The founding of the Royal Society in 1660 proved a watershed moment for the seventeenth-century's nascent natural history movement, providing its advocates with public recognition of their approach to knowledge-making and a focal point around which to organise their activities. Although the early Royal Society is often perceived as principally concerned with problems of nature far grander than physical health, many physicians interested in reforming clinical practices were also founding members, having embraced the new philosophy as a tonic to the related problems of excessive market competition and limited medical efficacy then confronting the profession.Footnote 1 While the Royal Society furnished these physicians with a new source of institutional authority for their proposed reforms, it also exposed certain competitive tensions between the approaches to knowledge privileged by physicians and virtuosi. These tensions ultimately undermined efforts to change the way in which medicine was practised.
The career and reform agenda of Christopher Merrett offers a particularly illuminating window into the challenges would-be reformers confronted during the second half of the seventeenth century. As a well-connected member of London’s medical elite, Merrett appeared ideally situated to bring about reform. He had taken his medical degree in 1643 at Gloucester Hall, Oxford, after which he moved to the city and set up a highly successful private practice. By 1651, he had been elected a Fellow of the Royal College of Physicians, and could count both Baldwin Hamey Jr and William Harvey as personal friends.Footnote 2 In 1653, Harvey even handpicked Merrett to serve as first Harveian Librarian to his collection that had recently been installed at the College House at Amen Corner,Footnote 3 for which Merrett was rewarded with a remittance on taxes and a £20 annual stipend.Footnote 4 Merrett eventually went on to serve several times as Censor for the College, charged with hearing professional grievances and regulating practice.Footnote 5
Merrett may have reached the pinnacle of his profession, but he was no apologist for elite practice. As was true of many younger physicians trained at Oxford and Cambridge,Footnote 6 he had cultivated a strong interest in the methods and conclusions of natural history, seeing these as a valuable complement to the natural philosophical approach that dominated traditional medical education. Shortly after arriving in London, he became involved with the influential ‘1645 Group’, a heterodox mixture of natural historians, physicians, and mathematicians who had gathered together at the behest of Theodore Haak with the hope of eventually actualising Francis Bacon’s vision of a state-sponsored learned society.Footnote 7 Merrett had further opportunities to explore natural history as Librarian of the Royal College, as the College House often served as a site for lectures and casual meetings on a wide range of experimental and natural historical subjects prior to the establishment of the Royal Society.Footnote 8
When this event occurred, it therefore made sense that Merrett would be among the Royal Society’s founders, and would become one of its most active members.Footnote 9 As was the case at the Royal College, Merrett took on several administrative duties for the Royal Society, heading the committee on the history of trades,Footnote 10 and contributing several papers to the Philosophical Transactions on artisanal production practices.Footnote 11 Merrett also became a prolific author in the 1660s, writing books on subjects ranging from a translation of Antonio Neri’s The Art of Glass’Footnote 12 to the Pinax Rerum Naturalium Britannicarum (a catalogue of British Flora considered one of the ‘exceptional books by English authors,’ according to the Italian visitor Lorenzo Magalotti),Footnote 13 to a treatise on the diseases of wine.Footnote 14 Although not all of these were well received – John Ray in fact described his Pinax as a ‘bungling’ work in a letter to Martin Lister – his sheer breadth of interests solidified his reputation as an authority on applied natural history.Footnote 15
Given these intellectual contributions, not to mention the prominent part he played in the affairs of the Royal College and Royal Society throughout the middle of the seventeenth century, Christopher Merrett has been remarkably overlooked in accounts of medicine during the Restoration. The little work that has been published directly on him has remained almost exclusively restricted to his activities as a naturalist or to his role in early English wine production.Footnote 16 While it is thus possible that Merrett is better known among viniculturalists than historians of science, he in fact played a prominent part in the internecine professional and intellectual troubles that characterised this period.
As Harold J. Cook has shown, the establishment of the Royal Society exacerbated epistemological tensions between the system of natural philosophy favoured by traditional medicine and the system of natural history then in vogue among chemical physicians and virtuosi. As a rule, advocates of natural philosophy continued to promote an overarching logos, arrived at primarily through the methods of disputation and reason, while natural history promoted the production of general knowledge claims through the accumulation of singular instances of natural phenomena using observation and experimentation.Footnote 17 In the context of medical practice, this difference manifested itself in a tension between a passive and preventative approach to care rooted in Galenic first principles and privileged by elite physicians, and an active interventionalist pursuit of cures that was rooted in empiricism and privileged by chemical physicians and professional apostates. To many, these two approaches seemed fundamentally and resolutely opposed.
As a member of both the Royal College and the Royal Society, these tensions inevitably shaped Merrett’s strategy of reform. Rather than choosing a single side, he instead sought to integrate elements of both into a new medical approach. In the two decades following the establishment of the Royal Society, he thus took part in a campaign to bring more experimentation into medicine, and thereby bring more physicians into the Royal Society’s fold.Footnote 18 By embracing knowledge derived from artisanal work and proposing an expansion of physicians’ activities to include drug production,Footnote 19 he hoped to enlarge the limits of established elite practice.Footnote 20 Importantly, however, experimentation and intervention were not to replace observation and prevention as the foundation of treatment. The logos Galen had provided would continue to dominate medical practice, even if it was to be increasingly supplemented by the fruits of experiment.Footnote 21
Disagreements over the wisdom of this approach eventually resulted in a schism within the Royal College between enthusiasts of the new philosophy, and more circumspect members. This soon turned into a pamphlet war, which raged between physicians, virtuosi, and apothecaries from 1668 to 1671.Footnote 22 Although Merrett was hardly alone in promoting closer relations between the two professional bodies, these events like as not contributed to his fall from professional grace at this time, which ultimately resulted in his alienation and eventual expulsion from the Royal College in 1681.
