Physicians, but leave this to every mans private judgment; Neither do
I hereby bind my self to the same practice, because some few Cases may
fall out (though to an equal advantage to the Patient) may perswade me
to the contrary. For I find some persons of that perswasion, as to
think they have not given satisfaction, unless they have payed for the
Medicines; but to such persons, I have always allowed them to give me
what they pleased themselves, for the cure only, to the full
satisfaction of both parties. Though I will not deny but some persons
out of gratitude for their Cure, have rewarded me beyond this
proposal. Some of my acquaintance have desired me to be more plain in
this last Paragraph, especially in that part of it where I say I do
not bind my self to the said practice; and to declare more fully the
Cases that may perswade me to the contrary; which are these and such
as these. First Where Patients of their own free offers will contract
with the Physician, or have formerly too meanly rewarded him for his
Cure, in both which the Statutes of our College allow a contract to be
made with Patients. Another case is, if a Physician be consulted once,
and for his Fee hath given Medicines gratis, if the Patient frequently
send for his Medicines without the least reward at all. Or if the
Patient living far in the Country, having (as before) once consulted
the Physician, as in the last case, and shall for weeks, nay months,
send for the same Medicines. Or if the Patients friend shall recommend
a Medicine to another friend of his unknown to the Physician; and
where he gives no Counsel, if a Physician in the Country shall desire
some of his Medicines, which are all the cases that occur at present;
I say in some of these, the Physician must needs be payed for his
Medicines; but in other, 'tis rational he should be payed for his
advice, as he desireth new Medicines, which charge will be far short
also of the Apothecaries Medicines, whether repeated or prescribed
upon new advice.
Now the great charge of Apothecaries Bills, and nauseousness of their
Medicines, appears to be the cause why long habitual diseases, as the
Kings Evil, Falling-Sickness, Convulsions, Melancholies, and Winds in
the Bowels, Gouts, &c. become seldom relieved, though they may with a
constant, facile way, be perfectly cured, where neither the great
charge, nor unpleasantness of Medicines, deterr them from a continued
necessary use of Remedies. And for the same reasons many will be kept
from relapses, who being tired out with taking variety of Medicines,
give over before the tone and strength of their parts is restored,
which is necessary to be done in all long Diseases.
He may so contrive his Medicines, first, That they may be taken in
small quantity, and be made more grateful to the tast, and stomach,
and perform more then those of the Apothecaries, commonly slovenly
made, and of themselves Fulsom, Nauseous, and Sluggish. Secondly, His
Medicines made for particular persons, may last Weeks, Months, nay
Years, whereas the Apothecaries Drinks, especially in the Summer time,
must be renewed once, or twice every day, to the excessive charge of
the Patient.
That his Medicines may be fewer, is evident in Physicians that
practise in the Country, who ride far to Patients, and carry in their
Mans Cloak-bag, Medicines enough, not only for the person he is sent
to, but also for most other persons, and Cases he meets with in his
Travels, and therefore his Closet needs contain but few, yet noble and
generous Medicines, and such as may serve him upon all occasions,
supplying what's defective from the Fields or Gardens. He may avoid
all pompous, useless, chargable Medicines of the Shops, and substitute
in their place, cheaper, and more conducible to health; He may very
well lay aside the precious Stones, Saphir, Emerals, &c. the high
priced Magistrals of Coral, and Pearl, made worse by their
preparations, or rather destroyed thereby in their Virtue, as also
Unicorns Horn; and Bezoar, all which are now rarely used alone, but in
the received Compositions; He may also spare the charges of leaf-gold,
for guilding Pots, Glasses, Pills, Electuaries, Boles, &c. which
serves only to raise the Bill.
He may teach the Patients facile and easie Remedies, as to make a
Clyster, apply Blisters, or Medicines to the feet, where they are
needful, &c. and in many Cases may cure by well ordering his Patient
only, without any Remedies at all, or but very few; being free to act
for the Patients Health, without the grumbling of the Apothecary; and
many other ways he may daily meet with, very advantageous to the
Patient.
He will have little use of Conserves, Syrups, Lohocks, &c. a greater
part whereof Sugar makes up, which doth more hurt to most persons,
then the other ingredients do good.
