which maketh books to be variously received, liked, and enter. tained, according to the variety of the reader's understanding and capacity:

Pro captu lectoris habent sua fata libelli.

Upon the reader's wit the fates of books depend.

But the best is, that I ever was regardless of the multitude, as well in this, as in all things else. If the judicious reader find any just fault with any thing contained-in this treatise, let him remem. ber, that Humanum est errare; that to err is incident to the frail. ty of our human nature. But I never was so wedded to my own opinions and conceptions, but that, upon better information, I ever was, and ever will be willing to acknowledge my errors, if I committed, or shall commit any, without esteeming it any shame so to do, any more than many good and worthy authors have done, when they published their retractions.

A DISCOURSE,

Setting forth the unhappy Condition of the Practice of Physick in London, and offering some Means to put it into a better; for the Interests of Patients, no less, or rather much more, than of Physicians.

BY JONATHAN GODDARD,

Doctor of Physick, Fellow of the College of Physicians, and of the Royal Society, and a Professor of Physick in Gresham-College.

London, printed by John Martyn and James Allestry, Printers to the Royal Society, 1670.

Quarto, containing sixty-two Pages.

January 19, 1669-70.

Imprimatur, Rob. Grove, R. P. Domino Episc. Lond. à
Sac. Dom.

THE

HIE art of physick hath had, in common with other arts and professions, the infelicity to be abused by the professors thereof; who, either out of insatiable avarice to make the utmost advantage of gain to themselves thereby, or out of pride and state, or humour, have given just occasion to the world to judge, that they had not that care and consideration of the lives and healths of persons with whom they had to do, as, in humanity, reason, and conscience, they ought to have had. Admitting this to be inexcusable, as to the persons guilty of it, yet it may be said, as to the present professors thereof, having the legal right to practise in the

city of London, and undertaken on their behalf, that there was never in any age, less grievance or cause of complaint upon any such account. However, that distinction between the vices of persons, and of arts or professions, is so clear and obvious, that whosoever transfers those of the one upon the other, must needs appear deficient in the use of his reason, or else partial and inju

rious.

As to the art itself, though it cannot be denied, that it is, as all human knowledge in other kinds, imperfect and defective; yet, that it should be an imposture (as ignorance in conjunction with confidence may surmise or charge upon it) the world doth so much abound with persons learned and judicious, and (though not professed physicians) competent to judge thereof, as to render it superfluous to go about to vindicate it from such an imputation. Neither is the imperfection and defect of knowledge in things relating to, or comprehended in the art, so great, as to render it an empty or mere notional speculation; but though it, as all other arts and sciences (the mathematicks excepted) hath too much abounded with notions and speculations wanting foundation in nature and experience; yet it may vie with any other for number of real truths and discoveries, sufficient to employ and take up the best intellectual abilities and studies of any person addicted to it, for his whole life: And especially in this age, after great improvement lately made therein, by many happy discoveries in nature, of great advantage and concern thereto.

According to the grand importance of this art, employed in the conservation of the life and health of mankind, it hath been the wisdom of princes and states to provide for the encouragement of the professors thereof, by liberal maintenance, privileges, and powers, honorary and advantageous, for the exercise thereof, whereby persons of eminent learning, education, and abilities might be induced to betake themselves to an art standing in need of such accomplishments; without which, in an inferior way of education, persons could not attain to any such improved judgment, as is requisite to the understanding and comprehension of the vast variety and exquisite subtilty of the things constituting the subject of that art, or relating thereto.

Accordingly, it hath been no less the wisdom of the princes and parliaments of this kingdom to provide for the encouragement and good regulation of the profession of physick therein, especially in London; insomuch that, by law and custom, it hath had as great advantages in the kinds beforementioned, with us, as in any country in the world. And, therefore, it is the more to be taken notice of, that at this time it should be reduced, probably, to the worst condition that it is in any where; more than probably, to such a condition as cuts off all hopes of honourable or free maintenance of the professors thereof, or the most part of them, and of improvement in the art itself, for the future; as may in some measure appear by what followeth.

The dividing and separating of that part of the art of physick,

which concerns the preparation and composition of medicaments, from the body of it, so as to put the practice of it into other hands, was never heard of in the ages of Hippocrates, Galen, and other ancient physicians; and hath been judged, by some of the chief authors in physick, to be of unhappy consequence to it, upon seve ral accounts. Hence many physicians, while there was a good understanding between them and the apothecaries (these keeping within their own bounds) thinking it became them, in civil respect, to leave all to these, that belonged to their art; and so, not concerning themselves to be judicious and versed therein, became strangers to the materials and preparations of medicines; and, by consequence, less able to prescribe the making of them, to the best advantage. And this the apothecaries have not been wanting to make their advantage of, to the disparagement of the physicians; so that it is justly to be accounted an error and neglect in such physicians; who, if they had given their minds to it, might have been as conversant in, and as well acquainted with the materials of remedies, whether vegetables, animals, or minerals, and all the more considerable ways of preparations thereof, as many other physicians, or any apothecaries; by frequent viewing, inspection, and observation, and chiefly by experimenting and exercising themselves in preparations more accurate, and of greater importance, chymical, or other: which are the ways that enable a physician authentically to prescribe.

And yet, notwithstanding such an error, and neglect of some physicians occasioned by it, the distinct practice and exercise of that part by apothecaries, as it hath been used in London, had its advantage; and was looked upon as a great ease and happiness to the practice of physick. For by this means physicians were freed from some troublesome and inferior employment; and they had the advantage of giving account, and making appear, upon occasion, all that was done on their part, by their prescriptions extant in writing, in case of any il! success, which might happen by error upon their account, or suspicion of hurt done to a patient, by any thing advised by them.

