Medical Practice, Urban Politics and Patronage: The London ‘Commonalty’ of Physicians and Surgeons of the 1420s

Abstract

Medical practice in fifteenth-century England is often seen as suffering from the low status and unregulated practice of which Thomas Linacre later complained. Unlike in many European cities, the provision of physic was uncontrolled, and while urban guilds oversaw surgery as a manual art, no comprehensive system of medical organisation or regulation existed. However, in a remarkable episode of the 1420s, a group of university-trained physicians and elite surgeons associated with Humphrey, Duke of Gloucester, briefly established just such a system. While their efforts initially secured approval for a national scheme, it was only in the City of London that they succeeded in implementing their plans. The detailed ordinances of the collegiate ‘commonalty’ they founded provide a unique insight into their attitudes. Drawing on continental models, they attempted to control all medicine within the city by establishing a hierarchy of practitioners, preventing illicit and incompetent practice, and offering treatment to even the poorest Londoners. Yet they failed to appreciate the vested interests of civic politics: achieving these aims meant curtailing the rights of the powerful Grocers and the Barbers, a fact made clear by their adjudication of a case involving two members of the Barbers’ Company, and the Barbers’ subsequent riposte—a mayoral petition that heralded the commonalty’s end. Its founder surgeons went on to revitalise their Surgeons’ Fellowship, which continued independently of the Barbers until a merger in 1540; in contrast, the physicians withdrew from civic affairs, and physic remained entirely unregulated until episcopal licensing was instituted in 1511.

A Barber-Surgeon’s Instrument Case: Seeing the Iconography of Thomas Becket through a Netherlandish Lens

“…In the fifteenth and sixteenth centuries, the surgeons and barber-surgeons, whose Companies were not amalgamated until 1540, were highly conscious of a need to promote their claim to social prominence and respectability. This was particularly keenly felt in their social relationship to other medical practitioners and, in light of their special status as medical craftsmen rather than medical theorists, to London's artisanal classes (Colston andRalley 2015, pp. 1103-26;Wear 2000, p. 124;Decamp 2016, pp.…”

Accountability in Healthcare: Sovereign Authority to Democratization

“…1 University faculties (Paris, Bologna, and Padua) and guilds (Florence and Valencia) conducted the required examinations for certification and controlled the practice of medicine. 6 Without an analogous system medicine in England lagged far behind its western European counterparts. Only a handful of physicians completed the arduous 13-to-14year medical curriculum at Oxford or Cambridge or attended a medical school on the continent.…”

Gilbert Kymer: Rector of the first conjoint medical college

“…Possibly following the example of how the law was regulated, in May 1423, two years after the parliamentary petition, Kymer and four senior physicians and surgeons successfully applied to the Mayor and Court of Aldermen of the City of London to create a Commonality or College that would oversee and regulate the practice of Physic and Surgery, but only within London and its environs. 19,30–32 This was a far-sighted and detailed proposal for a College in which physicians and surgeons would have equal status, its members would either have been educated at Oxford or Cambridge, or if not would have to undergo an examination in London, would limit their practice to their speciality, thus emphasising their status and expertise and excluding more general practitioners, such as barbers, and pay an entry fee, which would also exclude less qualified practitioners. They would provide free care for the poor, would help their fellow members in poverty and attend their funerals, and would discuss difficult medical cases with the Rector, and with Surveyors or Masters, respectively.…”

“…Kymer became the head of the College, or Rector of Medicine, with two physicians as Surveyors of Medicine, and two surgeons as Masters of Surgery. 30–32 They were duly sworn in that May 1423 before the Mayor and Court, and again in September 1424. The first Surveyor of the Faculty of Physic in the College was John Somerset (c.1390–1455), whose career was similar to that of Kymer, qualifying in medicine at Oxford and later Cambridge.…”