GENERAL MEDICAL PRACTICE IN THE TIME OF THOMAS VICARY Thomas Vicary Lecture delivered at the Royal College of Surgeons of England on 27th October 1966 by G. G. Macdonald, T.D., M.D., B.Sc., M.R.C.S. General Medical Practitioner and Past Master of the Worshipful Company of Barbers of London THOMAS VICARY (Fig. 1) was born, probably in Kent, about the year 1490. It is said that he was not gentle by birth or profession, but was one of Nature's gentlemen, with the best possession-an honest and true heart overflowing with kindly feelings towards his fellow men (South, 1886). Fig. 1. Thomas Vicary (1490?-1561). From an etching after the picture by Holbein. He became a member of the Barber-Surgeons' Company of London about the time when licences to practise surgery were first introduced under the 1511 Act (3 Henry VIII, c. xi). On 28th March 1514 he, with 71 other surgeons, was licensed under this Act to practise surgery by Richard Fitzjames, the Bishop of London. He was examined by four past Masters of the Surgeons' Company and by Dr. John Smythe, who was later to become a Fellow of the Royal College of Physicians of London (Poynter, 1961). In his earlier years he is thought to have had a small practice in Maid- stone, where his friend John Halle was als6 in practice. He was in G. G. MACDONALD Canterbury in 1527, when Henry VIII was making a royal progress through the countryside. The king had a " sorre legge" which was to tiouble him for most of his life (Clippingdale, 1922). Vicary had the good fortune and skill to make the sore place heal and the king was so pleased that he promoted Vicary to be Surgeon to the king with a grant of £20 a year. He also promised him the reversion of the office of Serjeant Surgeon to the king when the holder of that office, Marcellus de la More, should resign, die or forfeit the post. Vicary at that time was not a simple country practitioner as might be deduced from this narrative. He was a well-known London Barber Surgeon who was in the same year promoted from Third to Upper Warden in the Barber Surgeons' Company. Thus there is no parallel between his career and that of the late Sir Arthur Fripp, whose surgical skill received royal notice when he treated the Duke of Clarence while doing a locum only 18 months after qualification. In 1536 Marcellus de la More died and Vicary became Serjeant Surgeon to the king, an office which he also held under King Edward VI, Queen Mary and Queen Elizabeth. He was largely instrumental in the union of the Company of the Barber Surgeons and the Guild of Surgeons in 1540. He was Master of the Barber Surgeons' Company five times between 1530 and 1557. Only one man has equalled Vicary's record number of times of being Master and that was Robert Halyday, who was Master five times between 1475 and 1496. Halyday was the Vicary of his times and was instrumental in bringing together the Company of Barber Surgeons and the Guild of Surgeons in 1492, when both companies signed a " Composition" unifying their professional standards (Young, 1890). The union of the two companies in 1540 is commemorated by two fine pictures. The picture in possession of the Royal College of Surgeons (Fig. 2) is painted over the cartoons which were used by Holbein for the painting of the picture in the possession of the Worshipful Company of Barbers. As a Member of the College and of the Company I can make no distinction of merit between the two great pictures except to state that each is in part better than the other. Both pictures are in the hands of the restorers and soon both will be seen much more clearly. Vicary became rich in his later years as is shown by the minutes of the Court in 1557, when the Company was in financial trouble. " Mr. Thomas Vicary shall paye and dyscharge the debts of the house . and shall have the plate of the Crafte in pawne or pledge, untill such tyme as the sayd sumes of mony be unto hym payde agyne " (South, 1886). Vicary's skill as a practitioner is shown by his treatment of his royal patients, his private patients and his devotion to the " sick pore" in St. Bartholomew's Hospital, of which he was appointed Governor in 1548 after the refounding of the hospital. He remained in active practice up to his death. Thanks to the researches of Mr. Emmison, the County 2 GENERAL MEDICAL PRACTICE IN THE TIME OF THOMAS VICARY Archivist of Essex, we have a more accurate knowledge of the approximate date of Vicary's death (Emmison, 1961). The Steward's accounts at Ingatestone Hall show that