As for Infusions and Decoctions, he will find by experiment, how much
liquor, or Menstruum will suffice to extract the full vertue of the
ingredients, and what are helps, or hinderances thereunto, and thereby
neither suffer loss in the quantity, or quality of them.
He will discover the inefficacy of many of the Syrups and other
Medicines in the Shops, made of such ingredients, the qualities
whereof, what with boiling, what with the great quantity of Sugar
necessary to keep them, are either made useless or opposite to the
ends they are proposed for. Especially in such Plants, Seeds, and
Flowers, which consist of fine volatil parts, and even in drying and
pounding, or the least boiling exhale and evaporate, and therefore in
the common way of ordering them, lose their whole vertue or most of
their efficacy, and alter in their properties. From which by several
methods known to some Physicians, very generous and singular Medicines
may be produced.
He need not use so large Compositions consisting of such confused and
contrary ingredients, and will find good reason to lay aside those
unintelligible and unreasonable Compositions of Mithridate, and
Treacle, and the so much magnified Treacle-water, and will substitute
better in their places, of smaller charge, and less trouble; and this
all Physicians I have conversed with, and the College it self, by
their Book published for the common good, in the year before the
Plague, and all those Physicians in this City, who make or intend to
make their own Medicines, do confess.
But here Apothecaries open wide, and cry out that the Physicians are
great Cheats, and envious persons, for continuing such flat Medicines,
and not recommending to the World, or rather their Shops, our greater
secrets. The answer is easie, that the Medicines in our Pharmacopæa,
are the best of any other Pharmacopæa in the World, both for their
goodness, and well preparing of them, whether they be Chymical, or
Galenical; and therefore the same scandal will ly on all Pharmacopæa's
whatsoever. Secondly, I say that within these few last experimental
years, the practical part of Physic hath been much improved (as well
as Anatomy) especially by such as have put their hands to work; and
therefore till such improvement, this could not be well amended.
Furthermore, in making new Dispensatories, a full content must be had,
and 'twere not fit to move where the motion were not like to take
place, for though private men invent new ways of compounding and
preparing, and using their own invented Medicines, yet 'twill require
a long time to make them publickly known, and brought into common use,
and till that be done 'tis not possible to have them brought into a
common Dispensatory; besides, no man would make a motion for such a
reformation, unless he were well furnished with specificks, and then
'twill be required of him to expose them to the whole World, which how
incongruous it will be, every man may easily conceive; hereto add,
that the Apothecaries think themselves able enough by this present
Dispensatory, to out-beard Physicians, and do publickly profess (as
hath been said) that they understand the practice of Physic well as
they; how much more would they have said so, if they had been made
Masters of these secrets? And here I shall admonish those of my own
Faculty, who have devoted their Studies, Labours, and Purses, for the
improvement of their Art, to consider, that as natural things have
their bounds and limits, and that there is no new Creation of them,
and besides, that these things have their bounds also of improvement,
beyond which 'tis impossible for man to go; and that by a good method
and industry, that end may be attained; (though at present I must
confess, no Art is more capable of enlargement then ours:) I say let
all consider, and they will find, what a vast encouragement they have
to improve their knowledg so far, that they shall not only be able to
leave mankind destitute of no remedy Nature did ever produce; but also
restore and setle those Honours ignorant men would usurp, upon the
Learned Professors of this Science, and I see no reason why Physicians
should communicate their secrets to such persons, who will make use of
them, to the ruine of the Inventors, which is indeed a failer of
trust, for when a Physician writes his Bill, he trusts the Apothecary
only with making the Medicine for a particular occasion, and not to
make use of it as his own when be pleaseth for his own profit, and the
Inventor have no further benefit by it, then perhaps one single
advantage.
Lastly, When Dispensatories were first made, the Apothecaries were
really Physicians Servants, and wholy at their command, not in the
least intrenching on their business, and the rates of Medicines were
reasonable; which superiority over them still continues only in their
prescriptions, the forms whereof are always commanding to take this
and that, and to mix them, &c. but within these few last years they
have set up for themselves, and advanced the rates beyond all reason;
and to be sure, the more we teach them by our Books, the more they
will trangress in both.
