Monday, 16 December 2013

Patronage And Getting Away With Murder

The other night I caught a news special dedicated to explaining that a humanities education was, essentially, a worthless investment.  A more successful investment – that does not include living in your parents’ basement – meant pursuing a trade instead.  Now, for those of you who know me, you’ve already been treated to the rant about the decline of the humanities and the undervaluing of a classic education that teaches you how to think critically and function as productive citizens within a democratic society. 

But that’s a whole other rant for a whole other time in a whole other blog.

So how does any of that relate to the history of medicine?  Well, it doesn’t yet, but I’m getting there.  The same economist went on to extol networking as one of the most important tools that allows a humanities-educated 20something year old to find gainful employment.[1]  She said, roughly paraphrased, that networking was a valuable and time-honoured method of gaining employment – the world has always worked that way and always would.

Alright, fair enough.  I did just edit a chapter or two on the value of intellectual and social networks, formal patronage, and more informal “friendship” to the professionalization of surgery in the seventeenth century.  Patronage and early modern “friendship” – despite the nuances embedded in those historical terms – are recognizable to us as forms of networking.  Moreover, they did play very key roles in helping surgery, as a field, progress to the respected profession it is today.   

The medical field was in state of flux for the three hundred years typically considered “early modern.”  Definitions, professional boundaries, the nature of the body and disease were consistently negotiated, renegotiated, and redefined in the period.  Ideally, “surgeons” were to treat the outward signs of illness, cuts, wounds etc. and only do so with invasive surgery or outward medicines like bandages and balms.  “Physicians” or “doctors,” on the other hand, were allowed to treat using medications meant to be taken inwardly.

In reality, terms like “surgeon” or “doctor” often referred to practitioners who crossed each other’s occupational boundaries.  Moreover, these medical practitioners sometimes also practiced as apothecaries, weavers, and even smiths![2]  To complicate things further, in London, there were three competing bodies that governed medical practice: the Company of Barbers and Surgeons, the College of Physicians, and the church.

This was obviously a recipe for disaster.  London-based surgical practitioners – both within and outside of the Company of Barbers and Surgeons – frequently clashed with the College of Physicians over occupational boundaries, patients, and everything else under the sun.  The relationship between surgeons and physicians was not always negative.  The Company and College cooperated for anatomies and lectures while many individual practitioners treated patients together and were even friends.

On occasion, a particularly egregious case exacerbated tensions between the two groups and their governing bodies.  At the beginning of the 17th century, the College was faced with a troublesome surgeon who proved that even frequent and flagrant flouting of College strictures could be attenuated by patron power. 

Roger Jenkins, a member of the Weavers’ company and later member of the Barber Surgeon’s Company, is present in at least 20 entries in the Annals for various disciplinary hearings.  His modus operandi, it seemed, was to prescribe strong purging remedies that - on occasion - killed his patients.  On 2 April, 1599 he was found guilty of prescribing purging diets for pox patients.  He was summoned several times with all charges dismissed as he refused to admit to practicing internal medicine if there were no witnesses called against him.  
In November 1601, upon the confession that he had given multiple purgatives to ulcer patients, the College’s patience ran out and they sought to prosecute Jenkins to the full extent of the law.  The Jenkins case proved key in the College’s continued prosecution of surgical practitioners.  Jenkins’ defense, rested largely upon his claim that:

“I am a surgeon, he said, and in the work of surgery it is often necessary to use internal medicines.” 

This proved to be Jenkins’ downfall. The Chief Justice of England, Sir John Popham, was called in to adjudicate the case and upon review of the Acts relating to the College and Company, stated that surgeons were not to practice physick.  His later statements served to further reinforce the power of the College to both license and police medical practice.

Sir John Popham
  Jenkins’ continued problems with the College had, apparently, not decreased his standing in the eyes of the Company.  On 6 May, 1602  he was made free of the Weavers’ Company and admitted as a brother to practice surgery.  Despite imprisonment and fines, Jenkins continued his physick practice and was once again convicted by the College on 3 August, 1604.  Rather than just prescribing, on this occasion, Jenkins was also found guilty of creating and selling medicines out of his home. 

At this point, however, Jenkins’ status as a practitioner had changed – he was now attached to the household of an influential man.  The College response is telling: “partly on account of such a frank confession but particularly because of the position of the Lord who he served (that most honourable man the Lord Chamberlain) on this occasion we allowed him to depart.”  After informing the Lord Chamberlain, the Earl of Suffolk, of his surgeon’s misdeeds, they were informed that Jenkins would be punished by Suffolk himself and ordered to cease his practice.  

Lord Chamberlain Thomas Howard, 1st Earl of Suffolk and Jenkins' patron.
In the years thereafter, Jenkins was examined and approved to practice surgery and presented to the Dean of St. Paul’s in 1607.  He evidently became wealthy; enough so to voluntarily offer the Company £20 towards the contribution to the plantation of Ireland.  College censure, though both harsh and repeated, did not much affect Jenkins’ practice. 

Indeed, one wonders how seriously he was chastised – or, conversely, was protected by – Suffolk.  By 6 November, 1612, Jenkins is once again present in the College Annals.  Despite being summoned several times and confessing his practice, he was never again fined or imprisoned.

Jenkins may have gotten away - quite literally - with murder, but his case had long ranging repercussions:

1. It reinforced the importance to practitioners of powerful patrons and networks.
2. It exacerbated the problems between the College of Physicians and the Company of Barbers and Surgeons.
3. Popham's ruling emphasized the power of the College - and the superiority of physicians - over the Company and surgeons.

What do you think of Jenkins and his patron?  Is reliance on a patron to this extent acceptable?  Should the Company have stepped in and sanctioned a surgeon hurting their reputation and relationship with the College?  Comment here or on twitter @medhistorian

[1] I remain unaware of the statistics surrounding humanities-educated PhDs who received tenure-track positions based on the connections of their parents and their parents’ friends.
[2] For that reason, I tend to use the term “surgical practitioner” in my work; “surgeon” seems a bit of a misnomer on many occasions.

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