These disagreements hinged on suspicions many held about the true intentions of the Royal Society – and Merrett himself – towards elite practice. What was the status of the physician to be in the new philosophy? How would the apparent democracy of knowledge inherent in it translate into changes in the organisation of medicine? Would its ascendancy mean that those with chemical or empirical leanings (or even tradesmen) would, in the future, be legitimately allowed to practise medicine alongside university-trained physicians? By promoting the search for cures and proposing to link medicine to new experimental practices, Merrett appeared to some to be suggesting as much.Footnote 23
While it is unlikely that this was Merrett’s intention, the reforms that he had hoped would appeal to both sides ultimately proved appealing to neither. For all their possible merits, they reflected the aspirations that younger physicians like himself had held for their profession prior to the creation of the Royal Society, when co-operation between physicians and virtuosi still seemed possible. In the altered political and institutional climate of the 1660s and 1670s this aspiration seemed less idealistic than downright suspect.
In the sections that follow, I explore the relationship between Merrett’s own career path and the programme of reform he pursued, focusing primarily on his proposals for alleviating competition from apothecaries and reforming medical education. Both reforms are discussed in the context of the rapidly changing professional conditions he encountered after 1660. Ultimately, his failure to bring about a reconciliation between physicians and virtuosi through these measures did not prove that their two approaches to knowledge production were antithetical, but rather that the opportunities to develop such a shared approach were limited in the climate of mutual mistrust that prevailed.
Confronting Challenges to the Professional Order
Although the birth of the Royal Society was greeted as a happy event by younger Fellows of the Royal College such as Merrett, many older Fellows saw in its methods an existential threat to their way of practising. English physicians had battled sustained anti-authoritarian challenges to Galenism throughout the first half of the seventeenth century, as practitioners steeped in Paracelsian and Helmontian principles sought to overturn the Galenic reliance on diagnosis and prognosis in favour of botanical or chemical remedies. To such practitioners, the Royal College often seemed little more than a backward group of monopolists, out of touch with the intellectual revolution then shaking the foundations of the profession on the Continent.
In the charged and unpredictable political climate of the Interregnum, many advocates of chemical remedies had been given free rein to criticise physicians, and to peddle their treatment methods with little threat of prosecution. While the Royal College still possessed the legal authority to regulate practice, and in fact desperately needed to exercise this authority in order to alleviate growing commercial threats from apothecaries and irregular practitioners operating in the city, it lacked the governmental backing to enforce its legal claims.Footnote 24
The establishment of the Royal Society compounded this impotence by encouraging the self-proclaimed ‘chemical physicians’ to obtain legal justification for their own approach to medicine. Although the careful observer could note significant differences between virtuosi and chemical physicians, especially concerning their methods for producing truth claims,Footnote 25 the Royal Society certainly seemed to espouse democratic and empirical principles similar to those expressed by vocal critics of elite medicine such as Noah Biggs, Nicholas Culpeper, and George Thomson. Given the strength of political support behind the Royal Society, a similar society rooted in chemistry and aimed at the production of new medical cures seemed an increasing possibility. The result was a 1664–5 campaign to establish a royal charter for the Society of Chemical Physicians, justified in large part by the vogue for the new philosophy and its apparent similarities to chemical medicine. While this attempt ultimately failed (albeit barely), the rhetorical use the new philosophy was put to in promoting the chemical physicians’ claims underscored fundamental similarities between the virtuosi and some of the staunchest enemies of the Royal College.Footnote 26
By the time plague returned to London in early 1665, relations between physicians and the virtuosi had thus declined precipitously. Many older Fellows of the College had been intellectually wary of the new philosophy from the start, even if they accepted the interest that younger Fellows expressed in it. But the growing affinities between the chemical physicians and the virtuosi suggested that a more serious usurpation of their authority might be underway.
The Great Plague of 1665–6 eroded whatever goodwill remained by initiating a series of disasters for the Royal College and for Merrett personally. As the outbreak increased with the approach of summer, most licenced physicians chose to flee to the countryside in pursuit of their aristocratic clientele. The city was thus left virtually devoid of physicians, with the remaining Londoners relying on irregular practitioners and apothecaries to address their medical needs.
As Harveian Librarian and a resident of the College House, Merrett initially chose to stay behind to protect his own property and the collection of books and specimens that had been left in his charge. It is unclear whether he continued to practise during this time, or served among the few plague doctors then walking the streets, but this seems unlikely given that he also eventually fled out of fear for his family’s safety. Before leaving, however, he took the precaution of securing one thousand pounds and the most valuable items from the collection in an iron chest. This measure proved ineffective, as during his absence thieves broke into the College House and absconded with the chest’s contents.