He may receive encouragement from what he discovers, that is more then
ordinarily useful, whereas by writing Bills, he soon communicates to
the ignorant and lazy, who will neither spend time nor money to
advance the Art, but while the one is at work to his great charge,
lots of time, much pains and trouble, the others seek by petty tricks
and Arts to gain a name, and profit from the industrious. Nay some
Mountebanks have been set up by purchasing receipts of the Apothecary
or his Servants. And one of them told me, he set up a Quack by selling
and commending to him a Medicine he had long kept in his Shop and
could not otherwise put off, and that by degrees he made him a famous
practiser among the ignorant and poor people. An Act quite contrary to
the interest of the Company.
Hence also will arise an emulation amongst Physicians, who shall
exceed each other in noble remedies, and from thence a full and happy
improvement of whatsoever God hath created for the recovery of mans
health impaired; for from the Physician alone the advancement of
Physic is to be expected. How many simples of unknown properties have
been brought into use, to the great comfort of the sick? and many more
may be, as also many preparations, both simple and compound, both in
the Galenical, and Chymical practice, and by this means the Art will
be advanced to its just dignity, now much diminished, dishonoured, and
near to be lost by the intrusion of ignorant persons.
Greater respect will be given to such Physicians, as being the
immediate instruments of life and health, who will derive unto
themselves that which is now given to the Apothecaries, which proceeds
chiefly from fear lest they should do the Patient hurt; and so their
honour will be doubled, which every Physician looks principally at;
but the Apothecary being not so far concerned, looks chiefly at his
own profit, and regards not the Patients charge. For the greater the
Patients charge, the greater must needs be the Apothecaries gain;
whereas on the contrary, 'tis the Physicians Interest to cure the
Patient with the greatest ease.
He may proceed on safely and securely in his well experienced
Medicines, having before him not only what he hath prescribed for the
same Patient, but for all others in the like Case, and thereby keep in
memory what he would have forgot, if his Bill had remained on the
Apothecaries File; viz. the Medicines and their success. By means
whereof Physicians do not advance their knowledg so far as they might;
for how is it possible they should remember the particulars of their
Bills writ some days before? and therefore know not how to proceed so
well. But the Apothecaries having before them the whole series of
Medicines, brag they can do more then the Physicians, and by this
means insinuate the same opinion into people.
The Physician will be consulted in the beginning of Diseases, to the
safety and little expence of the Patient, who will not go first to the
Apothecary, who practiseth on him till the Case is desperate, and then
calls in a Physician when 'tis too late; and if he dyes, the Physician
must carry away the disgrace alone; but if he recover, the Apothecary
if he be so minded, by some trick will share with him in the honour:
and by this resort of people to the Apothecaries in beginning of
Diseases; we meet with few Cases of easie Cure, but are chiefly made
use of in dangerous Diseases, or those of short period, or such as are
accompanyed with great pains and torments, to our great and continual
anxiety.
The Physicians experience hereby as 'tis surer, so 'twill be greater.
He will make use of no Medicines but the choicest, and when they are
in their full vigour, and such as are durable, and after once or twice
Tryal of them, will seldom fail in his expected success; which cannot
be certainly had without some tryal. For though a man buy the choicest
ingredients, viz. Sena, which may appear to the Senses very good, yet
he cannot positively say, how well, nor yet what quantity of it will
work, till he hath made use of it. But afterwards he may confidently
apply the whole parcel he hath bought to his purpose. The like may be
instanced in a crop of Wheat or Barley, which the skillfullest
Husband-man cannot tell how they will yield for Bread, or Malt, till
he hath used them. Now how is it possible that a Physician can with
any certainty make use of several Shops, since there is so great
difference in the ingredients? and 'tis certain the same Medicine made
by several Apothecaries, shall differ much in colour, smell, and tast,
and consequently effect too; which cannot proceed from any other cause
then the difference of the ingredients themselves, or by omitting some
ingredients, or by substituting one thing for another; or by distinct
ways of preparing them. The same also may be said of Compositions,
much more of Chymical Medicines so much sophisticated, and of so much
danger and hazard, if not well prepared, which he cannot discover till
he hath seen the effect of them, unless it be such as he makes
himself, nor those neither till he hath made some tryal of them.
