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many of the King’s liege People, most especially of them that cannot discern the cunning from the uncunning’. The act therefore ruled that anyone wanting to practise medicine or ‘physic’ within seven miles of London must first submit themselves to examination by the Bishop of London or Dean of St Paul’s Cathedral, ‘calling to him or them [bishop and dean] four doctors of physic … as they thought convenient’.³ The religious authorities were to police the system because it was still widely accepted that the Church was primarily responsible for personal welfare, body as well as soul.

      However, in September 1518, Henry VIII himself intervened by issuing a Charter that took the power to regulate medicine in London out of the hands of the Church and gave it to a new body, the ‘College of Physicians’. This would issue licences to those considered learned and skilled enough to practise, and impose fines of up to £5 per month upon those who practised without a licence. The College was to be financed by these fines, as well as fees for conducting examinations and issuing licences.

      In London at the time, nearly all forms of commercial activity were controlled by guilds. These organizations were responsible for the apprenticeship system that trained new entrants into each trade, trainees being ‘bound’ to a master for a period typically of seven or eight years during which they would learn their craft. Once they had reached a sufficient standard of skill, they were ‘freed’ to practise in their own right. As freemen, they acquired a high degree of political influence, at least by the standards of the time. They could vote in elections for the Common Council, the City’s parliament, and through their guilds controlled the City’s administration: the Court of Aldermen and the Lord Mayor.

      The guilds were concerned with social as well as political status, and were preoccupied with matters of rank and dress. Each had its own uniform and liked to parade their colours on special occasions, which was why the guilds came to be known as livery companies. They fought ferociously over matters of precedence, jockeying for position in the official list of the twelve ‘chief companies, from whose membership the Lord Mayor was chosen annually. The most powerful was the Company of Mercers (cloth merchants), followed by the Grocers (originally known as the ‘Pepperers’), the Drapers, the Fishmongers, the Goldsmiths, the Skinners, and so on.

      The College of Physicians did not fit comfortably into this delicately arranged system. It was small – its membership was capped at twenty to thirty members or ‘Fellows’ compared to a thousand or so in the larger livery companies – yet its influence was enormous as it served not only most members of the Privy Council but the royal household itself, a fifth of the Fellows being officially engaged in attending the monarch. It exercised a monopoly over practice, and set standards, yet had no responsibility for training. In 1525, in an attempt to regularize the position, the Common Council passed an act accepting the College’s monopoly of medical practice but banned Fellows from dispensing medicines. This was to protect the Grocers, among whose ranks were the apothecaries, specialists in medicinal supplies and the preparation of prescriptions.⁴

      These arrangements laid the foundations for a medical system overrun with anomalies and riven with rivalries. It was a mess that got messier with every successive attempt to rationalize it. In the 1540s, an act was passed ‘for the enlarging of their [the College’s] privileges, with the addition of many new ones’, as the College’s first official history put it. Among the privileges so enlarged was the control the College exercised over the apothecaries. Henceforth, its officials were to have ‘full authority and power, as often as they shall think meet and convenient, to enter into the house or houses of all and every Apothecary … to search, view and see such Apothecary wares, drugs and stuffs as the Apothecaries or any of them have’. Any stuffs found ‘defective, corrupted and not meet nor convenient’ the doctors could order to be immediately destroyed on the offender’s doorstep.⁵

      The same year, another act amalgamated the Company of Barbers and the Guild of Surgeons, perversely in order to separate the two crafts. Surgery – or ‘chirurgery’, as it was then known, derived from the Greek for handiwork – was a manual occupation, learned like any other craft through apprenticeship. Its role in healing was to deal with external operations: amputating limbs, cauterizing wounds, resetting dislocations, removing tumours, letting blood, extracting teeth, and – the area that produced the most common demarcation disputes with the physicians – treating skin conditions, including diseases such as plague and pox. Since many members of the Barbers’ Company also offered such services, the aim of bringing them together with the surgeons was to ensure that they did so according to common standards. Surgeons who ‘oftentimes meddle and take into their cure and houses such sick and diseased persons as [have] been infected with the Pestilence, great Pox, and such other contagious infirmities’ were forbidden to ‘use or exercise Barbery, as washing or shaving, and other feats thereunto belonging’, and barbers were likewise forbidden from performing ‘any Surgery, letting of blood, or any other thing belonging to Surgery (drawing of teeth only excepted)’. To encourage the development of surgical skills, the act pledged an annual entitlement of four fresh corpses from the gallows, for use in anatomical lectures.⁶

      Having established surgery as a separate craft, another act was passed in 1543, just two years later, which threatened to destroy it. Dubbed the ‘Quacks’ Charter’, its preamble launched a blistering attack on the surgeons for their ‘small cunning’. ‘They will take great sums of money and do little therefore, and by reason thereof they do oftentimes impair and hurt their patients,’ it objected. Because of this, the act ruled that ‘every person being the King’s subject, having knowledge and experience of the nature of herbs, roots and waters or of the operation of the same’ should be allowed ‘to practise, use and minister in and to any outward sore, uncome [attack of disease], wound, apostemations [abcess], outward swelling or disease, any herb or herbs, ointment, baths, poultices and plasters, according to their cunning, experience and knowledge’.⁷ This effectively allowed more or less anyone to perform any surgical operation that did not require a scalpel.

      The identity of those who initiated the Quacks’ Charter is unclear, but the physicians must be among the suspects. They were concerned that the Barber Surgeons Act had given the surgeons too much power and were eager to undermine their privileges. The act may also have been a response to Henry VIII’s religious reforms. In the late 1530s, the process had begun of closing the Catholic monasteries, which until then had run the hospitals. This created a crisis in public healthcare that the act could help alleviate. Whatever prompted it, the effect was chaos, as it did not specify who was to determine the ‘knowledge and experience’ of those that it allowed to practise.

      The College lobbied both monarch and Parliament for further acts and charters reinforcing its own position. It also produced its own ‘statutes’, setting out in meticulous detail its rules and procedures. The earliest that survive date from 1555. They were written by Dr John Caius, one of the College’s most influential sixteenth-century presidents. His name was originally ‘Keys’, but, following a practice popular among intellectuals wanting to add gravitas to their names, he Latinized it to ‘Caius’, but kept the original pronunciation.

      Dr Caius’ statutes specified that there should be quarterly meetings, ‘Comitia’, attended by all the Fellows. At the Michaelmas Comitia (held on 30 September), the College selected from among its number a president and eight seniors or ‘Elects’. The Elects would then choose the ‘censores literarum, morum et medicinarum’, censors of letters, morality, and medicine – effectively the custodians of the physicians’ monopoly. They were to exercise these roles, not with the ‘rod of iron’ of olden times, Caius declared, but with a caduceus, the mythical wand entwined with two serpents carried by the Greek god Hermes, representing gentleness, clemency, and prudence, which has since become a symbol of medical practice. Caius personally donated a silver caduceus to remind the Censors of this responsibility. It was one they would often forget.⁸

      Their first role as censors of ‘letters’,

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