Another outbreak of plague the following summer brought with it a second disaster. Choosing to return to London ahead of his colleagues, Merrett was essentially alone in the College House when fire broke out in the city on 2 September. When it reached Amen Corner on the evening of 4 September, it was apparent that the College House would soon be destroyed. Merrett and the College bedel therefore set about removing the most valuable items from the collection to bring a safe distance away from the blaze.Footnote 27 Together, they were able to salvage 148 books (out of an estimated 1,300), the Annals of the Royal College, and portraits of Simeon Fox and William Harvey that Merrett had cut out of their frames. Otherwise, little of the collection or the remaining college records survived.Footnote 28
Rather than being praised for rescuing the few items he was able to, Merrett was widely blamed for the damage done to the collection, and ultimately censured for failing to save more. Some of his colleagues were perhaps rankled by his earlier readiness to abandon the College House to thieves, although it has also been suggested that they may have wished to deflect their personal culpability in fleeing London in the first place.Footnote 29
Whether or not Merrett was treated fairly in the aftermath of these events, the College leadership were justifiably concerned with the potential consequences of the destruction. Throughout the previous decade, the Royal College had tried in vain to reassert its control over practice in London, after a 1656 court decision had called into question the College’s statutory authority on this matter.Footnote 30 As librarian, Merrett had been expected to produce sufficient documentary evidence to support their original charter from Henry VIII, and had in fact published a book in 1660 outlining the legal powers of the Royal College. The Royal College nonetheless lost a subsequent 1665 appeal to Parliament to widen its regulatory power, and the destruction of the records promised to make future legal or political manoeuvres of this sort more difficult.Footnote 31
Worse still, the disappearing act the professional elite had performed during the previous two summers further compromised their already shaky reputation with the public. Noting an exchange with Jonathan Goddard after the first outbreak of plague in 1665, Samuel Pepys (hardly an enemy of the profession) expressed scorn at the rationale commonly provided for their exodus: ‘Dr Goddard did fill us with talke, in defence of his and his fellow physicians going out of towne in the plague-time; saying that their particular patients were most gone out of towne, and they left at liberty; and a great deal more, &c.’Footnote 32 Provided they did not die, the apothecaries and chemical practitioners who remained in London during the plague could take advantage of this absence by expanding their own practices, thus increasing their commercial clout (and likely their popular esteem) at the expense of their rivals.
For Merrett, these setbacks to the profession were compounded by his personal destitution. Having lost all his property, including his considerable personal library, Merrett’s only remaining possessions appear to have been those he had rescued from the collection. His choice to keep these perhaps reflected his hope of being reinstalled as Harveian Librarian once new accommodation for the Royal College was found. Instead, the College ultimately chose to abolish his post, and in 1669 paid him fifty pounds to surrender the lease he had held on the College House.
The Pamphlet War and the Search for a Middle Ground
The state of disarray in which the Royal College found itself following the destruction of the College House was reflected in a fractious change in its internal power structure. In 1667, the older conservative faction that had led the College since 1655 gave way to a younger leadership, more familiar with the new philosophy and more accepting of its goals. In fact, both Francis Glisson, who replaced Edward Alston as President, and George Ent, who replaced Baldwin Hamey Jr as consiliarus had, like Merrett, been part of the 1645 Group and founding members of the Royal Society.Footnote 33 The fact that Merrett was not granted a similar leadership role, and was in fact stripped of his status as Harveian Librarian, indicates the extent of his alienation from the Royal College in the aftermath of the fire.
Nevertheless, the change in leadership offered new opportunities for Merrett to return to professional relevance, even as it signalled the beginning of a significant schism within the Royal College. As a manifest expression of long-latent tensions, it marked the beginning of open conflict between those holding different visions for the future of medicine.While the ensuing pamphlet war was ostensibly concerned with the incursion of apothecaries into areas of practice traditionally held by elite physicians (especially diagnosis), it thus hinged on the question of what sort of knowledge was best suited for medical practice: either the preservation of health through learned advice rooted in Galenic principles; or the restoration of health through the application of specific therapies derived from experiment.Footnote 34
This pamphlet war is generally taken to have begun with an attack on Galenism by Joseph Glanvill, an Anglican clergyman and member of the Royal Society, in his book Plus Ultra.Footnote 35 Conceived as a supplement to Thomas Sprat’s History of the Royal Society, Plus Ultra directly contrasted the new philosophy with the classical sources of knowledge privileged by elite physicians. According to Glanvill, excessive reliance on the ancients had crippled progress in medicine through resort to speculative reasoning: ‘the Philosophers of elder times, though their Wits were excellent, yet the way they took was not like to bring much advantage to knowledge, or any of Uses of humane life.’Footnote 36 Though Glanvill (speaking, he suggested, for the Royal Society as a whole) acknowledged the value of ‘all the useful Theories and helps we have from them’, his appreciation did not extend the practical application of theory to medicine: ‘the unfruitfulness of those Methods of Science, which in so many Centuries never brought the World so much practical beneficial knowledge as would help the Cure of a Cut Finger, is a palpable argument, that there were fundamental mistakes, and that the Way was not Right’.Footnote 37
Sprat’s work had similarly questioned the usefulness of classical knowledge, underscoring the superiority of the new philosophy over Aristotelianism, and arguing that the experimental programme would provide the foundation for both true religion and domestic peace and prosperity.Footnote 38 For both authors, the limitations of classical knowledge could only be overcome by the wholesale adoption of the new philosophy as the primary method of knowledge production.
