500 Years of the Royal College of Physicians Professor Simon Bowman Harveian Librarian (with particular thanks to Kristin Hussey, Julie Beckwith, Louella Vaughan and other colleagues) 16th Century The Founding of the College 1518 1510 - 1500-1535 Church of England 1534 Cast list Thomas Linacre Cardinal Wolsey King Henry VIII 1460-1524. 1st PRCP 1470-1530 1491-1547 B: Derby (age 27 in 1518) Educ: Canterbury, Oxford, Florence, Padua Tutor to: Prince Arthur Royal Physician Medical Marketplace • Extremely vigorous and varied • Array of people jostling for custom - surgeons/barbers - Apothecaries/grocers/spicers - ‘illiterate Monks and Empiricks’ - assorted other quacks, blood-letters and charlatans… • Plague, influenza, smallpox, dysentery, syphilis Physicianly Medicine c1518 • Hippocrates, Galen, Avicenna: 460-370 BC 129-200 AD 980-1037 AD • Four Humors: blood, phlegm, choler (yellow bile), melancholy (black bile) • Treatments – Bloodletting & Purging – Astrology – Uroscopy – Herbs & Medicines Founding of the College • Founded in 1518. Linacre=PRCP • Bulwark against ‘quacks & charlatans’ • Based on Padua? ‘Humanism’ • Right to ‘make Statutes … most expedient for publick Service’ • ‘With regard to their own dignity, the good of the people, and in particular to the honour of the Universities (Oxbridge)’ • 1st home=Knightrider Street The 1518 Charter • Granted same rights as previously given to the Church to regulate medical practice within 7 miles of the City of London • Rights to examine, admit and appoint • President elected for 1 year at a time • 4 Censors; 6 Founding members; Circa 16-20 physicians in London in 1518 • 1523 Act of Parliament The Earliest College • Regulation of medical practice - examination to grant licences - prosecution of irregular practitioners - oversight of apothecaries and surgeons • ‘Publick Health’ • ‘Enlist themselves in the service of the ‘English realm’ The RCP Charter 1546 Grant of Arms ‘An Anxious Organisation’ • Conflicted internally • At war with the universities, the apothecaries, the surgeons (and various others) • Insecure identity of the Physician Purpose Unclear • Founded primarily as a regulatory body • Difficult to provide Publick Health when nothing is known about mechanisms/spread of disease • No intellectual programme – but lots of people thought there ought to be Challenged the Guilds • Apothecaries and Surgeons previously self- regulating • Intrusive and punitive Challenged the Universities • Oxbridge previously granted licenses • College attempted to dictate what knowledge was required Dependent on Royal Patronage Wedded to Galen • Galen = 4 humours • Exams based on Galen • Hostile to any other theorising • BUT already substantial doubts about accuracy Academic Elitism • Oxbridge only Fellows • All other = Licentiate • BUT other universities better • Creation of social and then religious divisions - clear deviation from intent of Charter The Odd Social Position of the Doctor • Sit outside of norms of medieval life - no structure • Manners of a gentleman, but not one • Marry late, if at all • Dependent on patronage of seniors The Case of John Geynes • 1559-60, Dr Wendy accused John Geynes, an Oxford doctor, of ‘shamelessly asserting to the vulgar that Galen had erred’. • Geynes repeated asserted before the whole College. • Declined to submit this in writing • Set up by the sheriffs and forced to write document • Then changed mind and recanted • Examined and admitted to the College in 1560 • Censor 1561, Elect 1562 • Died 1563 Dr Roderigo Lopez FRCP b1517- d1594 Portuguese Converso Physician to QE1 1581 Diplomacy with Spain and Portugal Guilty of Treason 1594 Hung drawn and quartered Earl of Essex Dr (William) Goddard • Expelled from the College in 1649 for disobedience • Applied to rejoin in 1660 – refused • Goddard then stormed Comitia – tried to take his seat forcibly – meeting dissolved • Kings Bench Court – initially sided with Goddard but then agreed College had the right to govern its internal affairs End of the 16th Century • Different by 1563 • Aggressive prosecution • Strict rules of conduct ‘Statutes’ • Ceremonial style John Caius PRCP 1555 Norwich, Cambridge, Padua • Restricted entry to the College • Hierarchical structure 17th Century Plague, war and fire Pharmacopoeia Londiniensis • (‘1st British National Formulary’) • Royal Proclamation • First Edition full of errors • 2nd Edition published 1618 • College’s first big project • Rivalry with the Apothecaries • 1617: Worshipful Company of Apothecaries • 1649; Nicholas Culpeper – English translation plus list of herbs etc William Harvey 1578-1657 Biography Folkestone Canterbury Cambridge Padua St Barts Hospital FRCP, Censor, Treasurer, LL Royal Physician, James 1 & Ch1 Burmarsh Kent