He will much inlarge Materia Medica, Chymistry and Pharmacy, and
discover the grounds of them, and wherein the efficacy of remedies
lyes, and thereby lay open a whole Ocean for new discoveries, and by
the by observe many useful products and Phenomena of Nature, to the
great improvement of his Art, and sound Natural Philosophy, which are
not taken notice of by Apothecaries, and their Servants; for all which
they have neither will nor skill.
As to the improvement of Medicines, this may be added, by the
experimenting Physician, that in distill'd waters he will consider and
find which of them will afford any virtue, which only phlegm
equivalent but to Conduit-water, which of them will keep long, and in
perfection, which soon or in what time decay, and spend them
accordingly, and in compound distill'd waters, will find cause to lay
aside many simples as nothing conducing, or rather weakning the
efficacy of the Medicine designed; whereby much charge and trouble
will be spared, and better compositions be made.
He will gain and keep to himself Patients, who have diseases they are
unwilling should be known by Apothecaries and their Boys, and all such
as have a mind to turn over their File.
The Patient will have better opinion of the Medicines, and confidence
in the use or them, and the Physician more satisfied in his
Conscience, and better assured of the success.
He will gain reputation to his Art, by restoring it to its first
institution and practice, by the Founders and Heroes of Physic.
By constantly practised Medicines he will find out a better method of
Cure, and may hereby arrive at the true causes of diseases.
He will observe what Medicines by precipitation or other ways, alter,
destroy, or weaken one another, whereby of good ingredients singly
used, a bad Composition may be made, and therefore fail in the success
expected. Many more things might be here added, which a skillful
observer, and versed in the way to make experiments (no easie matter)
will daily find, and at present I do not so much as give hints of
them, but shall hereafter, as occasion and opportunity require.
He will have more scope to be charitable to the poor, and more civil
and obliging to his friends, by curing them gratis, or at small
charges.
He need not trouble himself with ways of concealing the use of his
Medicines, by setting down no directions in his Bill, but giving them
to the Patient, which the Apothecary soon learns; nor with giving some
of his own Medicines at a pinch, which if they succeed not, to be sure
the Apothecaries will cry down in all places, but will conceal all
eminently good successes, as disadvantageous to themselves; nor by
placing their Arcana's in the Shops of those Apothecaries they
commonly make use of; nor by recommending their Patients to such
Apothecaries they intrust their secrets with. For then great
complaints are made that the Physicians carry away their Customers,
and take away their livelyhood, affirming they are willing to fetch
them from the prescribing Doctors Apothecaries. To which I answer,
that they do fetch them, but perhaps not always; since I have heard
them often say, these secrets were but the Medicines of the London
Dispensatory disguised under new names, to the discredit of the
Physicians that prescribed them. And I well remember some of them have
neglected to fetch from my house, not far from their own, some of my
preparations, though they had them gratis, for the fetching; whereby
the Patients have suffered, and thought I neglected them, 'till they
were rectified by another Visit. Nay one of them told me, he had
rather dy with his own Shop-Medicines, then be cured with my
Magistrals: much more would he have said of Patients, manifestly
preferring his own profit before their lives; a most Unchristian
saying!
One singular advantage such a Physician will have, that the slanders
of the Apothecaries will appear to be malicious, as being raised
against such as act contrary to their profit.
By this means Physicians will unite against the common Enemy, will
contribute mutual assistance, and communicate more freely to one
another their practice and remedies; and also the frauds and unlawful
practices of the Apothecaries, will conceal the counsels, and act
whatsoever may tend to the advance of their Art; and Patients also
will discover the Apothecaries censures, and practices against the
Physicians and their prescriptions.
Hereby that great interest will decay Apothecaries have in Families
for their petty officiousnesses (which Physicians not to displease
them have put them upon) these will be taught Nurses, and the
assistants, and which are by some of these as well, certainly more
diligently performed then by the Apothecaries.