In 1670, the political pamphleteer and physician Henry Stubbe, possibly writing at the behest of the ousted Baldwin Hamey Jr, published two pieces in response to this interpretation of the ancients. Both The Plus Ultra Reduced to a Non Plus,Footnote 39 his reply to Glanvill, and Legends, No Histories,Footnote 40 his reply to Sprat, represented the Royal Society as a threat, not only to the foundations of natural knowledge, but to the stability of the prevailing religious and political order.Footnote 41 Whereas Sprat argued that the modesty, humility, and cautious scepticism elicited by the scientific temperament would reduce sectarian religious enthusiasm and discourage submission to papal authority, Stubbe saw the new philosophy as a gateway to the acceptance of a variety of heretical positions, from atheism to papacy.Footnote 42
Glanvill and Sprat’s attacks on elite medicine were also worrying, as Stubbe could not see any great improvements deriving from the new methods. ‘Most that the Novellists have done,’ Stubbe argued, ‘is to find out new reasons for an antient practice’.Footnote 43 While he acknowledged certain limitations of Galenism, the experimental programme undermined the professional authority of medicine by privileging speculative treatments that promised cures but often failed to deliver them.
Many physicians critical of Galenic practice had indeed emphasised the material ‘cure’ of disease. Thomas Sydenham would eventually suggest that a physician was to cure disease and ‘do naught else’.Footnote 44 But Merrett did not consider prevention and treatment to be fundamentally incompatible – even if different means were employed to achieve the two ends. While Glanvill had called into question the basic efficacy of Galenic approaches to health and illness, Merrett believed that certain aspects of experimentation could be incorporated into the established Galenic repertoire without undermining its central tenets.Footnote 45 In claiming this middle ground, Merrett was joined by Jonathan Goddard, another veteran of the 1645 Group and founding member of the Royal Society, and Daniel Coxe, a much younger Fellow who had only been elected to the Royal College in 1665.Footnote 46 As Coxe succinctly expressed their position, ‘medicines which have a sensible operation, specifics, and chymical remedies, have all a subserviency to [Galenic] method.’Footnote 47
They further argued that the introduction of drug production into elite practice could alleviate competitive tensions between physicians and apothecaries.Footnote 48 This would ensure learned and authoritative oversight of the production process, while expanding the revenue base for physicians at the expense of their professional rivals. As it would entail further exploration into the properties of the constituent ingredients of complex remedies, it was hoped that it might also lead to new discoveries.
Admittedly, the authors seldom provided concrete examples of the ways in which treatments were likely to improve through drug production, or of the specific experimental methods to be employed. The few examples of experimentation they offered suggested that new cures might emerge as much from the learned evaluation of existing treatments as from the discovery of new substances; for instance, Merrett emphasised the way in which distillation and precipitation might allow physicians to better evaluate the fundamental properties of existing therapeutic substances by examining their simple constituents. Through the exploration of simples, the experimenting physician could ‘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.’Footnote 49
This was of course one of the central rationales for distillation offered by Paracelsus and Van Helmont, although like the chemical physicians who followed them, they generally sought to replace rather than augment the traditional practice. For Merrett, the experimental approach was instead most fruitful when it coupled practical art with learned judgment – a coupling that could only be accomplished by those who had received traditional philosophical training. Once developed, this approach could lead to new discoveries, no matter what artisanal activities were being explored. Virtually any trade could lead to improvements in natural knowledge about the body, provided their products and processes could be subjected to the discerning gaze of the learned physician.
While Merrett, Goddard, and Coxe were careful to highlight their ties to traditional Galenism, critics of their approach quickly came to associate it with Glanvill’s sweeping attack on ancient knowledge. Following the publication of Merrett’s A Short View of the Frauds and Abuses Committed by Apothecaries, an anonymous reply appeared entitled Lex Talionis, which accused Merrett of an underhanded attempt to promote the interests of the Royal Society by creating a wedge between physicians and apothecaries.Footnote 50
Merrett may have damaged his case for improved relations between the Royal College and the Royal Society in responding to this claim, as he insinuated that Henry Stubbe had authored the anonymous pamphlet, and then claimed – somewhat disingenuously – that the Royal Society actually posed little threat to the Royal College.Footnote 51 He took the fact that many physicians remained active in both institutions as an illustration of continued mutual goodwill,Footnote 52 and further suggested that loyalty of these members lay squarely with the Royal College. If the Royal Society came to be perceived as a threat to their livelihood, physicians would quickly leave.Footnote 53
Despite this claim, Stubbe saw in Merrett’s proposals the beginnings of a take over attempt by the Royal Society. In Campanella Revived,Footnote 54 a further attack on the new philosophy, he denied authorship of Lex Talionis (probably truthfully),Footnote 55 but ultimately agreed with its main point concerning Merrett’s loyalties by describing Merrett’s pamphlet as yet another of the ‘puny strategems of the virtuosi’ for grabbing power.Footnote 56 He further argued that the proposal for closer relations between the activities of physicians and virtuosi would fail to improve medicine, as virtuosi lacked the medical expertise necessary to bring about such improvements. In other words, they lacked the traditional training necessary for the exercise of learned judgment.Footnote 57
This exchange between Merrett and Stubbe produced little resolution, resulting in détente rather than outright victory. Most of those involved simply appear to have eventually lost interest in the issue as the years dragged on. Glanvill remained an active participant until 1673, when he grew tired of refuting Stubbe’s criticisms of the Royal Society and the accusations of impiety levelled against him. Stubbe turned his pen away from medicine and towards the Third Dutch War.Footnote 58 Merrett continued to promote his reform programme,Footnote 59 but appears to have become increasingly concerned with seeking a legal recourse for what he perceived as his ill-use at the hands of the College.
Despite their exhaustion with the issue, both Stubbe and Merrett – probably the two most active participants in this exchange of pamphlets – remained devoted to restoring some sense of coherency to medicine. For Stubbe, this could be best accomplished by more vigilant observation of existing regulatory mechanisms controlling the activities of apothecaries and other potential commercial threats. For Merrett, it required fundamental transformation of the way medicine was understood and practised. Order could not be restored to commercial relations unless the profession itself was transformed.