But these are really, and upon the whole account, advantages to the profession of physick, only upon this supposition, that apo. thecaries keep within the limits of their work and trade, not meddling with the practice of physick themselves; the prescriptions of physicians being faithfully and fafely lodged with them, to the use of their patients, and the benefit of the apothecaries in their trade, Otherwise, neither the advantages before-mentioned, nor any other, can ever compensate the disadvantage and detriment, not only to the profession and professors of physick, but to the publick: In consideration whereof, it were to be accounted a small inconvenience, for physicians to put themselves to the drudgery of making all the medicaments they have use of in their practice, if need were; and to depend upon their own single reputation and credit with their friends and patients, for their vindication, as the case should require.

In comparison to physicians, it may easily be made out, what advantages apothecaries, taking upon them to practise, may have in London, upon their particular communication of all their remedies, to them, to get the whole, or so much of the practice from the physicians, as shall not leave a competency for them to subsist upon. For the apothecaries being bred up all the time of their youth as apprentices in London, while physicians are studying at the Universities, and having so much the more advantage to get a numerous acquaintance, besides that, by keeping open shops, more general notice may be taken of them, when they shall be able to pretend to, and make ostentation of being masters of, or knowing all the secrets and practice of all the physicians in London; it is obvious, how much this must take with the vulgar, and with all such persons, as, being not bred up to learning themselves, cannot be sensible of the advantage of a generous education in all kinds of learning, for improving the mind and understanding, and enabling of it to exercise such a piercing judgment and large comprehension of so subtile and numerous natures and things, as the knowledge whereof is requisite to the art of physick. And, therefore, though there be not so much danger of such ostentation prevailing among the nobility, gentry, and persons of learning and parts in the city; yet how far it may, amongst others, who are the great number and bulk, is not hard to conceive by what hath been experienced.

For, allowing a physician, in his youth, to have had the reason, parts, and ordinary capacity of another of his age, and then to have been bred up in learning of languages, to render him master of the knowledge contained in books written in those languages; then in arts, some whereof minister advantages to the understanding of the nature and causes of things, all do improve the mind and understanding, by exercise at least, to discern and judge of things; then, supposing him to apply his study to natural philosophy, such as is more real and solid in this age, by many happy experi mental discoveries in nature; and, lastly, to the art of physick, and the knowledge of the body of man, with all the parts of it, by anatomical administrations, experiments, and observations; of the actions and uses of the same; the diseases to which they are obnoxious, with the remedies thereof: and admitting a physician to make it his continual work to improve in the knowledge of all these (which his interest must incline him to do) by the study, practice, and experience of twenty years, or more: Now, supposing all this, in the common reason of mankind, he must have a manifold advan. tage to the understanding of the nature, cause, and cure of a discase, above another whose education hath rendered him incapable of any of the accomplishments beforementioned, or of any considerable share thereof; and yet many times it is found, that one that is illiterate, and can speak no reason of any thing, but only make ostentation with a few canting terms; yea, sometimes a nurse, or such kind of woman, by a confidence arising out of ignorance, shall arrogate more knowledge or ability to themselves, and shall be better thought of, among the unlearned and incom

petent to judge, than such a physician as hath been described before. And how much more may an apothecary, upon the pretensions beforementioned, carry a reputation, with such people, above such a physician?

And, if the art of physick, or one half of it, were the knowledge of receipts or forms of medicines to cure diseases, apothecaries might have more pretence to vie with physicians; but, to be sure, that is the least part of it, and a manifold greater proportion of judgment and skill is requisite to discover the disease, than to apply the remedy; and, without such discovery, abundant and frequent mischief may be done, even to the destruction of life, by applying medicines in themselves safe, and, according to the vulgar term, wholesome; and not only so, but by the omission of the proper remedies in their seasons, through the same want of judgment; which mischiefs, by omissions as well as otherwise, whoever pretends to the practice of physick, hath to answer for. In such cases, How can that be a sufficient plea, which passeth for current generally, That nothing was done, but only some cordial given, or what was very safe? though at best nothing to the purpose. Whereas, in the beginning of many diseases, while the opportunities of applying the great remedies, and doing to the purpose, are either only, or to the best advantage to be taken, that doing nothing but, &c. is the undoing of the patient, if loss of life be so to be accounted; there being so much difficulty and danger, in many diseases that carry the least appearance of either, as to require the first and earliest opportunities for a physician to act towards their cure.

This communication of medicines by physicians to apothecaries, whereby they come to be so great masters of receipts, is, in the plain reason and nature of the thing, a trust, whereof they are free to make the advantage or profit that belongs to their trade, by selling such medicines at valuable rates, according to their costliness, or elaborateness in their preparation. But the advantage of directing and prescribing their use, in all cases, belongs to the physician; and the hindering him herein, to the impairing of his practice, is a breach of trust, and unworthy, as well as injurious dealing by him, as may farther appear by the following consideration.

All laws of nature and nations, all justice, equity, and reason of mankind, do allow to cvery person the benefit of his own inven. tion; which, if it be of that nature, that the bringing of it into use and practice doth necessarily import the discovery of it, according to our laws, patents for terms of years are granted. But, if an invention be of such a nature, that it may be concealed in the use and practice, no limitation, for private advantage or profit thereby, is set by law; it is only honesty, ingenuity, or interest, that can restrain from making unreasonable or unconscionable advantages in such case. Now, any medicines or receipts for cure of diseases, invented by physicians, or coming to their private knowledge only; or any new use or virtue of an old known medicine, discovered by any physician; in relation to those physicians,