Hereby the filii Artis, or younger Physicians, will sooner come into a
better and more setled practice, and not be beholden to Apothecaries
to bring them Patients wherewith they often upbraid them, and glory
amongst themselves and to other persons, that they introduced such and
such a Physician.
Hereby Chirurgeons will be restored to some of their employment now
usurped by the Apothecaries, as leting of blood, applying Leeches,
Plasters, Cupping-Glasses, Syringing and Salivation, wraping up bodies
in Cere-Cloaths, &c. which indeed do more properly belong to them then
to the Apothecaries; hereby also haply many occasions of quarrel
betwixt Physicians and the Apothecaries will cease, each party acting
according to his own way.
By this means Pseudochymists, and other Mountebanks mouths and
revilings will be stopped, only exclaiming for this, that Physicians
make not their own Medicines. But since the publication of these
papers I am informed that the said Pseudochymists and Mountebanks rail
against me, this Book, and the way propounded, as much as the
Apothecaries, though before equal Enemies each to others. So that they
have fulfilled the Proverb, of like to like. And no wonder since
hereby their Kingdom of darkness is brought to light, and they are
obliged to oppose it, as the Copper-Smiths were to revile St. Paul for
speaking against the Idol of Diana of the Ephesians, whereby their
trade was lost.
And as for the reasonableness of it, that the Physician ought to
support himself by all lawful ways and means, and to have præeminence
above those ignorant persons that incroach upon his profession, 'tis
confessed by all that have considered the great charge, study, and
labour, before he can arrive at any benefit from it; for he must take
the chargeable degrees of Batchellor, and Master of Arts, Batchellor
of Physic, and after 14 years standing, the degree of Doctor; besides
his bare expences for his maintenance in the University, Charges in
Anatomies, knowledg of natural things; Travels abroad, Chymistry, and
Experiments; his Library, Habit, his more free way of living in a
suitable house, and Attendants, greater Taxes, &c. insomuch that a
Doctor of Physic spends more before he comes to practise, then will
set up perhaps a dozen Apothecaries in a way of livelihood; and
besides, great sums of money before he can put himself in a fitting
Equipage: whereas on the contrary, many young men before their time of
Apprenticeship is out, provide well for themselves by Quacking; and
certainly the Study of Physic, and consequently the knowledge of
Nature, must bid farewel to the Universities, if Shops be permitted to
make practisers, for such the people will soon create Doctors, which
title the Apothecary takes upon him, though he understand not the
reason of the name, to the great shame of the Universities, and
Faculty, when ignorant people shall give, and they challenge the same
title for nothing, attained by the Physician at a great rate and long
study, the vulgar taking Practiser and Doctor to signifie the same
thing. And which no persons of knowledg and education do, and perhaps
most other persons give them in way of Jeering.
From the handsom support of Physicians these benefits will accrue to
the publick, that thereby the honour all Nations yield to the English
Physicians will be kept up, who in the late times, when the reputation
of the Nation was well neer forfeited abroad, the Physicians then in
being, most whereof are now living, and Members of the College,
maintained the credit, for learning and value, of this Kingdom, and
since his Majesties happy return, some of them have kept up the honour
of the Faculty; which manifestly appears by the great esteem
Foreigners have of their Books, by often printing them, and
translating into Latin what hath been published in English, though
they are no where so depressed as in England.
A second benefit to the publick is, that men of competent Estates will
breed up their Sons in the Art of Physic, giving them such education
as is necessary, and will not vouchsafe to place them out to
Apothecaries, though now adays want of learning and degrees are
adjudged as needful a qualification for the exercise of Physic, as
formerly 'twas for Preaching, and the Shops fit to supply both.
I will conclude this part of my discourse with this observation; that
the Laws of England in all their Acts of Parliament, have granted the
practice of Physic to Physicians and them alone, and in no clause
thereof put in any restraint at all upon them, but every where, either
new priviledges, or a confirmation of the old, have been granted, by
the said powers. Whereas on the contrary, the Law supposeth cheats in
the Apothecaries Shops, and therefore impowers our Censors to destroy
and burn what they find bad and corrupt.