The Challenge of Competition: How to Control the Rogue Practitioners?
Merrett used the pamphlet war as an occasion both to present himself as a moderate voice among an increasingly immoderate chorus, and to present explicit reforms that could help restore congenial relations between the two communities with which he was most directly involved. Both were undoubtedly efforts at self-promotion, as bringing about better relations between physicians and virtuosi could only help him improve frayed relationships with his colleagues. However, they also reflected his long experience with the challenges of regulation, both as a private practice physician and as a Censor.
Like most physicians practising in this period, Merrett perceived the problem of competition as arising from growing cracks in the edifice of the established professional order. By charter, medical services were divided into a tripartite structure in which physicians diagnosed disease and offered prognosis through observation and discourse with patients; apothecaries made and sold drugs according to physicians’ orders; and surgeons ‘laid on hands’ by setting bones, amputating limbs, bloodletting, etc. This order was supported by English common law, but was difficult to enforce.Footnote 60 Although the Royal College sought to punish individuals who strayed too severely from the established relations,Footnote 61 their activities often resulted in piecemeal and inconsistent punishments for the various apothecaries, travelling empirics, drug peddlers, midwives, and traditional healers practising on the London scene. During the time in which Merrett was an active Fellow, virtually no prosecutions were undertaken.Footnote 62
Traditional physicians also had to contend with changing consumer dynamics in the city, which encouraged practitioners to move away from their clientelistic emphasis on personal counsel towards the production and sale of medical commodities.Footnote 63 The replacement of personal ties with money ties offered significant advantages for the practitioner, allowing greater freedom of movement and the capacity to scale the supply of products to the demand.Footnote 64 The traditional division of medical labour therefore came under increasing pressure as the century progressed, both from without (via a skyrocketing number of individuals practising outside of the official professional structure) and within (via practitioners seeking to branch out from their prescribed roles).Footnote 65
For Merrett, as for many other physicians, one of the greatest threats to the established professional order appeared to be apothecaries who counselled and diagnosed patients in addition to selling drugs.Footnote 66 While this threat diminished after 1703 with the finding of the Rose Case (in which it was decided that apothecaries had the legal right to diagnose but could not charge for the privilege),Footnote 67 competition with apothecaries remained intense throughout the second half of the seventeenth century.
Recognising the similarities in the work of apothecaries and virtuosi–physicians, Merrett sought to distinguish between them based on their relative capacity for learned judgment, and to stress the need for more direct oversight over the production techniques apothecaries employed. Such regulatory measures were well within the legal rights of the Royal College, and had constituted the primary means of restricting the practices of apothecaries in the past. A return to the status quo ante of professional relations was thus called for in the short term.
But oversight could be nothing more than a stop-gap solution to problems endemic in the growing medical marketplace. Inspections and prosecutions could not yield lasting results, either because they were unsystematic and costly, or because the unstable political fortunes of the Royal College limited its ability to follow through on its regulatory rights.Footnote 68 A permanent solution lay not in simply confining the activities of apothecaries, as Stubbe had argued, but in assuming these activities oneself. In newly commercial London, it was not enough to simply restrict trade; physicians also had to provide a superior product.
Thus, Merrett concluded that ‘as affairs now stand between the Physicians and Apothecaries of England… [the physicians] ought to make their own medicines if they intend to support their own faculty and the honour of it’. This would ultimately improve the quality of the product delivered to the consumer by ‘the avoiding of the insufferable charges imposed upon our patients by the high bills of the Apothecaries, and the uncertainties of our success by reason of their detracting, substituting, putting in false, decayed and unwholesome ingredients into our receipts.’Footnote 69
Merrett provided a legal rationale for this expansion of practice by repeating the popular claim that physicians had historical priority in drug production.Footnote 70 He suggested that Greek physicians regularly experimented with drugs prior to the appearance of apothecaries by serving as pharmacopaei, or makers of medicine. Apothecaries were initially pharmacopolae, or simple sellers of prepared medicines, until physicians gave over drug production to these assistants and commercial distributors.Footnote 71
Merrett further argued that drug production was needed to improve patient safety and address the poor quality of the care delivered by apothecaries. His pamphlets were studded with anecdotes describing the fatal errors apothecaries had made through poor diagnosis and dangerous production practices. Apothecaries were presented as more dangerous to the public than ‘all the others… Divines, Quacks and Mountebanks, &c’.Footnote 72 They were a ‘poysonous weed’, whose late budding and growth threatened to ‘choak the sweet flower’ of the elite physician’s practice.Footnote 73 Merrett referred, for instance, to an unnamed apothecary working in the Strand, ‘who with three doses of Mercurius Dulcis, given against the Worms of three Children, did the same day worm ‘em out of their lives’, and to another, whose prescribed treatment for ear inflammation ‘[forced] the inflammation into the brain, immediately occasioned a phrensie, and not long after a Corps’.Footnote 74