Estate Harvey’s Library De moto cordis 1628 The Plague Years • Physicians follow rich patrons out of London • Prosecutions for quack remedies and illegal practice • Counter- accusations of abandoning the public Civil war and aftermath 1642 English Civil war starts 1649-1651 Charles II invades 1649 Execution of Charles 1 1658 Oliver Cromwell dies 1660 ‘The Restoration’ Plague & Burglary 1665; Fire of London 1666 • Christopher Merrett • Dorchester Library • Baldwin Hamey Jr 1600-76 Amen Corner 1651, Censors room, Ashlins Estate, Essex End of the 17th Century • The Dispensary (planning from c1670) - provision of free treatment to the poor - controversial Sir Samuel Garth - Apothecaries • New Royal charter (James II) 1687 • The Glorious Revolution 1688 • William & Mary 1689 - ‘purge’ of the College - increase in number of Fellows to 70 - James II charter rescinded after the Revolution • Argue for years about College membership Royal Society 1660 Initially housed in the RCP William 2nd Viscount Brouncker RCP RS Charles II 18th Century The age of science (and Enlightenment) Isaac Newton Robert Boyle The College and the New Science • ‘New Science’ = Newton, Boyle and Locke • Contradicts Galen in all ways • Splits College into two – Ancient Faction and The Experimentalists • These line up with other affiliations at times of political turbulence • College ceases to hold meetings • Debate around medical knowledge ‘outsourced’ to the Royal Society after 1660 ‘The Magnificant Princes’ Sir Hans Sloane 1660-1753 Richard Mead 1673-1754 Born in Ireland Born Stepney Jamaica travel (D of Albemarle) Utrecht, Leiden, Padua Sloane’s drinking chocolate Foundling Hospital PRS 1727-1749 Great Ormond Street Hospital PRCP 1719-1735 Transmissible disease British Museum 1753/1759 RCP & Royal Society Chelsea Physic Garden Great collector Foundling Hospital Royal physician The Licentiates • New breed of medical men • Often Scottish and/or non-conformist • Therefore not Oxbridge, which is in relative decline at this time • Often enthusiastic about ‘new philosophy’ • Often ‘middling class’ Siege of Warwick Lane • Tensions between Fellows and Licentiates reach breaking point in 1767 • Case of Dr Letch – left open as to whether Licentiates were members. • College stormed by Licentiates and take seat at the table. William Browne PRCP • Multiple court cases. Lord Mansfield • contemporary issues on religion, inclusion and franchise The End of the Eighteenth Century • Relative end to aggressive regulatory stance of the College • College does the right thing and allows certain Licentiates to become Fellows • Overhaul of statutes and eventual reform • ‘Other functions’ (publishing, promotion of vaccination, asylums, study of epidemics) come to predominate – end of Galen • Better relationships with Apothecaries & Surgeons William Heberden 19th Century Professonalism and Standardisation 19th Century Sir Henry Pall Mall 1825 Halford Addison Hodgkin Q 1837-1901 Bham 1825 UCL 1827 KCL 1830 BMA 1832 GMC 1860 Munk Bright Public Health: reports on Leprosy and vaccination GPs Prelude to Real Change • Massive expansion in the number of doctors • Changes to medical education – the ‘proto-GP’ • The extension of franchise • Repeal of Test and Corporation Act • The machinery of Empire • External campaigns esp. the Lancet The Medical Act of l858 • Founding of the General Medical Council • First instance of state oversight of a profession • Licensing and regulation of ALL doctors • College retained: - the right to examine - the right to charge fees - the right to recommend names to the register 20th Century • The NHS • Public Health • Smoking • Alcohol, Obesity, Air Pollution • Women in Medicine • Diversity • International • Training & Education • Policy The College’s Six Homes • Knightrider Street • Amen Corner Knightrider Street 1518 Amen Corner 1614 • Warwick Lane • Pall Mall East • Regents Park Warwick Lane 1667 Pall Mall East 1825 • Knowledge Quarter, Liverpool RCP North Liverpool 2017/ St Andrew’s Place 1964 2020 Historical Collections • Portrait collection: Pharmacopoeia • Zoffany, Hoyland, Lawrence, Epstein, Frink, Annigoni • Rare books/manuscripts: • Vesalius (1543), • Chaucer (1440), • Wilton Psalter (1250), • Caxton (1473) • Anatomical Tables & Prujean chest • Silver & other collections Matthew Baillie th th • 16 c Caduceus, 17 c Mace, William Harvey’s rod, 1761-1823 • John Radcliffe’s cane • Symons collection William Harvey: Ceaseless Motion RCP500 Charter The RCP500 Charter reaffirms the commitment made by physicians to: • provide the highest standards of patient care • train, develop and support doctors • act as leaders • promote good health and prevention of ill health. • no regulation or licensing 21st Century Thank you .