have spoken concerning the Demea­nour of Apothecaries, to the Sick, to Physicians and to their own Fraternity, and it is hoped, that it will ob­tain those good ends for which it was intended, viz. the be­nefit of the Sick, and the making of the buisiness of Apo­thecaries more comfortable to themselves, and more pro­fitable to Mankind.

Concerning Midwives.

IT is no small wonder to those who do well consider it that Midwifery, which is of so great concernment to the conservation of Women, and bringing children into the world, should be under little or no Regulation: and that it is free for any Woman, urg'd by necessity, or tempted by profit to undertake so weighty an Employment, autho­rized thereunto by those who have no skill themselves, and upon the Certificate of half a dozen of gossiping Neigh­bours, easily admitted upon the weighty motive of five or six pounds.

Hence is it, that many very young, ignorant, unhandy Women, of little or no skill to turn themselves to the se­veral accidents occurring in that affair, or ability to re­duce preternatural Scituations of Children when towards the Birth, or to know how to bring them into the world in different postures; of very incompetent Knowledg also to advise Women in the various contingencies of their Labours and Lyings in, are yet permitted to practice that Art, without any previous examination, or any proper course taken for furnishing them with necessary Skill, for such an un­dertaking.

Hence is it also, that the Lives of very many women and children are unobservably lost; many women disabled for futute Conceptions, and rendred sickly through the whole course of their lives, and many Children distorted, made obnoxious to Diseases of the Head, the Rickets, and many other weaknesses: These through their unskil­fulness working the Bodies of Women, where there is no occasion, because they would not be thought igno­rant, and on the other hand often neglecting opportuni­ties, [Page 29]through want of Knowledg what and when to do, whereby sometimes one, and sometimes both Mother and Child are very much endangered, or lost.

Hence is it likewise, that the Man-Midwife is call'd upon on every small occasion, to the great augmentati­on of the Charge, to the infinite distast of modest Wo­men, and this either because of the Ignorance of the Midwife, or because she would engage the Man Midwife to give her a good word, and speak well of her amongst the Women.

Where▪ by the way, it is to be taken notice of, that the Man-Midwives proper business ought only to be where one or the other is deed, where an Instrument and vio­lence is to be used, which is an action not agreeable to the softness of the female Sex. In all other cases Midwives ought to understand how to behave themselves, and to deliver Women, and so they were in former ages used to do, until now there [...]s grown a kind of Trade, Confederacy and Combination between some Midwifes and some of the men exercising that work.

Considering the whole matter, I thought it expe­dient, to communicate to the World, both the pre­sent state of Midwifery, as I have done, and also to subjoyn a few Proposals for the better Regulation and Government of that so important a Business.

1. That two Members of the Colledg of Physicians should set themselves apart particularly for Midwifery, and Ute­rine Diseases: and that in order thereunto they should, ab initio, direct their Studies chiefly to these ends.

2. That no Midwife should be admitted to the Practice of Midwifery until she had first signified the same to the President of the Colledg, and Censors, and also to the o­ther two Physicians engag'd in the Practice of that Art; and that a month, at least, before she admits her self to exa­mination: during which time, inquisition is to be made of her behaviour, her life and conversation.

3. That at a time then to be appointed, she be examined by the said President, Censors, and two Fellows, concern­ing her fitness for such an undertaking, and that likewise the Midwife her self, whose Deputy she has been, do viva voce certifie concerning her being skilful and well under­standing what she desires to undertake. And that then the President, Censors and Fellows, well approving her fitness, do authorize her to practise the Art of Midwifery, by Letters of License under the Colledg Seal, the Fees to be but rea­sonable.

4. That no Woman do practise the said Art, but such as are in this manner licensed thereunto, and that upon a con­siderable penalty.

5. That for the better enabling Midwives to this Em­ployment, they be permitted to be present in the Colledg at the Dissection of Womens Bodies.

6. That this be drawn into form by learned Counsel, and added as a supplement to the Charter of the Colledg of Physicians.

The Office of Faculties may herein something suffer, but 'tis apparently for common good: The forwardness of Womens thrusting themselves, without due fitness, reasona­ble skill and preparation, is indeed hereby restrained, but that is both just and necessary: since all men will easily as­sent, that a publick benefit is to be preferred before private Commodity and injurious Licence.

FINIS.

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