While claims were hardly likely to improve professional relations, Merrett took pains to distinguish between so-called ‘honest’ apothecaries, who remained wedded to traditional practices and accepted complete subservience to physicians, and ‘practising’ apothecaries, who put patients at risk by claiming an expertise in medical practice, and assuch, capacity for learned judgment that they themselves lacked. In a move designed to promote honest practices among apothecaries, Merrett proposed that all members of that profession thus take an oath every seven years in which they would ‘praepare and dispense the praescriptions of Physicians exactly without the least alteration, omission, or addition’. Apothecaries were also encouraged to support physicians in their attempts to regulate the profession by opposing the ‘frauds and insinuations of Empiricks and Practising Apothecaries’.Footnote 75
Merrett suggested that physicians take a similar oath at regular intervals that put them in mind of their own duties to the honest apothecary, and constrained their future drug production practices to ‘such drugs that are very difficult, requiring art and care, and whereon the weight and principal efficacy of Curing great Diseases doth depend’.Footnote 76
These oaths implied an inter-professional arrangement based on the gentlemanly principles of mutual trust and goodwill.Footnote 77 If apothecaries continued to undermine the commercial viability of elite physicians by diagnosing disease and prescribing remedies, professional relations would remain antagonistic and physicians would be forced to radically expand their production practices in order to compete. If apothecaries returned to their traditional role, much of the old division of labour between the two professional bodies would be restored. Apothecaries would continue to mix and supply most drugs to patients, although physicians would take over the production of certain complicated remedies in order to ensure their safety.Footnote 78
It is impossible to determine the extent to which Merrett’s appeals to apothecaries represented a genuine attempt at rapprochement – especially since Merrett was not simply advocating a return to the status quo ante of the sort promoted by Stubbe. Indeed it is easy to read his pamphlets as rhetorical machinations designed to give physicians an upperhand in the struggles against this emerging commercial threat (the nastiness of some of his criticisms against the apothecaries certainly suggests such a reading).Footnote 79 But the fact that he proposed a compromise that placed complex drug production firmly in the hands of experimentallyinclined physicians indicates the extent to which he envisaged new intellectual and practical activities for improving the bargaining position of this profession.
The Challenge of Education: What to Teach the Physician?
While competition from apothecaries had to be addressed if physicians were to maintain legitimate authority over diagnosis and prescription, escaping the state of intellectual stagnation in which medicine appeared to languish required sweeping changes in the way physicians were educated. This was a decidedly upstream and non-regulatory solution to the problem of competition. Since Merrett viewed the threat from apothecaries and irregular physicians as largely deriving from limitations in existing medical knowledge and practice, he advocated measures to improve this knowledge through a geographical and topical expansion of subject matter, an embrace of new scientific discoveries coming from the Continent, and new artisanal knowledge coming from all directions at once.
This approach was consistent with the Baconian tradition in which Merrett was steeped, which held that philosophical and artisanal fields of knowledge production were equally capable of contributing to an understanding and mastery of nature. This had long been a central tenet of advocates of the new philosophy, serving as a basic principle of Boyle’s Invisible College, Hartlib’s Comenian Group, and Haak’s 1645 Group.Although final judgment about scientific truth was always reserved for learned gentlemen, who possessed both the freedom and discernment to evaluate facts, the production of raw data about nature remained thoroughly democratic.
As head of the programme on the history of trades, Merrett sought to draw to the Royal Society knowledge related to a variety of artisanal practices, from traditional transformative arts such as refining, brewing, and smelting, to activities as far-flung as clock-making or moulding. It was hoped that through this the Royal Society would become the nexus for all knowledge of trades that could be rendered into text, hopefully giving rise to fertile interactions between different fields.
Merrett had personally assisted this programme through his research. In preparing to translate The Art of Glass, for instance, he had sought out Italian glassmakers living in England in order to better understand the materials and practices Antonio Neri had included in his recipes for glass production. Merrett’s vinicultural research contained similar recipes for identifying and curing the ‘diseases of wine’,Footnote 80 and drew analogies between the treatment of these diseases and the treatment of his patients, implying that the tools applicable in one arena might also be applicable in the other.Footnote 81
Although Merrett promoted the acquisition of artisanal knowledge as an important part of reformed medical education, he acknowledged the continued primacy of established university training. Merrett’s ‘reformed’ student, like his traditional counterpart, was expected to possess a working knowledge of Latin and Greek and to have studied philosophy at either Cambridge or Oxford. Through such study the student ‘learns to speak like a Scholar, and is informed in the principles of Nature, and the constitution of natural bodies’.Footnote 82 This training was not only required for the physician to exercise authority over other medical practitioners, but also provided the foundations of learned judgment that distinguished his understanding of nature from the tacit and contingent natural knowledge produced by artisans.
While the medical statutes of the mid-seventeenth century specified that the student spend seven years at either Oxford or Cambridge, however, Merrett proposed that the student spend only two years there, and devote much of this time to the direct study of nature rather than to disputation or philosophical training.Footnote 83 The student was then expected to leave the university in pursuit of practical knowledge of the body and treatment techniques.