Vicary was alive on 31st January 1561 to receive payment of five shillings for a visit he had paid to Sir William Petre on 23rd January 1561 (Fig. 3). We do know that Vicary died before the end of 1561. His will was proved by his widow on 7th April 1562. It must be remembered that in England up to the year 1752 the year ended on 24th March. All the dates in this lecture will be given according to the old calendar, which was in use at the time. Vicary lived at the end of the Middle Ages. Fifteen hundred and forty- three is often taken to mark the end of that era because that year saw the _ ~~~~~~~~~~~~~~~~~~~__1s~~~~~~~~~~~.jA Fig. 2. Commemoration of the Act of Union of 1540 between the Barbers' Company and the Guild of Surgeons. Painting by Holbein in the possession of the Royal College of Surgeons of England. publication oftwo epoch-making books, Defabrica Corporis humani by the 28-year-old Belgian, Vesalius (1514-64) (Fig. 4), and De revolutionibus orbium caelestium by the aged Pole, Nicholas Copernicus (1473-1543). From these two seeds of published observation and thought grew the scientific outlook of mind and ultimately the mental explosion of modern science. Men gradually felt themselves free to state in public what they thought and observed, and to throw off the chains of outworn authority and dogma. Scientific thought began to change in 1543, but other things changed more slowly. Even now we retain the mediaeval institutions of the Monarchy, the Peerage, the Commons in Parliament assembled, the English Common Law, the Courts of Justice interpreting the rule of law, the hierarchy of the Established Church, the parish system, the Univer- sities, the Public Schools and the Grammar Schools (Trevelyan, 1942). The study of general practice in Vicary's time is the study of mediaeval medicine and the mediaeval philosophy of the healing art. 3 G. G. MACDONALD In Roman Britain there was an excellent system of military hospitals with elaborate arrangements for the evacuation of the sick and disabled soldiers to Rome and other important cities, where noble ladies vied with each other in their civic duty of caring for the men in the hospitals and even taking them into their patrician homes for lodging and treatment. With the fall of Rome all this was lost, and the Dark Ages of mediaeval medicine began. They are dark ages only in our minds because we know so little about them. No one who has seen Ravenna will ever think that the age was dark in learning or achievement. In England at the beginning of the Middle Ages general medical practice was in the hands of leeches and wise women, and purveyors of magical Fig. 3. " Money to the Surgeons. To Mr. Vicars the Surgeon on the 23rd day 5s. To Baltroppe the Surgeon that day 5s. To Baltroppe the 24th day 6s. 8d. To Baltroppe the 25th day 5s. To hym the 27th day and to hym the 28th day 5s. xxxj. s viiid." Transcription by the County Archivist of Essex, Mr. Emmison, by courtesy of the Essex Record Office (catalogue mark D/DP A9). incantations. In later Anglo-Saxon and Norman times the Church was the main provider of medical help. In Vicary's time the barber surgeons, the physicians, the surgeons, the apothecaries and a host of enthusiastic amateurs acted as general practitioners. There was little drama of new discovery until the time of Vesalius, and it took nearly a hundred years after him before the scientific method developed in this country. The work of Roger Bacon (1214-94) was the only bright flicker in the scientific darkness of the land. He was the European inventor of spectacles, but, fearing to be denounced by the Church as a powerful and dangerous magician of satanic origin, he left the method of construction secret, only confiding it to his friend, Heinrich Gothals, at the Monte Cassino monas- tery. Heinrich told Salvinus de Armatus, who passed on the knowledge and took the credit. Salvinus de Armatus also invented a modern form of truss in the second half of the 13th century (Gordon, 1960). 4 GENERAL MEDICAL PRACTICE IN THE T1ME OF THOMAS VICARY The leeches In England in the early middle ages some men and women in each community were outstanding in their luck or skill in the healing art. They became recognized as " Leeches "-the Anglo-Saxon term for healer. Their wisdom was handed down by word of mouth from genera- tion to generation. It was not until early in the seventh century that the Angles and Saxons developed extensive written records. Some leeches were promoted on the battlefield.