This knowledge began with anatomy – a subject that was much out of favour with chemical physicians, but to Merrett the ‘basis and foundation, whereon the weighty structure of physick is to be raised’.Footnote 84 Merrett suggested that the student thus leave England and enrol in the Collegium Anatomicum in Leiden,Footnote 85 where he was to supplement the abstract anatomical training he received with its practical application in the hospital. Through such training the student would develop a better understanding of the physiological foundations of diagnosis and prognosis – the two most important tools of elite medical practice.Footnote 86 Similar training was then to be taken at the famous L’HôtelDieu and La Charité hospitals in Paris.Footnote 87
Hospital education would also provide the student with a greater understanding of experimental pathology, especially if the student was willing to branch out from the passive observation of illness to active manipulation of bodies through empirical exploration. Merrett thus suggested that students evaluate the action of various substances within the body by poisoning animals and dissecting them to uncover their specific pathological effects.Footnote 88
In addition to private experiments of this sort, Merrett proposed that the student apprentice himself to an apothecary for the period of a year, and thereby learn the art of composing drugs. This would not only enable physicians to ensure their safety and efficacy, but would also add legitimacy to the physician’s efforts at regulation. Otherwise ‘it would be adjudged ridiculous, should a Physician undertake to reprehend, and afterward bend his force, to suppress and decry Apothecaries, privately or publickly, without having first acquired a particular experience in their Art.’Footnote 89 It was precisely the lack of this knowledge that had undermined previous attempts by physicians to regulate their counterparts.Footnote 90 It was equally important for physicians to become acquainted with surgery, as in England they also claimed superintendence over this group. Merrett therefore proposed that the student spend an additional year in apprenticeship to a surgeon, observing technique and discovering the rules by which this craft was practised.Footnote 91 Merrett did not go so far as to suggest that the student actually perform surgery, but rather that he develop his understanding through ‘ocular inspection’ and the handling of instruments.Footnote 92
The final stage in Merrett’s proposed education was even less traditional, being the equivalent of a natural historical ‘grand tour’ of the Continent. Merrett did not consider medical education complete until the student had moved beyond the pure pursuit of medical knowledge to embrace the full range of activities and forms of knowledge pursued by mankind. This allowed the aspiring physician to contribute to a variety of human pursuits, rather than focusing solely on the advancement of his profession:
As a Picture is raised to the highest point of admiration by the variety of excellent colours; so the Intellectuals of a Physician are incomparably adorned with the addition of those various accomplishments, his Travails through several Countreys afford. Wherefore ought not to content himself, with the sole improvement of his profession, for so vast an expense, trouble, and passing through so many dangers, but like an expert Chymist, draw essences of all discourses, the ingenuity of those Travailers from other parts of the world do offer.Footnote 93
The range of materials the physician was expected to survey was prodigious. In Rome, it was holy relics and antiquities; in Naples, the wonders of nature found about the Pazzuolo. In Liverno, the student should observe shipbuilding, fountains, and art. In Pisa, a church steeple, in Lucca, ramparts, and in Milan, the Citadel. The student should then pass from Italy to Basel where he was to view Holbein’s Dance of the Dead, and from there to Strasbourg, where he was to examine the intricacies of the clockwork in the Cathedral of Our Lady of Strasbourg and marvel at the height and artifice of the steeple. Eventually, the student was to make his way to Heidelberg and examine the structure of the Prince Elector Palatin’s castle as well as his cavalry. From there he should pass to Mainz to examine a perpetuum mobile that had kept exact time for seven years without being wound. In virtually all of these cities Merrett implored the student to stop and sample the local vintage of wine and to survey different techniques of wine production. In total, Merrett listed twenty-seven different cities the student should visit on his way to becoming a fully educated physician.Footnote 94
In a smaller piece written a decade after this proposed travel plan, Merrett argued that the physician should also become acquainted with ‘philosophical trades’ such as those of refiners and dyers. Members of such trades were familiar with the methods of chemistry, and through experimentation might ‘without much difficulty discover, the compounds of Medicinal Waters, which hath hitherto puzzled all the World.’ Merrett saw similar promise in all trades, to the extent that ‘no Manufacture but affords some light in Physics’.Footnote 95 Activities appearing to have little bearing on medicine or its reform were thus fundamental to improved medical knowledge, as this knowledge was ultimately tied to a broader understanding of nature available to artisans manipulating her products.
Knowledge of philosophical trades was also required for physicians to properly assess the foundations of efficacy, as ‘from ignorance of these things proceeds the doctrine of occult qualities’. Improper method made a muddle of everything, ultimately rendering it impossible for the physician to distinguish good remedies from bad ones or to discern the causes of their action within the body. ‘Hence Receipts get credit, Medicines so often altered, and new ones gap’t after, whereof as yet there is no end.’Footnote 96
As is clear from such statements, Merrett’s proposed educational reforms rested on an epistemological foundation somewhat different from that supporting established elite medical education. While he continued to stress the primacy of Galenism, he also suggested a qualitative continuity between passive observation of nature or redirection of natural processes and active intervention in nature. Medicine was traditionally rational and purely observational. Unlike the tacit, embodied knowledge of the surgeon or the apothecary, physicians sought to treat patients solely on the basis of the external signs of illness exhibited by the body. This dissociation from manual work helped to demarcate medicine as superior to other forms of medical knowledge.
Merrett sought to undercut this existing intellectual and practical hierarchy in his educational proposals by pointing to the fruitfulness of experimental and artisanal forms of knowledge production. The transformative arts such as glassmaking, distillation, and refining, were as capable as pure observation of producing valid natural knowledge and of improving the state of medicine. In suggesting continuities between observation and intervention, Merrett thus encouraged the adoption of an active and even physical style of knowledge production, to supplement the dispassionate and discerning gaze on which physicians tended to rely.Footnote 97
Merrett was hardly the first to advocate for such changes in the way medicine was taught. Throughout the Interregnum, university education had been the subject of fierce debates, reflecting the intimate connections thought to exist between the educational and the political order. Like Merrett, earlier advocates of educational reform, such as the radical cleric and physician John Webster and the chemical physician Noah Biggs, had challenged excessive reliance on ancient sources and dogmatic methods. However, they had sought to completely replace the traditional curriculum with an updated one of their own choosing. In the case of Webster, for instance, this mostly derived from Bacon and Robert Fludd, and consisted of an eclectic admixture of experimentalism, alchemy, and astrology.Footnote 98 In contrast, Merrett clearly wished to retain core elements of traditional Galenic training, making it the foundation upon which his untraditional proposals rested.
Merrett’s reforms obviously lacked concrete strategies for implementation. No student would ever be able to undertake the kind of education he had proposed, no matter how intrepid they might be. But unlike his predecessors, Merrett appears to have been less interested in implementation than in exhibiting the range of available knowledge from which the physician might draw his understanding of nature, the human body, and human artifice. They served his rhetorical purpose of encouraging a broadened conception of medical education that nonetheless remained grounded in established philosophical training.
Although the pamphlet war had provided Merrett with an opportunity to advocate for a wide range of reforms, it appears to have done little to restore the professional standing he once held. Indeed, he became increasingly unpopular in the years that followed as he mounted a vigorous legal campaign to be reinstated as Harveian Librarian. Insisting that this had been a lifetime appointment, Merrett appears to have refused to relinquish the items he had rescued from the College House until a satisfactory resolution could be reached. Rather than accede to this somewhat extortionate demand, in 1681, Merrett was effectively expelled from his Fellowship on the pretext that he had failed to attend meetings. The next President, John Micklethwaite, took the matter of the remaining books to the Chancery Court, in a complicated legal proceeding lasting two years. Finding in favour of the Royal College, the Court ordered Merrett to return all he had saved to the new College Quarters at Warwick Lane.Footnote 99
The expense of these legal proceedings may have played a role in his eventual expulsion from the Royal Society two years later – for being in arrears in his subscription payments since 1668.Footnote 100 Merrett spent the remaining years before his death in 1695 at his house at Hatton Garden, apparently engaged in private practice and peddling remedies of his own design, but staying well beyond the fray of professional politics.Footnote 101
The personal and professional failures Merrett experienced in his later life followed an intertwined path. While Merrett was among several physician–virtuosi to ascend to positions of authority within the Royal College, he is the only one to have experienced such a precipitous decline. Jonathan Goddard, who like Merrett advocated a rapprochement between physicians and virtuosi rooted in the production of drugs, left the pamphlet war unscathed, and continued to play an active role in both the Royal College and the Royal Society until his death in 1675. It thus seems likely that Merrett was already the object of some antipathy by the time the pamphlet war began, which perhaps explains why his activities appeared to have received special critical scrutiny.
Nevertheless, the attacks that critics such as Stubbe levelled against his proposals were rooted in real concerns for the future of the profession. If medicine was no different in kind from knowledge of the rest of nature, then physicians could not legitimately claim a monopoly over the human body, no matter how much traditional training they had received. Under such circumstances the virtuosi inspired by natural history, and who made the entirety of nature his purview, could be seen as superior to the physician inspired by natural philosophy, who focused solely on the human body at the expense of the rest of the world. Medicine was therefore at some risk of becoming a minor satellite of the new philosophy – especially if its physicians chose to adopt the same methods used by the virtuosi in an attempt to improve their competitive advantage in the medical marketplace.
When Merrett’s proposed reforms are interpreted in this way, it is easy to understand why some saw his embrace of experimentalism and artisanal knowledge as potential threats to traditional practice. As much as the activities of apothecaries constituted a commercial challenge in their own right, it seemed possible to address these through existing (though admittedly inefficient) regulatory measures. The qualitative distinction between medical knowledge and knowledge of the rest of nature would thus remain intact, and physicians could continue to claim a monopoly over their field.
However, Merrett does not appear to have seen in his reform proposals the same wholesale reformulation of medical theory and practice that his critics saw. Rather, in his idealised vision of medical regulation and education, experimentation and artisanal knowledge added to traditional practice without radically reformulating what came before. At the heart of medicine one continued to find the Galenic mainstays of learned observation and prevention. Knowledge of the body thus remained distinctive from other kinds of knowledge, if only because it was best obtained by those who had first received philosophical training.
The failure of Merrett’s reform effort did not result in a wholesale usurpation of medicine at the hands of the Royal Society juggernaut, though it did result in permanent changes in the way in which traditional physicians presented themselves. Harold J. Cook has argued that traditional physicians quickly adopted a series of rhetorical shifts in which the old emphasis of Galen was replaced by a new emphasis of Hippocrates as the intellectual progenitor of medicine. It also became commonplace for physicians of all stripes to argue that their medical knowledge derived from empirical experience, whether or not it did, and to promote monocausal theories of disease aligned with this experience. Although the pursuit of universal cures gradually began to eclipse the emphasis on prevention and tailored medical advice, many aspects of Galenic practice in fact remained in use for centuries longer.Footnote 102
Remarkably, this unplanned outcome seems largely consistent with the kind of reforms Merrett advocated. In practice, it was apparent that both medical approaches could comfortably coexist with little threat of contradiction, as they had different goals and were relevant to different aspects of the disease experience. While the conditions of knowledge production promoted by the new philosophy undoubtedly posed an intellectual challenge to traditional medicine, this challenge was more palpably felt in the meeting halls of the Royal College and Royal Society than in the consulting rooms of private practice. Here, at least, the two traditions could comfortably coexist.
An earlier version of this paper was presented at the Early Sciences Working Group in the History of Science Department at Harvard University. Special thanks goes to Katherine Park, Steven Shapin, Elizabeth Yale, Michael Laycock, and two anonymous reviewers for their valuable suggestions. The author also thanks the Robert Wood Johnson Foundation Health & Society Scholars program for its financial support.